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Neuroradiology Case of the Week
Case 409
May 2009
Balasubramanya Kolar, MD and P-L Westesson, MD, PhD, DDS
Clinical
Presentation: An 85-year-old female presented with acute loss of vision in right eye.
Imaging Findings: On MR there is a well-defined T1 hypointense and T2 hyperintense lesion in the region of the left-sided lacrimal gland which is inverting and becoming hypointense on FLAIR images that is suggestive of a lacrimal gland cyst.
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Figure 1: Axial T2-weighted image shows a well defined hyperintense cystic lesion in the region of left lacrimal gland.
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Figure 2: Coronal T1-weighted image shows a hypointense cystic lesion in the region of left lacrimal gland.
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Diagnosis: Lacrimal gland cyst
Discussion: A lacrimal gland/fossa lesion often presents as a palpable mass in the superolateral aspect of the orbit. Half of lacrimal gland masses are of epithelial origin (equally divided between benign mixed adenomas and malignant carcinomas) while the other half are of the lymphoid inflammatory type including pseudotumor and lymphoma [1]. The lacrimal fossa can also be the site of origin of masses such as pseudotumor, lymphoma, metastasis and developmental cysts such as dermoid and epidermoid cysts [2].
Obstruction of the excretory duct of any lacrimal gland results in the entity called dacryops or simple ductal cyst. Cysts of the accessory lacrimal glands have also been reported [3]. A ductal cyst of the major lacrimal gland or dacryops is a rare clinical entity, encountered mainly in its palpebral lobe [4].
CT findings of ductal cysts involving the major lacrimal glands have been reported previously, and consist of fluid CT-density lesions in the region of the lacrimal glands, lateral to the globe [5]. Soft-tissue density on CT scans has also been reported in a few cases [4,6].
The main differential diagnosis of these benign ductal cysts is dermoid or epidermoid cysts [4-6]. Histopathologic examination can help one readily differentiate these entities. MRI showing characteristic lipid signal within dermoids and hyperintense signal on FLAIR within epidermoids can also differentiate these lesions.
References:
- Hesselink JR, Davis KR, Dallow RL, Roberson GH, Taveras JM. Computed tomography of masses in the lacrimal gland region. Radiology. 1979 Apr;131(1):143-7. [PubMed]
- Balchunas WR, Quencer RM, Byrne SF. Lacrimal gland and fossa masses: evaluation by computed tomography and A-mode echography. Radiology. 1983 Dec;149(3):751-8. [PubMed]
- Khoury NJ, Haddad MC, Tawil AN, Ma'luf RN. Ductal cysts of the accessory lacrimal glands: CT findings. AJNR Am J Neuroradiol. 1999 Jun-Jul;20(6):1140-2. [PubMed]
- Bullock JD, Fleishman JA, Rosset JS. Lacrimal ductal cysts. Ophthalmology. 1986 Oct;93(10):1355-60. [PubMed]
- Haik BG, St Louis L. Radiologic recognition of orbital dacryops. AJNR Am J Neuroradiol. 1989 Sep-Oct;10(5 Suppl):S89-90. [PubMed]
- Smith S, Rootman J. Lacrimal ductal cysts. Presentation and management. Surv Ophthalmol. 1986 Jan-Feb;30(4):245-50. [PubMed]
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