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A 60-year-old woman with an asymptomatic left lacrimal gland mass found incidentally
Digital Journal of Ophthalmology 2017
Volume 23, Number 4
October 18, 2017
DOI: 10.5693/djo.03.2017.07.001
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Sudip D. Thakar, BS | Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
Oded Sagiv, MD | aOrbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
Michael Tetzlaff, MD, PhD | Department of Pathology and Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
Adel El-Naggar, MD, PhD | Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
Matthew Debnam, MD | Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston
Thomas J. Kandl, MD | Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
Bita Esmaeli, MD, FACS | Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
Treatment
Given the concerns for growth of the lacrimal gland mass and the possibility of a metastasis from the patient’s known previously treated recurrent sinonasal carcinoma, the patient underwent a left anterior orbitotomy with total resection of the lacrimal gland mass 2 weeks after this presentation. Gross evaluation of the surgical specimen revealed an encapsulated mass with a homogeneous yellow, tan cut surface (Figure 2). Histopathologic analysis of the tumor revealed an encapsulated tumor with a surrounding fibrous capsule (Figure 3A), consisting of a variable density of benign spindle cells with densely cellular areas (Antoni A areas, Figure 3B), including focal Verocay body formation (Figure 3C) juxtaposed with less cellular regions, where the spindle cells were loosely arranged in a myxoid background with prominent hyalinization of the tumor-associated vessels (Antoni B areas, Figure 3D).
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Figure 2
A, Gross surgical specimen showing the appearance of the lacrimal gland mass. B, Gross specimen in cross section.

Figure 3
Lacrimal gland schwannoma. A, Scanning magnification reveals an encapsulated spindle cell tumor with areas of hyper- and hypo-cellularity adjacent to glandular tissue (hematoxylin-eosin [H&E] original magnification ×40). B, Spindle cell tumor comprised of areas of relative hypercellular Antoni A areas (H&E ×200). C, with Verocay body formation (arrowheads; H&E ×200). D, Antoni B area consisting of loose arrangement of spindle cells in a myxoid background with hyalinized thick-walled vessels (arrowheads; H&E ×200).