Lacrimal gland enlargement may provoke the ophthalmologist to perform a biopsy. There is a well-developed clinical algorithm for lacrimal gland biopsy to allow the ophthalmologist to avoid taking an incisional biopsy from a suspected benign mixed tumor (pleomorphic adenoma) of the lacrimal gland. In general, ophthalmologists should strive to remove suspected pleomorphic adenomas in their entirety to avoid spillage of tumor tissue into the orbit and the possibility of recurrences. There is no contraindication to incisional biopsy into suspected adenoid-cystic carcinoma.
The lacrimal gland may be host to malignant lymphoma, especially of the MALT type.
Many lacrimal gland enlargements are not neoplastic. Idiopathic orbital inflammation (orbital pseudotumor) may affect the lacrimal gland (at which point many ophthalmic pathologists render the diagnosis of sclerosing dacryoadenitis). Wegener's granulomatosis may present in an ocular-limited form (restricted to the orbit) and may produce lacrimal gland enlargement. Sarcoid may produce lacrimal gland enlargement.
This lacrimal gland was diffusely enlarged and inflammed. A careful search of the connective tissue near the lacrimal gland tissue revealed non-caseating granulomas (insert): special stains were negative for organisms. The patient was diagnosed as having sarcoid.
In suspected lymphomas, it is important to submit fresh tissue for flow cytometry and/or immunohistochemistry.
In suspected benign mixed tumors (pleomorphic adenomas), the ophthalmologist should refrain from making incisions into the capsule which may retract, thus compromising the pathologist's ability to assess the adequacy of the resection margin.
Ophthalmologists should, in general, refrain from asking pathologists for frozen section diagnoses on lacrimal gland lesions. Idiopathic orbital inflammation of the lacrimal gland (sclerosing dacryoadenitis) may mimic adenoid cystic carcinoma histologically -- and the treatment optioins for these two lesions is strikingly different!
The technician should consider lacrimal gland tissue to be analogous to salivary gland tissue. In fact, the lacrimal gland is a variation upon the theme of a minor salivary gland!
Pathologists should be especially wary of interpreting frozen sections of lacrimal gland biopsies when the histologic differential diagnosis includes both adenoid cystic carcinoma and sclerosing dacryoadenitis.
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