Metastastic Tumors to the Lacrimal Gland from Distant Primary Cancer

Abstract

Purpose: To characterize the clinical, radiological, and pathological features of patients with metastases to the lacrimal gland from distant primaries. Methods: Multicentre retrospective case series and a review of the literature of cases of metastases to the lacrimal gland. Results: We present 4 cases of lacrimal gland metastases, with the primaries being renal cell (n = 2) and breast (n = 2) carcinoma. The literature review identified 40 additional cases (19 male, mean age, range 21–84 years) of lacrimal gland metastasis. Based on these 44 cases, including 4 from the present study, 2 patterns of metastasis were identified: 23 cases (52.3%, 23/44) with lacrimal gland enlargement without bony erosion, and 21 cases (47.7%, 21/44) with associated bony erosion of the superolateral orbit of whom 12 (57.1%, 12/21) had intracranial extension. The most common primary for lacrimal gland metastasis without bony erosion was breast cancer (56.5%, 13/23), whereas hepatocellular carcinoma was the most common cause of lacrimal gland metastasis with bony erosion (52.4%, 11/21). Lacrimal gland metastasis was the first presentation of cancer in 15 cases (34.1%, 15/44) and was the first presentation of metastasis in 12 cases (27.3%, 12/44). Conclusions: Metastasis to the lacrimal gland is a potential cause of lacrimal gland enlargement. It may be the initial sign of distal occult cancer or occult metastatic disease. Different patterns of metastasis may be seen with different underlying primaries.