The lacrimal gland is the epicenter of a broad spectrum of neoplastic and inflammatory diseases (see box). Space occupying lesions of the lacrimal gland and its fossa constitute approximately 5% to 13% of orbital masses upon biopsy.<sup>53 Kennedy R.E. An evaluation of 820 orbital cases Trans Am Ophthalmol Soc 1984 ;  82 : 134-157

Cliquez ici pour aller à la section Références, 81 Reese A.B. Expanding lesions of the orbit Trans Ophthalmol Soc UK 1971 ;  91 : 85-104

Cliquez ici pour aller à la section Références, 96 Shields J.A., Bakewell B., Augsburger J.J. , et al. Classification and incidence of space-occupying lesions of the orbit. A survey of 645 biopsies Arch Ophthalmol 1984 ;  102 : 1606-1611

Cliquez ici pour aller à la section Références</sup> Based primarily on Reese's<sup>82 Reese A.B. The treatment of expanding lesions of the orbit with particular regard to those arising in the lacrimal gland. The Seventh Arthur J Bedell Lecture Am J Ophthalmol 1956 ;  41 : 3-11

Cliquez ici pour aller à la section Références</sup> 1956 clinicopathologic survey of 112 consecutive expanding lesions of the lacrimal gland, most authorities report that approximately 50% of the lesions originate from epithelial elements of the lacrimal gland and 50% are of nonepithelial origin.<sup>21 Font R.L., Gamel J.W. Adenoid cystic carcinoma of the lacrimal gland. A clinicopathologic study of 79 cases. Ocular Pathology Update New York: Masson Publishing (1980). 

Cliquez ici pour aller à la section Références, 28 Goder G.J. Tumours of the lacrimal gland Orbit 1982 ;  1 : 91-96  [cross-ref]

Cliquez ici pour aller à la section Références, 85 Rootman J., Lapointe J.S. Tumors of the lacrimal gland. Diseases of the orbit: A Multidisciplinary Approach. Philadelphia: JB Lippincott (1988). 

Cliquez ici pour aller à la section Références</sup> Of nonepithelial lesions, 50% are lymphoid tumors and 50% are infections and inflammatory pseudotumors. Among the epithelial tumors of the lacrimal gland, approximately 50% are pleomorphic adenomas (benign mixed tumors), 25% adenoid cystic carcinoma, and the remainders are other types of carcinoma. Recent reports, however, suggest that inflammatory lesions and lymphoid tumors are more common and that epithelial malignancies of the lacrimal gland are considerably less frequent than commonly cited, ranging from 22% to 47%.<sup>25 Font R.L., Smith S.L., Bryan R.G. Malignant epithelial tumors of the lacrimal gland: A clinicopathologic study of 21 cases Arch Ophthalmol 1998 ;  116 : 613-616

Cliquez ici pour aller à la section Références, 53 Kennedy R.E. An evaluation of 820 orbital cases Trans Am Ophthalmol Soc 1984 ;  82 : 134-157

Cliquez ici pour aller à la section Références, 85 Rootman J., Lapointe J.S. Tumors of the lacrimal gland. Diseases of the orbit: A Multidisciplinary Approach. Philadelphia: JB Lippincott (1988). 

Cliquez ici pour aller à la section Références, 95 Shields C.L., Shields J.A., Eagle R.C. , et al. Clinicopathologic review of 142 cases of lacrimal gland lesions Ophthalmology 1989 ;  96 : 431-435

Cliquez ici pour aller à la section Références, 96 Shields J.A., Bakewell B., Augsburger J.J. , et al. Classification and incidence of space-occupying lesions of the orbit. A survey of 645 biopsies Arch Ophthalmol 1984 ;  102 : 1606-1611

Cliquez ici pour aller à la section Références, 104 Stewart W.B., Krohel G.B., Wright J.E. Lacrimal gland and fossa lesions: An approach to diagnosis and management Ophthalmology 1979 ;  86 : 886-895

Cliquez ici pour aller à la section Références</sup> Properly distinguishing between these two groups is of paramount importance because several of the lesions are life threatening.

Information from clinical history, physical examination, ultrasonography, and radiographic soft-tissue contour analysis help determine to which category of disease the lacrimal gland tumor belongs: inflammation, lymphoproliferative disorder, benign epithelial tumor, or malignant epithelial tumor. Acute presentation without contiguous bony changes is suggestive of inflammatory disorders. Insidious painless onset (less than 1 year) in a senescent age group with radiographic evidence of a lesion molding or conforming to ocular and bony contours rather than indenting adjacent structures are hallmarks of lymphoproliferative diseases. Subacute presentation of short duration (usually 4 to 6 months) and radiographic evidence of infiltration of adjacent structures, irregular erosion or destruction of bone, and calcification are distinctive of malignant epithelial neoplasms. Chronic presentation without pain associated with a radiographic finding of lacrimal fossa remodeling is suggestive of benign lacrimal gland tumors.

Management protocols based on clinical and radiographic features of lacrimal fossa masses have been well-established in the literature.<sup>40 Hurwitz J.J. A practical approach to the management of lacrimal gland lesions Ophthalmic Surg 1982 ;  13 : 829-836

Cliquez ici pour aller à la section Références, 104 Stewart W.B., Krohel G.B., Wright J.E. Lacrimal gland and fossa lesions: An approach to diagnosis and management Ophthalmology 1979 ;  86 : 886-895

Cliquez ici pour aller à la section Références, 117 Wright J.E., Rose G.E., Garner A. Primary malignant neoplasms of the lacrimal gland Br J Ophthalmol 1992 ;  76 : 401-407  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Readers are referred to the seminal article by Wright and co-workers<sup>118 Wright J.E., Stewart W.B., Krohel G.B. Clinical presentation and management of lacrimal gland tumours Br J Ophthalmol 1979 ;  63 : 600-606  [cross-ref]

Cliquez ici pour aller à la section Références</sup> outlining an algorithm for the differentiation and efficacious management of lacrimal gland

fossa masses. This article reviews the clinical characteristics, pertinent diagnostic and pathologic features, biologic behavior, and conventional management protocols for some of the common lacrimal gland disorders. A new treatment protocol for adenoid cystic carcinoma is highlighted.