Pleomorphic adenoma of lacrimal gland - which surgical approach?

     Purpose: Pleomorphic adenoma is the most common epithelial tumour of lacrimal gland. Due to the risk of malignization it should be diagnosed and treated sooner as possible. It develops in adults, without gender’s preference. In most cases it presents as painless proptose and progressive dystopia with slow evolution, without diplopia or inflammatory signs.

     Method: Description of four clinical cases of patients with painless proptose and hipotropia, without other ophthalmologic symptoms; with several years of evolution. They were submitted to a complete ophthalmologic exam, Ecography and Orbitary’s CT. The surgical approach in one case was lateral’s orbitotomy with osteotomy and in the other three cases was anterior orbitotomy.

     Results: In the four cases it was excised the encapsulated tumour without disruption of the capsule. The histological results revealed pleomorphic adenoma. All patients are in regular clinical and imagiologic surveillance, without evidence of recurrence.

     Conclusions: Although rare, its diagnosis and treatment is essential. Since the recurrence and malignization risk increases with tumour’s biopsy, the final diagnosis is made with the histology of the entire surgical mass. The good prognosis depends on the total removal of the encapsulated tumour. The surgical approach depends on the imagiologic and clinical tumour’s characteristics.