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.
Carcinoma, Squamous Cell/radiography ; Conjunctival Neoplasms/radiography ; Cysts/radiography ; Eye Neoplasms/*radiography ; Hemangiopericytoma/radiography ; Humans ; Lacrimal Apparatus/*pathology ; Lacrimal Apparatus Diseases/radiography ; Lipoma/radiography ; Lymphoma/radiography ; Neoplasms, Glandular and Epithelial/radiography ; Neurofibroma/radiography ; Sarcoma, Myeloid/radiography

No abstract available.
Bone Marrow/*pathology/radiography/radionuclide imaging ; Carcinoma, Adenoid Cystic/*diagnosis ; Eye Neoplasms/*diagnosis ; Female ; Humans ; Lacrimal Apparatus/*pathology/radiography/radionuclide imaging ; Lacrimal Apparatus Diseases/*diagnosis ; Maxilla ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; *Positron-Emission Tomography ; *Tomography, X-Ray Computed

Hemangiopericytomas are soft tissue tumors composed of pericapillary pericytes. These tumors are rare in the lacrimal sac. To the author's knowledge, only four previous cases of these tumors occurring in the lacrimal sac have been reported. A primary hemangiopericytoma of the lacrimal sac in a 34-year-old female is reported. Total excision with the surrounding tissue appears to be the treatment of choice for this tumor.
Adult ; Eye Neoplasms/*pathology/radiography/surgery ; Female ; Hemangiopericytoma/*pathology/radiography/surgery ; Humans ; Lacrimal Apparatus Diseases/*pathology/radiography/surgery ; Tomography, X-Ray Computed

Lacrimal sac diverticulum is a rare condition, and its various symptoms complicate differential diagnosis. We present cases of a peculiar type of lacrimal diverticulum. A 5-year-old girl and a 50-year-old woman presented with a protruding mass inferior to the medial canthus. Each lacrimal system was patent to irrigation. The masses compressed and distorted the lacrimal passage and had no apparent connection with the lacrimal sac in dacryocystography or computed tomography. Surgical exploration and complete excision of the masses were completed. Each patient had an inverted Y- and an inverted V-shaped multilobular cystic mass that was pathologically confirmed as a lacrimal sac diverticulum. Lacrimal sac diverticula may rarely take the form of a multilobular cyst and can present as a lower lid mass. We speculate that an abnormality in lacrimal embryogenesis resulted in multiple blind pouches, a peculiar type of lacrimal sac diverticulum.
Child, Preschool ; Diagnosis, Differential ; Diverticulum/radiography/*surgery ; Eyelids/radiography/surgery ; Female ; Humans ; Lacrimal Apparatus Diseases/radiography/*surgery ; Middle Aged ; Tomography, X-Ray Computed

When a patient is presented with a subconjunctival cyst, it is not only hard to reveal its true nature clinically but also easy to rupture during excision. We experienced cases with cysts of the accessory lacrimal gland in two patients with subconjunctival cysts. They had lid swelling at initial presentation and underwent surgical excision of subconjunctival cysts located in superior portion of the upper tarsal plate. The lining of these cysts composed of ductal epithelia. Biochemical analyses for serum and cystic fluid were performed in one case, in which was found high Ig A titer in the cystic fluid. These cysts seemed to originate from the duct of Wolfring's accessory lacrimal gland, considering their anatomic locations and pathologic findings. Complete removal of the cyst is important, because recurrences have been reported in cases of incomplete removal or simple aspiration.
Adult ; Conjunctival Diseases/pathology/surgery ; Cysts/*pathology/surgery ; Female ; Humans ; Lacrimal Apparatus Diseases/*pathology/surgery ; Orbit/radiography ; Tomography, X-Ray Computed

