Histopathological Study of Lacrimal Gland Tumors

Transcription

1 ORIGINAL ARTICLE Pratikkumar B. Desai 1, Ami Shah th Year Resident, Pathology Department, B.J.Medical College, Civil Hospital, Ahmedabad 2 Associate Professor, M. J. Institute of Ophthalmology, Civil Hospital, Ahmedabad ABSTRACT BACKGROUND:. The lacrimal gland is un-capsulated, multilobulated secretory gland situated in the lacrimal gland fossa, behind the supratemporal orbital rim. Tumor and Lesion of the lacrimal gland contain 5 to 18 % of all orbital mass. Aims and objectives: To study the incidence and prevalence of tumor of lacrimal gland. To study the clinical pattern with regard to age, incidence, gender distribution of the tumor. To highlight the histopathological findings that help in making diagnosis of various tumors of lacrimal gland. Also find out the incidence of various types of tumor in lacrimal gland. To find out the common age of presentation for individual tumor. To provide an updated incidence of epithelial lacrimal gland tumours by histopathological examination. MATERIAL AND METHODS: Total 94 cases of lacrimal gland tumors were studied over a period of 20 Years, From1994 to 2014 at department of pathology, M & J Institute of Ophthalmology, Ahmedabad. A detailed clinical history was obtained and specific attention was given to age, sex, pathological examination including gross and microscopy. For the histopathology haematoxylin and eosin stained section were studied from different areas. Sections were studied for tumors cells type which include size, shape, characters of nucleus, nucleolus, mitosis, cytoplasm & arrangement of cells. Malignant tumors were specifically studied for muscular, perineural, lymphatic, and vascular invasion. RESULT: Out of 94 studied lacrimal gland tumors 62cases(65.95%) were benign tumors, and 32 cases(34.04%) were malignant tumors. Pleomorphic adenoma was the commonest lacrimal gland tumor and accounted for 65.95% of all lacrimal gland neoplasms. Adenoid cystic was the commonest Malignant tumor, accounted for 27.65%. Most of the benign neoplasms occurred in 3 rd to 5 th decade, while the malignant neoplasms more common in 5 th decade. Females were slightly more commonly affected than Males For all lacrimal gland tumors. In addition to it pain was observed in 25 cases, skin involvement seen in 1 case, palpable cervical lymph nodes in 1 cases in which metastatic deposits were seen. One case of Pleomorphic adenoma shows malignant changes, 4 cases shows recurrent lesion in Pleomorphic adenoma (positive previous history). CONCLUSION: Benign tumors were common than malignant tumors. Pleomorphic adenoma was the commonest lacrimal gland tumor and accounted for 65.95%. Adenoid cystic was the commonest malignant tumor, accounted for 27.65%. Most of the benign neoplasms occurred in 3 rd to 5 th decade, while the malignant neoplasms more common in 5 th decade. Females were slightly more commonly affected than Males For all lacrimal gland tumors. Key words: Lacrimal gland, benign, pleomorphic adenoma, adenoid cystic, mucoepidermoid. INTRODUCTION Lacrimal gland is un-capsulated, secretory gland. It has multiple lobe, it situated behind the supratemporal orbital rim in lacrimal gland fossa. Lacrimal gland tumors and its lesion contain 5 to 18% of all orbital mass. 5,6 Basically lacrimal gland divide into the acini and ducts histologically, its histological structure is *Corresponding Author: Dr. Pratikkumar B Desai H-202, Ganesh Genesis, Near Jagatpur Railway Crossing, Near Ghodhrej Garden City, Jagatpur, Ahmedabad, Pincode pratik01desai@gmail.com quite similar to salivary gland, and lacrimal gland lesion are less common in prevalence so the classification system for lacrimal tumor are based on the salivary gland tumor WHO classification 7,8,9 Another important point is that lacrimal gland tumors have not been studied in detail before in our population. The aim of our study is to identify the distribution of different histological types of primary lacrimal gland tumors in our population and to correlate the clinical, Histopathological features of such tumors surgically treated at our tertiary referral centre. 50 Int J Res Med. 2015; 4(3);50-54 e ISSN: p ISSN:

