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Case Study: June 2017
History
A 45 year old male presents with a left supero-temporal mass associated with infero-medial displacement of the globe. Imaging shows a mass in the left lacrimal gland and no masses elsewhere highly suggestive of a primary tumour at this location. Surgery is undertaken to remove the affected gland.
The Figures illustrate the key pathology of the lacrimal gland mass.
Questions
1. What feature is shown in Fig 1 and 2?
2. What do Figs 3 and 5 show?
3. What is the likeliest diagnosis?
4. What does Fig 6 show?
Answers
1. Mucin extravasation (Fig 2 is an Alcian Blue-PAS stain)
2. Goblet cell containing cells, intermediate cells and squamoid cells.
3. Well differentiated mucoepidermoid carcinoma (MEC)
4. This is a FISH investigation to assess for the presence or absence of the CRTC1-MAML2 fusion encodes a chimeric protein that confers a significantly better prognosis in a proportion of MECs.
References
Andreoli MT, Aakalu V, Setabutr P.Epidemiological trends in malignant lacrimal gland tumors.Otolaryngol Head Neck Surg. 2015 Feb;152(2):279-83
Alkatan HM, Al-Harkan DH, Al-Mutlaq M, Maktabi A, Elkhamary SM.Epithelial lacrimal gland tumors: A comprehensive clinicopathologic review of 26 lesions with radiologic correlation.Saudi J Ophthalmol. 2014 Jan;28(1):49-57
von Holstein SL, Coupland SE, Briscoe D, Le Tourneau C, Heegaard S.Epithelial tumours of the lacrimal gland: a clinical, histopathological, surgical and oncological survey.Acta Ophthalmol. 2013 May;91(3):195-206.