Granulomatous inflammation is characterized by granuloma formation with a cellular infiltrate of epithelioid cells, giant cells, and chronic inflam-matory cells.It could be diagnosed as a subtype of inflammatory pseudotumor when such identifiable causes of granulomatous inflammation have been ruled out. We performed excisional biopsy on 3 patients who complained of upper eyelid mass.The levator muscle was mainly affected in two patients and the lacrimal gland in one patient. Microscopic examination of the mass demonstrated chronic granulomatous inflammation including non-caseating necrosis, diffuse chronic inflammatory cell infiltrates, and granuloma com-posed of histiocytes, multinucleated giant cells, lymphocytes, and epithelioid cells in all 3 patients.There was no evidence of foreign material and infec-tion with tuberculosis, mycosis, and parasites.The diagnosis of sarcoidosis, connective tissue disease, and Wegener's granulomatosis could be ruled out through the basic hematological test, chest radiograph, and blood tests such as angiotensin converting enzyme, lysozyme, antinuclear antigen, and anti-neutrophil cytoplasmic antibody. We experienced 3 cases of chronic granulomatous inflammation of the eyelids without identifiable causes which responds to excision and postoperative steroid therapy without recurrences.
Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Connective Tissue Diseases ; Diagnosis ; Epithelioid Cells ; Eyelids ; Giant Cells ; Granuloma ; Granuloma, Plasma Cell ; Hematologic Tests ; Histiocytes ; Humans ; Inflammation* ; Lacrimal Apparatus ; Lymphocytes ; Muramidase ; Necrosis ; Peptidyl-Dipeptidase A ; Radiography, Thoracic ; Recurrence ; Sarcoidosis ; Tuberculosis ; Wegener Granulomatosis

We report four unusual cases of upper eyelid retraction following periorbital trauma. Four previously healthy patients were evaluated for unilateral upper eyelid retraction following periorbital trauma. A 31-year-old man (Case 1) and a 24-year-old man (Case 2) presented with left upper eyelid retraction which developed after blow-out fractures, a 44-year-old woman (Case 3) presented with left upper eyelid retraction secondary to a periorbital contusion that occurred one week prior, and a 56-year-old man (Case 4) presented with left upper eyelid retraction that developed 1 month after a lower canalicular laceration was sustained during a traffic accident. The authors performed a thyroid function test and orbital computed tomography (CT) in all cases. Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case. CT showed no specific findings in the second or fourth cases. Upper eyelid retraction due to superior complex adhesion can be considered one of the complications of periorbital trauma.
Accidents, Traffic ; Adult ; Eye Injuries/*complications/surgery ; Eyelid Diseases/*etiology/radiography ; Female ; Humans ; Lacerations/complications/surgery ; Lacrimal Apparatus/*injuries ; Male ; Middle Aged ; Oculomotor Muscles ; Orbital Fractures/*complications/surgery ; Tomography, X-Ray Computed

Chronic sclerosing sialadenitis, also known as Kuttner tumor, is a chronic inflammatory disease of the salivary glands that is reported in a few cases in medical literature. Recent reports suggest that certain aspects of sclerosing diseases, including chronic sclerosing sialadenitis or dacryoadenitis, should be classified under immunoglobulin G4 (IgG4)-related sclerosing disease based on immunohistochemical studies. This study reports an unusual case of IgG4-related sclerosing disease appearing simultaneously in the lacrimal glands, submandibular glands, and extraocular muscles. A 56-year-old male presented with complaints of bilateral eyelid swelling and proptosis that began two years ago. Computed tomography confirmed that bilateral submandibular enlargements also existed five years ago in the subject. Orbital computed tomography and magnetic resonance imaging revealed bilateral lacrimal gland enlargement and thickening of extraocular muscles. Typical findings of chronic sclerosing dacryoadenitis were revealed upon pathologic exam of the right lacrimal gland. Immunostaining revealed numerous IgG4-positive plasma cells. Through these clinical features, we make a diagnosis of IgG4-relataed sclerosing disease in the subject.
Biopsy, Fine-Needle ; Diagnosis, Differential ; Facial Muscles/*immunology/pathology/radiography ; Follow-Up Studies ; Humans ; Immunoglobulin G/*immunology/metabolism ; Immunohistochemistry ; Lacrimal Apparatus/*immunology/metabolism/pathology ; Lacrimal Duct Obstruction/complications/diagnosis/*immunology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sclerosis ; Submandibular Gland/*immunology/pathology/radiography ; Submandibular Gland Diseases/complications/diagnosis/*immunology ; Tomography, X-Ray Computed