A mass in the fossa of the lacrimal gland may be caused by a number of processes. The diagnosis requirs a careful patient assessment.
Differential diagnosis of a lacrimal gland mass includes:
(1) infection
(2) other inflammatory condition
(3) benign tumor or cyst
(4) malignant tumor (malignant mixed cell, adenoid cystic, other)
Presentation of a benign mixed tumor: painless, slow progression, pressure changes on X-ray
Presentation of a malignant tumor: pain, rapid progression, destruction on X-ray
Parameters:
(1) duration of symptoms
(2) X-ray findings
(3) clinical findings
(4) response to antibiotic therapy
Duration |
X-Ray |
Clinical |
Response to Antibiotics |
Diagnostic Approach |
< 12 months |
normal |
inflammatory |
improved without mass |
observe |
< 12 months |
normal |
inflammatory |
mass |
incisional biopsy if does not regress |
< 12 months |
normal |
without inflammatory changes |
NA |
incisional biopsy |
< 12 months |
pressure changes |
NA |
NA |
incisional biopsy |
< 12 months |
destructive changes |
NA |
NA |
incisional biopsy |
>= 12 months |
normal |
NA |
NA |
en bloc excision |
>= 12 months |
pressure changes |
NA |
NA |
en bloc excision |
>= 12 months |
destructive changes |
NA |
NA |
incisional biopsy |
Specialty: Hematology Oncology, Ophthalmology