An Atypical Preentation of Adenoid Cytic Carcinoma of the Lacrimal Gland

Purpoe To report a cae of lacrimal gland adenoid cytic carcinoma (ACC) with an atypical initial preentation and to potulate an anatomical explanation for thi unuual biologic behavior. Deign Interventional cae report. Method An orbital magnetic reonance imaging tudy of a 58-year-old man who complained of progreive diplopia and orbital dicomfort dicloed a oft tiue ma in the left cavernou inu and orbital apex. The left lacrimal gland and the contiguou bone appeared normal. Reult Biopy of the intracranial ma revealed ACC of unknown origin which wa judged to be unreectable. He underwent two cycle of intraarterial cytoreductive chemotherapy followed by a left medial maxillectomy with phenoethmoidectomy, orbital exenteration, and chemoradiation. ACC tumor cell were identified in nerve fiber bundle urrounding and within the lacrimal gland. Concluion In patient preenting with an infiltrative ma in the cavernou inu or orbital apex, metatatic dieae from an occult lacrimal gland primary hould be conidered, even with a normal-appearing lacrimal gland.