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A case of pleomorphic adenoma of the lacrimal gland invading the lower orbit

ABSTRACT Pleomorphic adenoma is a benign tumor that originates from the lacrimal gland and typically develops in the upper orbit. There is a risk of postoperative recurrence due to capsule damage by biopsy or incomplete tumor resection. Here, we report a case of primary lacrimal gland pleomorphic adenoma that extended to the lower orbit. A 76-year-old man visited a nearby clinic with swelling of the right eyelid, and was referred to our department because of decreased vision in the right eye and marked chemosis. At the initial presentation, external eye findings showed swelling of the right eyelid, and elastic hard masses were palpable beneath the skin of the upper and lower eyelids. Magnetic resonance imaging revealed a multinodular tumor in the upper and lower orbits, measuring about 2 cm in the long axis. Excision was attempted by a transcutaneous approach from the upper eyelid, and the tumor was totally removed as a mass without damage to the capsule. The orbital mass was histologically diagnosed as pleomorphic adenoma of the lacrimal gland. We encountered a rare morphological variation of pleomorphic adenoma of the lacrimal gland that extended to the lower orbit. When diagnosing large tumors extending to the upper and lower orbits, total tumor resection should be attempted without biopsy due to the possibility of pleomorphic adenoma.