Occurrence of lacrimal gland tissue outside the lacrimal fossa: comparison of clinical and histopathological findings

Abstract

ABSTRACT.Purpose: To analyse clinical referral diagnoses and the location of lesions with histologically verified lacrimal gland tissue occurring outside the fossa of the lacrimal gland. Methods: Sections of lesions excised from areas outside the fossa of the lacrimal gland containing lacrimal gland tissue on histological examination were collected from the files of the Eye Pathology Institute, Copenhagen, Denmark. Specimens spanned a period of 50 years. Sections were re-examined and referral data on location and clinical diagnosis were compared with histological findings. Results: A total of 120 lesions were collected. Of these, 59 (49%) consisted of prolapsed lacrimal gland. The remaining 61 (51%) lesions contained ectopic lacrimal gland tissue, either as part of a complex choristoma in 38 (32%) cases, or as solitary ectopic lacrimal gland tissue in 23 (19%) cases. The majority (97; 81%) of lesions had been located at the temporal epibulbar conjunctiva and included mainly prolapsed lacrimal gland and complex choristoma. The clinical referral diagnoses covered a wide spectrum of lesions. The most frequent clinical diagnoses were non-specific tumour (35%), non-specific cyst (18%) and dermoid (11%). Of the 61 lesions containing ectopic lacrimal gland tissue, only two had been preoperatively diagnosed as such and only two of the 59 lesions with prolapsed lacrimal gland had been correctly diagnosed. Conclusions: Prolapsed palpebral lobe of the lacrimal gland was the most common lesion and, as expected, the prime location was the temporal conjunctiva. Despite this location, the referring clinical diagnosis was often wrong or non-specific. Surgeons seem to have been unaware of the various clinical manifestations of extrafossal glandular tissue, particularly when excising lesions in the upper temporal region of the conjunctiva. Surgical intervention in this location may jeopardize the excretory ducts of the lacrimal gland and may consequently lead to dry eye and thus should be avoided when the typical clinical appearance of prolapsed lacrimal gland is encountered.

Inferomedial Dermolipoma With Ectopic Lacrimal Gland

“…Ectopic lacrimal gland tissue is a rare histologic finding that most commonly affects the bulbar conjunctiva and limbus. 5 It has also been described in the eyelid, conjunctiva, sclera, cornea, iris, choroid, and orbit. 6 It can present either as an isolated choristoma, or as a complex choristoma also containing cartilage, nerve, or be located within a dermolipoma, as was found in the described case.…”

“…In their study, they found that most cases (38, 62%) were complex choristomas, while 23 cases (38%) represented isolated ectopic lacrimal gland tissue. 5 All of the cases were located temporally, with 48 cases (79%) in the temporal epibulbar conjunctiva, and 13 cases (21%) located in the temporal orbit outside the lacrimal fossa. 5 To our knowledge, the described case may represent the first description of ectopic lacrimal gland occurring in the medial orbit deep in the inferomedial conjunctiva.…”

“…6 It can present either as an isolated choristoma, or as a complex choristoma also containing cartilage, nerve, or be located within a dermolipoma, as was found in the described case. 5 Like a dermolipoma, ectopic lacrimal gland tissue tends to occur deep in the superotemporal conjunctiva, and is thought to be aberrantly located palpebral lacrimal gland tissue from the adjacent lacrimal fossa. 6 Alyahya et al 5 reported the largest series of ectopic lacrimal gland describing 61 such cases.…”

“…5 Like a dermolipoma, ectopic lacrimal gland tissue tends to occur deep in the superotemporal conjunctiva, and is thought to be aberrantly located palpebral lacrimal gland tissue from the adjacent lacrimal fossa. 6 Alyahya et al 5 reported the largest series of ectopic lacrimal gland describing 61 such cases. In their study, they found that most cases (38, 62%) were complex choristomas, while 23 cases (38%) represented isolated ectopic lacrimal gland tissue.…”

Pleomorphic adenoma of retrobulbar ectopic lacrimal gland: a rare occurrence

“…The lacrimal apparatus comprises of the main lacrimal gland and the two sets accessory glands (of Krause and of Wolfring). While the main lacrimal gland is situated in the orbital lacrimal fossa, its palpebral lobe is situated on the temporal side of the superior fornix [1]. Whilethe eyelids [2], tarsal plate [3] and the nasal mucosa [4] have been reported to harbor ectopic lacrimal gland tissue, the commonest sites involved are the bulbar conjunctiva and limbal area [5,6].…”