A 35-year-old woman has painless, gradually increasing proptosis displaced downwards and nasally. CT shows a well-defined superotemporal orbital mass arising from the lacrimal gland fossa with smooth excavation of the adjacent bone. The MOST appropriate management is:

• A Incisional biopsy followed by external beam radiotherapy
• B Complete excision with intact capsule through a lateral orbitotomy ✓
• C Fine needle aspiration cytology and observation
• D Systemic corticosteroids with serial imaging

Explanation

Pleomorphic adenoma is the commonest benign epithelial tumour of the lacrimal gland, producing a well-defined mass with smooth bony fossa remodelling. Management is complete intact excision, since capsular breach from incisional biopsy or incomplete removal seeds tumour cells and leads to recurrence or malignant transformation to carcinoma ex-pleomorphic adenoma years later. This absolute avoidance of biopsy is the single most examined fact about this tumour.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.