A 50-year-old woman presents with a 6-month history of constant deep orbital pain and a firm superolateral orbital mass displacing the globe inferomedially. CT shows a lacrimal gland mass with irregular bone destruction and calcification. The MOST important implication of these findings is:

• A Incisional biopsy followed by local excision will be curative
• B The lesion is benign and requires only serial imaging
• C The lesion carries a high risk of perineural spread and distant metastasis ✓
• D The lesion will regress spontaneously with systemic corticosteroids

Explanation

Pain, bone destruction, and calcification in a lacrimal gland mass indicate adenoid cystic carcinoma, the most common malignant epithelial tumour of the lacrimal gland. It shows a strong tendency for perineural invasion along the trigeminal branches, giving pain and paraesthesia, with late distant metastasis to lung and bone and a poor long-term prognosis despite radical surgery. Benign pleomorphic adenoma is painless, slow growing, and moulds rather than destroys bone.

Reference: Kanski's Clinical Ophthalmology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.