The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Pleomorphic adenoma of the lacrimal gland

Photo by Professor Chua Chung Nen

This 32 year-old woman was referred because of a three-year history of progressive proptosis and hypotropia. The referring doctor performed a biopsy through the superior fornix which showed pleomorphic adenoma (Note: this is against the normal teaching which recommended en bloc excisional biopsy for suspected pleomorphic adenoma as limited biopsy can cause seeding with risk of recurrence and malignant transformation).

 

Examination revealed normal vision in both eyes. The left upgaze was limited. She was listed for complete tumour excision via lateral orbitotomy. The operation was carried on the 29th May, 2007.

 

Left proptosis with ptosis and hypotropia.

 

A left lacirmal mass can be seen on the coronal and axial CT scan.

 

Pre-operative coronal MRI scan showing the location of the lacrimal gland tumour.

 

Pre-operative axial MRI scan showing the location of the lacrimal gland tumour.

 

Photos showing steps of the operation. A sub-brow incision was made and the periosteum

was peeled from the lateral orbital wall. A bone drill was used to carry out the lateral orbitotomy.

With the bone out of the way, the periosteum was incised to gain access to the lacrimal tumour.

The whole tumour was removed en bloc. The tumour measured 2.5 cm X 1.7 cm X 1.4 cm. 

The lateral orbital bone was replaced using 2/0 prolene.

 

First day post-operative showing decreased proptosis and hypotropia. The eyelid was

swollen from the post-operative swelling. A tube drain was inserted perioperatively

to drain any post-operative orbital haemorrhage.

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