Ductal Adenocarcinoma Ex Pleomorphic Adenoma of theLacrimal Gland: a Rare and Morbid Malignancy

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a rare malignant transformation of a benign primary pleomorphic adenoma(PA). We report the case of a 62-year-old male who presented with a swelling over his left temple. Imaging revealed a lyticlesion over the left orbital wall with soft tissue extension suggestive of malignancy. He underwent an en bloc resection of themass with orbital exenteration, craniotomy, and reconstruction. Pathology demonstrated a lacrimal gland ductal adenocarcinomaarising from a PA which led to the diagnosis of ductal adenoCa ex PA. Postoperatively, he received chemotherapy with 6cycles of cisplatin and concurrent radiation therapy (RT), but his course was complicated by recurrent bacterial meningitisand abscesses and he ultimately opted for comfort measures. Patients with PA of the lacrimal gland experience aninsidiously enlarging painless swelling of the orbit with transformation to Ca ex PA highlighted by a rapid onset of bulbarenlargement, displacement, and often proptosis. Ductal adenoCa ex PA is aggressive with a poor prognosis and has noestablished standard of care. This case highlights the rarity of this condition and the need for more literature to helpdirect treatment