2 MATERIAL AND METHOD Total 94 cases of lacrimal gland tumors were studied over a period of 20 Years, From1994 to 2014 at department of pathology, M & J Institute of Ophthalmology, Ahmedabad. A detailed clinical history was obtained and specific attention was given to age, sex, pathological examination including gross and microscopy and immunochemistry was done where required. For the histopathology haematoxylin and eosin stained section were studied from different areas. Sections were studied for tumors cells type which includes size, shape, characters of nucleus, nucleolus, mitosis, cytoplasm & arrangement of cells. Malignant tumors were specifically studied for muscular, perineural, lymphatic, and vascular invasion. The biopsy fixed in 10% buffered formalin solution was routinely processed, sectioned and stained using haematoxylin and eosin stains. RESULTS The present study consists of 94 cases of lacrimal gland tumor from M & J institute of Ophthalmology, B. J. Medical College, civil hospital, Ahmedabad from 1994 to In the present study majority of the patients of Lacrimal gland tumor belong to the age group yr, with youngest patient 5 yr of age and oldest 78 yr of age. The present study showed incidence of lacrimal gland tumors in Male is 40 cases (42.55%), and in Female 54cases(57.45%). A slight Female predominance was seen in lacrimal gland tumor. In total 94 cases, 62 cases (65.96%) are Benign, and 32cases (34.04%) are Malignant. Amongst total 94 cases, most common tumor is Pleomorphic adenoma, incidence of Pleomorphic adenoma is 62cases (65.95%), followed by Adenoid cystic 26 cases (27.65%), followed by Mucoepidermoid Carcinoma 3 cases (3.19%), and One cases of Squamous cell (1.06%), One case of Primary ductal (1.06%), and One case of Malignant Pleomorphic adenoma (Malignant mixed tumor) 1.06%. In this present study out of 94 Lacrimal gland tumors, 62 cases were of Pleomorphic adenoma accounting for 65.95% of all Lacrimal gland tumors. Peak incidence was seen in 3 rd and 4 th decade. A slight female Preponderance was seen. Most of the cases were diagnosed clinically as Pleomorphic adenoma. Out of 62 cases of Pleomorphic adenoma, Female have 38 cases (61.29%), and male show 24 cases (38.71%), means slight higher incidence in Female but no clear cut predominance. Among total 94 cases, 26 cases of Adenoid cystic were noted comprising of 27.65% of all Lacrimal gland tumors and, most common age presentation 5th decade of life. Most common age for presentation of Adenoid cystic is year, 11 cases (42.31%). Among 26 cases of Adenoid cystic, incidence in Female 16 Cases (61.54%), and male 10 cases (38.46%). Incidence slightly higher in female but no clear cut gender predominance. Three (3) cases of Mucoepidermoid s were seen comprising of 3.19% of all lacrimal gland tumors. 3 cases were seen in Males. Tumors were common in 5 th and 6 th decade. DISCUSSION Lesion and tumors of the lacrimal gland compromise 5 to 18% of all orbital masses studied Histologically. In our study we have taken 94 cases of lacrimal gland tumor over a period of 20 years at Tertiary care centre. Out of 94 cases, 62 cases (65.96%) were benign and 32 Cases (34.04%) were malignant. In the recent series published, 29 to 55% tumors were Malignant epithelial tumors. 1,2,3 In various study comparison; we found most common tumor in the lacrimal gland tumor are Benign Pleomorphic adenoma. In our study 62 cases(65.95%) of Pleomorphic adenoma, in Shilds et al. 1989(1) study 17 cases (53%), in Font & Gamel1987 study 365 cases (51%), in Wright et al 1992 study 78 cases (61%), i Font et al.1998 study 17cases (38%).Second most common tumor and most common malignant tumor are Adenoid cystic, in our study No of a cases are 26 (27.56%), in Font & Gamel 70 cases (26%), in Shilds et al study 2 cases (6%), Wright et al 1992 study Int J Res Med. 2015; 4(3);50-54 e ISSN: p ISSN:

3 cases(30%), in Font et al.1998 study 12 cases(27%).second most common malignant tumor is Mucoepidermoid, in our study 3 cases (3.19%), in Font & Gamel 1987 study 34 cases (13%), in Shilds et al study 3cases (9%), in Wright et al 1992 study 6 Cases (5%), in Font et al.1998 study 7 cases (16%). CONCLUSION Out of 94 studied lacrimal gland tumors 62cases (65.95%) were benign tumors, and 32 cases (34.04%) were malignant tumors. Pleomorphic adenoma was the commonest lacrimal gland tumor and accounted for 65.95% of all lacrimal gland neoplasms. Adenoid cystic was the commonest malignant tumor, accounted for 27.65% of all lacrimal gland tumors, followed by Mucoepidermoid comprising of 3.19 % of all lacrimal gland tumors. In the present study, the lacrimal gland neoplasms presented over a wide range of age from 5 years to 78 years. Most of the benign neoplasms occurred in 3 rd to 5 th decade, while the malignant neoplasms more common in 5 th decade. Females were slightly more commonly affected than Males For all lacrimal gland tumors. All the patients presented with mass. In addition to it pain was observed in 25 cases, skin involvement seen in 1 case, palpable cervical lymph nodes in 1 cases in which metastatic deposits were seen. One case of Pleomorphic adenoma shows malignant changes, 4 cases shows recurrent lesion in Pleomorphic adenoma (positive previous history).early detection and proper diagnosis of malignant lacrimal gland tumor impact in the management, prognosis and survival of these patients. Table 1: Age distribution in Lacrimal gland tumors Age in years No of cases Percentages(%) % % % % % % % > % Table 2: Gender distribution in Lacrimal gland tumor Male % Female % Table3: Incidence of malignant and benign tumor No of cases Percentages (%) Benign % Malignant % Table 4: Incidence of various tumor type in Lacrimal gland tumor Type of tumor No of cases Pleomorphic Adenoma % Adenoid cystic % (ACC) Mucoepidermoid % (MEC) Squamous cell % (SCC) Primary ductal % Malignant Pleomorphic % adenoma or Malignant mixed Tumor(MMT) Percentages (%) Table 5: Age Disturubtion in Pleomorphic Adenoma Age in Year No of Cases Percentages (%) % % % % % % % > % TOTAL % Table 6: Gender distribution in Pleomorphic adenoma Male % Female % Total % Table 7: Histological Features Tumor cellularity No of cases Predominantly cellular 31 Predominantly stromal 00 Mixed cellular and stromal 05 Table 8: Histological features Histological Features No of cases Myxoid differentiation 58 Chondroid differentiation 26 Hyaline changes 28 Squamous metaplasia 29 Plasmacytoid cells 20 Cystic degeneration 21 Cellular atypia 04 Calcification 04 Oncocytic metaplasia 02 Osseous metaplasia 00 Adipose metaplasia Int J Res Med. 2015; 4(3);50-54 e ISSN: p ISSN:

