A 42-year-old man has a firm, slowly enlarging, painless mass in the right lacrimal gland fossa displacing the globe inferonasally. CT shows a well-circumscribed globular lesion with smooth remodelling of the lacrimal fossa bone. The MOST appropriate next step is:

• A Incision biopsy through the eyelid to confirm histology before any surgery
• B Fine needle aspiration cytology
• C Systemic corticosteroids with follow-up imaging
• D Complete excision of the mass intact within its capsule, without prior incisional biopsy ✓

Explanation

Pleomorphic adenoma of the lacrimal gland requires complete intact excision at first surgery. Incisional biopsy or FNAC risks capsular violation and spillage of tumour cells, causing recurrence or malignant transformation to carcinoma ex pleomorphic adenoma, which may be fatal. Steroids treat dacryoadenitis, but the well-circumscribed mass with bony remodelling here indicates a benign epithelial tumour.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.