A 45-year-old woman has a painless, slowly enlarging mass in the superotemporal part of the left orbit causing downward and inward displacement of the globe. Imaging shows a well-circumscribed lesion with bone remodelling but no destruction. Which management principle is correct?
- A Incisional biopsy followed by radiotherapy
- B Complete excision with intact capsule at first surgery ✓
- C Debulking with preservation of residual gland
- D Observation with annual imaging
Correct answer: B. Complete excision with intact capsule at first surgery
Explanation
Pleomorphic adenoma of the lacrimal gland must be excised completely with its capsule intact at the first operation. Incomplete excision or incisional biopsy risks spillage of tumour cells and malignant transformation to carcinoma ex pleomorphic adenoma, which carries a poor prognosis. Radiotherapy has no established role, and observation allows progression toward malignant change.
Reference: Parsons' Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.