4 Crystalloid metaplasia 00 Bordering or extending into 03 pseudocapsule Extending beyond pseudocapsule 00 Table 9: Age Disribution of Adenoid Cystic Carcinoma Age No of Cases Percentages (%) % % % % Table 12 : comparisons Frequency of Lacrimal Gland Tumors % % % > % Total % Table 10: Gender distribution in Adenoid cystic Male % Female % Total % Font & Gamel 1987 no (%) Shilds et al. 1989(1)No(%) Wright et al 1992(7)No(%) Font et l.1998 (9) No.(%) M & J Institute No (%) Pleomorphic adenoma 365(51%) 17(53%) 78(61%) 17(38%) 62(65.95%) Myoepithelioma Adenoid cystic 70(26%) 2(6%) 38(30%) 12(27%) 26(27.56%) Mucoepidermoid 34(13%) 3(9%) 6(5%) 7(16%) 3(3.19%) Primary Ductal 25(9%) 2(6%) 4(3%) 3(7%) 1(1.06%) Squamous cell (1.06%) Malignant Pleomorphic (1.06%) Figure 1: Microscopic appearance of Benign mixed tumor (Pleomorphic adenoma) Figure 2: Cartilaginous differentiation in Pleomorphic adenoma Figure 3: Microscopic appearance of Adenoid cystic REFERRENCE 1. Font RL, Gamel JW. Epithelial tumors of the lacrimal gland; An analysis of 265 cases. In: Jakobiec FA, ed. Ocular and adnexal tumors. Birmingham, AL: Aesculapius Publishing Co;1978: Wright JE, Rose GE, Garner A. Lacrimal gland. Br J Ophthalmol 1992;76: Font RL, Smith SL, Bryan RG. Malignant epithelial tumors of the Lacrimal gland: A clinicopathologic study of 21 cases. Arch Ophthalmol 1998;116: Wright J E, Rose G E, Garner A. Lacrimal gland. Ophthalmology 1985, 92 : Font RL, Smith SL, Bryan RG. Malignant epithelial tumors of the Lacrimal gland: A clinicopathologic study of 21 cases. Arch Ophthalmol 1998;116: Wright J E, Rose G E, Garner A. Primary malignant neoplasms of the Lacrimal gland. Ophthalmology 1985, 92 : Wright J E, Rose G E, Garner A. Lacrimal gland. Ophthalmology 1985, 92 : Shields CL, Shields JA, Eagle RC, Rathmell JP: Clinicopathologic review of 142 cases of lacrimal gland lesions. Ophthalmology 96:431, Int J Res Med. 2015; 4(3);50-54 e ISSN: p ISSN:

5 6. Ni C, Cheng SC, Dryja TP, Cheng TY: Lacrimal gland tumors: A clinicopathological analysis of 160 cases. Int Ophthalmol Clin 22:99, Forrest AW. Epithelial lacrimal gland tumors: Pathology as a guide to prognosis.trans Am Acad Ophthalmol1954:58: Zimmerman LE,Sanders TE, Ackerman LV.Epithelial tumors of the lacrimal glnad:prognostic and therapeutic significance and histologic type. Int Opthalmolclin 1962:2: Seifert G, Sobin LH. The world Health orginazations Histopathological classification of salivary gland tumors. A commentary on the second edition. Cancer 1992:70: Rosai and Ackerman, surgical pathology,10 th edition, 54 Int J Res Med. 2015; 4(3);50-54 e ISSN: p ISSN: