Lacrimal gland tumours: the role of CT and conventional radiology.

The X-ray features of 66 lacrimal gland tumours, comprising 32 benign pleomorphic adenomas, 24 carcinomas and ten lymphomas, are reviewed. The role of radiology in the management of these patients is discussed. Although lacrimal gland tumours present no unique radiological appearances, the diagnosis and pathological type may be suggested by a combination of conventional radiography and CT scan. It is important to distinguish the pleomorphic adenoma clinically and radiologically from other lesions of the lacrimal gland, since this tumour must be excised in toto. Incisional biopsy or partial removal may result in a disastrous recurrence with seeding into bone and soft tissue. X-ray signs of malignancy in lacrimal gland tumours include invasion and sclerosis of the adjacent bone of the lacrimal fossa, calcification in the tumour and extension outside the lacrimal gland area shown on CT scan. The pre-operative diagnosis of malignancy was improved from 42% to 73% by CT. Indentation or enlargement of the lacrimal fossa was seen in 80% of benign pleomorphic adenomas. Although nonspecific, this sign in a patient with a painless lacrimal gland swelling of over 12 months' duration, without radiological evidence of malignancy, is strongly indicative of a benign tumour.