Lacrimal Gland Lesions Biopsied in a Tertiary Eye Center in Saudi Arabia: A Clinical, Radiological, Surgical, and Histological Review

Figures & data

Table 1 Common Clinical Presentation of Lacrimal Gland Lesions

Diagnosis	Gender M^a/F^b N=18/30	Laterality Bi/Unilateral N=12/26	Decreased VA^c N=12	Lid Swelling N=46	Proptosis N=15	Erythema N=20	Pain N=19
Epithelial Lesions
Benign
-Dacryops	1(5.5%)/0	0/1(3%)	1(8%)	1(2%)	1(6.7%)	1(5%)	1(5%)
-PA^d	2(11%)/1(3%)	0/3(8%)	1(8%)	2(4%)	3(20%)
Malignant
-ACC^e	1(5.5%)/0	0/1(3%)	1(8%)	1(2%)	1(6.7%)	1(5%)	1(5%)
-SCC^f	1(5.5%)/0	0/1(3%)	1(8%)	1(2%)	1(6.7%)		1(5%)
Non-epithelial Lesions
- Non-specific inflammation	5(28%)/12(40%)	2(17%)/15(42%)	4(33%)	17(37%)	2(13%)	10(50%)	10(52%)
-Specific inflammation
IgG4-RD^g	2(11%)/3(10%)	3(25%)/2(6%)	1(8%)	5(11%)	2(13%)	3(15%)	1(5%)
Sarcoidosis	0/3(10%)	3(25%)/0		3(6.5%)
Sjogren Syndrome	1(5.5%)/0	0/1(3%)		1(2%)		1(5%)	1(5%)
Churg-Strauss Syndrome	0/1(3%)	0/1(3%)		1(2%)
ALHE^h	0/2(7%)	0/1(3%)		2(4%)		1(5%)	1(5%)
TED^i	0/1(3%)	0/2(6%)		1(2%)	1(6.7%)
-Lymphoproliferative Lesions
RLH^j	1(5.5%)/3(10%)	0/4(11%)	1(8%)	4(9%)	2(13%)
ALH^k	1(5.5%)/3(10%)	3(25%)/1(3%)	1(8%)	4(9%)	2(13%)	2(10%)	2(10.5%)
EMZL^l	1(5.5%)/0	1(8%)/0
B cell lymphoma	2(11%)/0	0/2(6%)	1(8%)	2(4%)		1(5%)	1(5%)
T cell lymphoma	0/1(3%)	0/1(3%)		1(2%)

Notes: ^aMale, ^bFemale, ^cVisual acuity, ^dPleomorphic adenoma, ^eAdenoid cystic carcinoma, ^fSquamous cell carcinoma, ^gIgG4- related disease, ^hAngiolympoid hyperplasia with eosinophilia, ⁱThyroid eye disease, ^jReactive lymphoid hyperplasia, ^kAtypical lymphoid hyperplasia, ^lExtranodal marginal zone lymphoma.

Table 2 Histopathological Distribution of Lacrimal Gland Lesions

Diagnosis	Frequency	Percent
Epithelial Lesions
Benign
-Dacryops	1	2%
-PA^a	3	6%
Malignant
-ACC^b	1	2%
-SCC^c	1	2%
Non-epithelial Lesions
Inflammation
-Dacryoadenitis (nonspecific inflammation)	17	35%
-IgG4-RD^d	4	10.5%
-Sarcoidosis	3	6%
-ALHE^e	2	4%
-Sjogren Syndrome	1	2%
-Churg-Strauss Syndrome	1	2%
-TED^f	1	2%
Lymphoproliferative
-RLH^g	4	8%
-ALH^h	4	8%
-EMZL^i	1	2%
-B-cell lymhoma	2	4%
-T-cell lymphoma	1	2%

Notes: ^aPleomorphic adenoma, ^bAdenoid cystic carcinoma, ^cSquamous cell carcinoma, ^dIgG4 related disease, ^eAngiolymphoid hyperplasia with eosinophilia, ^fThyroid eye disease, ^gReactive lymphoid hyperplasia. ^hAtypical lymphoid hyperplasia, ⁱExtranodal marginal zone lymphoma.

Figure 1 (A) Histopathology of Lacrimal Gland showing perivascular granulomatous inflammation with eosinophilic infiltration in Eosinophilic granulomatosis with polyangiitis (Haematoxylin-Eosin stain (H&E), magnification X 200) (B) Angiolymphoid Hyperplasia with Eosinophilia showing endothelial proliferation with scattered eosinophils H&E, magnification X 200 (C) Cluster of Differentiation. CD34 stain showing endothelial proliferation with plumped endothelial cells of the same patient.

Figure 2 Pleomorphic Adenoma of The Lacrimal Gland; (A) Coronal fat saturated T2-WI and Apparent Diffusion Weight (ADC) image with lobulated outline, (B) Non-restricted pattern on Diffusion Weight Image (DWI).

Figure 3 Right lacrimal gland enlargement with subtle enlargement of the right medial rectus muscle sparing the tendinous insertion in Thyroid Related Orbitopathy (TRO).

Figure 4 Chronic inflammation showing mixed lymphocytes and plasma cells infiltration (Haematoxylin-Eosin Stain H&E, magnification X100).

Figure 5 MRI of Extranodal Marginal Zone Lymphoma (A) Coronal fat saturated and post contrast (B) Fat suppressed T1 with contrast and apparent diffusion coefficient images (C) Diffusion Weight Image showing restricted pattern (mean 0.85 X 10_3).