Lacrimal Gland Intra-Lobular Duct Cysts Associated with Focal Vasculitis

Description of the clinical and histopathological features of unusual lacrimal gland intra-glandular duct cysts.

A 38-year-old male presented with bilateral upper lid lumpiness, which was worse on the left. Computed tomography scan showed bilateral multiple lacrimal gland cysts, which were larger on the left compared to the right. After two unsuccessful attempts to excise the largest cyst on the left side, it was removed at the third attempt using a novel technique that incorporated the use of fibrin glue to fill the remaining cavity.

The microscopy of the left-sided cyst comprised a cavity containing fibrin glue, lined by intra-lobular lacrimal gland duct epithelium. The cyst wall contained reactive lymphoid aggregates, plasma cells and eosinophils associated with fibrosis. Focally, there were small vessels affected by an acute vasculitis associated with eosinophils and a granulomatous component.

We ascribe the cyst formation to the effects of tractional fibrosis secondary to focal vasculitis and to obstructive fibrosis of the lacrimal ductules. This case also described a novel use of Tisseel fibrin glue to assist intact removal of a lacrimal gland cyst.