Histopathological Spectrum of Lacrimal Gland Lesions: A Retrospective Clinicopathological Study of 68 Cases from a Tertiary-Care Centre

Abstract

Background: Lacrimal gland lesions span a wide range of epithelial, lymphoproliferative, melanocytic and mesenchymal entities. Because their clinical and radiological features overlap considerably, histopathological examination is required for a definitive diagnosis. The reported distribution of these lesions differs between series, reflecting variation in referral patterns, geography and inclusion criteria. Aim: To describe the histopathological spectrum of lacrimal gland lesions and to correlate the histopathological findings with the available clinical, demographic and radiological features. Materials and Methods: This retrospective study reviewed lacrimal gland specimens received in the Department of Pathology & Laboratory Medicine, Nizam’s Institute of Medical Sciences, Hyderabad, in collaboration with the Department of Ophthalmology, Neelima Institute of Medical Sciences, over a 42-month period (January 2021 to June 2024). Inflammatory lesions and lesions of the lacrimal sac or drainage system without lacrimal gland involvement, were excluded. Clinical, demographic, radiological and histopathological data were analyzed and lesions were grouped as benign epithelial, malignant epithelial, lymphoproliferative, or mesenchymal and melanocytic. Results: Sixty-eight cases were included. The mean age was 43.2±16.8 years and 40 patients (58.8%) were female. Benign epithelial tumors formed the largest category (32/68; 47.1%), followed by lymphoproliferative lesions (17/68; 25.0%), mesenchymal and melanocytic tumors (13/68; 19.1%) and malignant epithelial tumors (6/68; 8.8%). Pleomorphic adenoma was the most frequent single diagnosis (18/68; 26.5%), followed by papilloma (7/68; 10.3%) and oncocytoma (5/68; 7.4%). All lymphomas were of B-cell lineage: MALT lymphoma in 9 cases (13.2%) and B-cell non-Hodgkin lymphoma in 8 (11.8%). Soft-tissue tumors accounted for 11 cases (16.2%) and melanoma for 2 (2.9%). Adenoid cystic carcinoma was the commonest malignant epithelial tumor (4/68; 5.9%). Bone destruction on imaging was confined to malignant lesions (p = 0.001). Conclusion: Benign epithelial tumors, chiefly pleomorphic adenoma, were the dominant group in this series, while lymphoproliferative and mesenchymal lesions together made up a substantial share. Histopathology, supported by immunohistochemistry and radiological correlation, remains central to accurate diagnosis and management.