Abstract ID: 26-559
A rare case of secretory carcinoma of the lacrimal gland: a case report
Author: Helena Fawdry Base Hospital / Institution: Luton & Dunstable Hospital
Presentation Type: ePoster Presentation
Purpose
Secretory carcinoma, previously known as Mammary Analogue Secretory Carcinoma (MASC), is a recently characterised low-grade malignancy, most commonly arising from the salivary gland. Lacrimal gland involvement is exceptionally rare, with only 2 cases reported to date. We present a usual case of lacrimal gland secretory carcinoma, discussing the clinical, imaging and histological findings and implications for management.
Methods
Single-centre case report
Results
A 62-year-old Afro-Caribbean male presented to our district general hospital with an 8-month history of progressive unilateral proptosis, diplopia, pain, epiphora and conjunctival injection. Examination revealed reduced visual acuity and colour vision, restricted motility and a palpable firm superolateral orbital mass causing significant proptosis and hypoglobus. Imaging revealed a heterogenous, lobulated, enhancing extraconal lesion centred on the lacrimal gland. An incisional biopsy was reported as benign lacrimal gland tissue with occasional lymphocytic aggregates. Blood tests revealed mildly elevated IgG4 levels but were otherwise unremarkable. Therefore, a trial of high-dose oral corticosteroids was commenced, with no clinical improvement.
Given the high clinical and radiological suspicion of malignancy, lacrimal gland excisional biopsy was undertaken via lateral orbitotomy. Histopathology demonstrated a low-grade indolent carcinoma, with morphological and immunohistochemical features consistent with secretory carcinoma, without perineural or vascular invasion. Complete tumour excision was confirmed on post-operative imaging; however, piecemeal removal limited margin assessment.
Conclusion
Secretory carcinoma is a rare but important differential in patient presenting with lacrimal gland pathology. This case highlights the potential for falsely reassuring biopsy and the importance of clinical, imaging and pathological correlation.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Helena | Fawdry | Luton & Dunstable Hospital |
| Naomi | Aloka | Luton & Dunstable Hospital |
| Sheryll | Kamat | Luton & Dunstable Hospital |
| Mohammad | Alkhlaifat | Luton & Dunstable Hospital |
| Susan | Sarangapani | Luton & Dunstable Hospital |
| Engin | Akyol | Luton & Dunstable Hospital |