[Safety of the preoperative evaluation of pleomorphic adenoma: a retrospective analysis]

The main problem of the management of suspected pleomorphic adenoma of the lacrimal gland is the safety of the preoperative diagnosis without biopsy. The current clinical standard (en bloc resection if suspected) has been questioned in this regard in recent publications. In this context we have analysed all consecutive lesions of the lacrimal gland region in our department for 5 years and evaluated pre-and intraoperative clinical and histological findings in regard to the safety of the preoperative diagnosis pleomorphic adenoma.

Retrospective analyses were performed for 93 consecutive cases of lesions of the lacrimal gland, which were resected or biopsied in the Department of Ophthalmology Charité CVK 2005 - 2009, so that a histological assessment was available. Clinical symptoms, radiological signs, histological diagnosis, therapeutic approach and results were documented.

65 patients had a dacryoadenitis (70 %), 5 were diagnosed with sarcoidosis (5 %), in another 5a pseudotumour of the orbit was diagnosed (5 %). Pleomorphic adenomas were found in 4 patients (4 %), 10 patients had a lymphoma (11 %), 7 of these 10 had an extranodal marginal zone lymphoma (EMZL), an adenocarcinoma was diagnosed in one patient (1 %), two patients had adenocystic carcinoma of the lacrimal gland (2 %) and another patient had a malignant mixed tumour as a consequence of an incomplete resection of pleomorphic adenoma (1 %). 8 patients were treated by an en bloc resection following the preoperative diagnosis pleomorphic adenoma.

The majority of lesions in the lacrimal gland are inflammatory processes. The preoperative evaluation of the diagnosis pleomorphic adenoma had a sensitivity of 100 % and a specificity of 50 %.