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The radiological spectrum of orbital pathologies that involve the lacrimal gland and the lacrimal fossa.

Jung WS, Ahn KJ, Park MR, Kim JY, Choi JJ, Kim BS, Hahn ST - Korean J Radiol (2007 Jul-Aug)

Bottom Line: The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass.A careful clinical evaluation and moreover, a pathologic verification, are needed.In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, 62 Youido-dong, Youngdeungpo-gu, Seoul 150-713, Korea.

ABSTRACT
CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.

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A malignant lymphoma in a 41-year-old woman.A gadolinium enhanced T1-weighted coronal image shows an elongated soft tissue mass (arrow) along the superior lateral aspect of the left eye globe. This lesion shows homogeneous and strong enhancement. Another enhancing nodule is noted at the inferior medial aspect of the left eye globe.
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Figure 6: A malignant lymphoma in a 41-year-old woman.A gadolinium enhanced T1-weighted coronal image shows an elongated soft tissue mass (arrow) along the superior lateral aspect of the left eye globe. This lesion shows homogeneous and strong enhancement. Another enhancing nodule is noted at the inferior medial aspect of the left eye globe.

Mentions: Primary orbital lymphomas represent approximately 5-14% of the extranodal lymphomas. Within the orbit, these tumors arise from the conjunctivae, eyelids, or retrobulbar tissue; lacrimal gland involvement is rare (Fig. 6). An orbital lymphoma usually occurs in older people, and the average age for occurrence of this tumor is in the sixth decade of life. Lymphoid tumors are part of a disease spectrum that includes benign lymphoid hyperplasia (Fig. 7), atypical lymphoid hyperplasia and malignant lymphoma. There is a tendency towards bilateral involvement. Whereas most lacrimal gland tumors develop in the deeper orbital lobe, lacrimal lymphomas involve the entire lacrimal gland diffusely, including the palpebral lobe. This tumor can surround the eye globe and can have a concave pancake appearance (6).


The radiological spectrum of orbital pathologies that involve the lacrimal gland and the lacrimal fossa.

Jung WS, Ahn KJ, Park MR, Kim JY, Choi JJ, Kim BS, Hahn ST - Korean J Radiol (2007 Jul-Aug)

A malignant lymphoma in a 41-year-old woman.A gadolinium enhanced T1-weighted coronal image shows an elongated soft tissue mass (arrow) along the superior lateral aspect of the left eye globe. This lesion shows homogeneous and strong enhancement. Another enhancing nodule is noted at the inferior medial aspect of the left eye globe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627159&req=5

Figure 6: A malignant lymphoma in a 41-year-old woman.A gadolinium enhanced T1-weighted coronal image shows an elongated soft tissue mass (arrow) along the superior lateral aspect of the left eye globe. This lesion shows homogeneous and strong enhancement. Another enhancing nodule is noted at the inferior medial aspect of the left eye globe.
Mentions: Primary orbital lymphomas represent approximately 5-14% of the extranodal lymphomas. Within the orbit, these tumors arise from the conjunctivae, eyelids, or retrobulbar tissue; lacrimal gland involvement is rare (Fig. 6). An orbital lymphoma usually occurs in older people, and the average age for occurrence of this tumor is in the sixth decade of life. Lymphoid tumors are part of a disease spectrum that includes benign lymphoid hyperplasia (Fig. 7), atypical lymphoid hyperplasia and malignant lymphoma. There is a tendency towards bilateral involvement. Whereas most lacrimal gland tumors develop in the deeper orbital lobe, lacrimal lymphomas involve the entire lacrimal gland diffusely, including the palpebral lobe. This tumor can surround the eye globe and can have a concave pancake appearance (6).

Bottom Line: The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass.A careful clinical evaluation and moreover, a pathologic verification, are needed.In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St Mary's Hospital, Catholic University College of Medicine, 62 Youido-dong, Youngdeungpo-gu, Seoul 150-713, Korea.

ABSTRACT
CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.

Show MeSH
Related in: MedlinePlus