Giant pleomorphic adenoma of the lacrimal gland

Epithelial tumors of the lacrimal gland are much rarer than inflammatory lesions and lymphoid tumors.1,2 Pleomorphic adenoma accounts for approximately 40% to 50% of these epithelial neoplasms.3-7 It comprises 10% to 25% of lacrimal gland neoplasms and 5% of all orbital masses examined by biopsy.8 The term mixed tumor was introduced by Minssen in 1874,9 and the World Health Organization in 1980, adopted the name pleomorphic adenoma for this benign glandular tumor.10 Most series indicate a male predominance and a peak incidence in the fourth decade. Pleomorphic adenoma of the salivary gland presents clinically as a painless, slow-growing mass. Similarly, the lacrimal gland tumor has a slowly progressive onset as a painless superotemporal orbital mass. Usually, only slight fullness of the upper eyelid is seen. The cardinal sign of all neoplasms of the lacrimal gland is forward proptosis and inferonasal displacement of the ocular globe.11 However, if there is pain or paralytic ptosis of the upper eyelid, a malignant tumor is a possibility.4,12 Moreover, a short duration of the symptoms usually suggests an inflammatory condition or a malignant tumor. Histologically, the pleomorphic adenoma of the lacrimal gland is identical to neoplasms originating in the salivary glands, as well as in other serous glands of the body. It is composed of cords of well-differentiated epithelial tubules derived from the ducts of the lacrimal gland within loose myxomatous connective tissue.11 Received from the Department of Oral & Maxillofacial Surgery,