A 50-year-old woman has a well-defined, slow-growing mass in the superotemporal quadrant of the orbit causing painless downward and nasal displacement of the globe. Imaging shows a firm lobulated mass in the lacrimal gland fossa without bone destruction. Histology after excision shows epithelial and myoepithelial elements in a chondromyxoid stroma. The MOST important principle governing its management is:

• A Debulking with radiotherapy to preserve the globe
• B Complete excision with intact capsule, avoiding incisional biopsy ✓
• C En bloc orbital exenteration in all cases
• D Incisional biopsy first to grade the tumor before planning excision

Explanation

Pleomorphic adenoma is the commonest benign lacrimal gland epithelial tumor. Incomplete excision or incisional biopsy ruptures the pseudocapsule and seeds tumor, leading to multifocal recurrence and risk of malignant transformation to carcinoma ex pleomorphic adenoma. Hence the rule is intact total excision without prior biopsy. Exenteration is reserved for frankly malignant lacrimal gland tumors, and radiotherapy is not primary treatment here.

Reference: Parsons' Diseases of the Eye, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.