[Neoplastic space-occupying lesions of the orbits. II. Space-occupying lesion in the area of the lacrimal gland].

In part two of this paper about orbital tumors, neoplasms of the lacrimal gland are discussed: These have to be properly separated from inflammations. While inflammatory affections of the lacrimal gland make up the majority of private practice consultations, in cases referred to an eye clinic the relation between inflammatory diseases and neoplasms is about equal (between 1987 and 1990, 14 neoplasias and 14 inflammations were seen at the University Eye Clinic, Zurich). The benign pleomorphic adenoma of the lacrimal gland should be removed in toto in its capsule. For this procedure a lateral orbital fenestration is required. An excisional biopsy is considered the method of choice while an incisional biopsy should be avoided because of the risk of recurrence. On the other hand, incisional biopsy is used in the cases of adenoidcystic carcinoma and lymphoma. After confirmation of an adenoidcystic carcinoma by biopsy, orbital exenteration has to follow as soon as possible. In cases of lymphoma, possible oncological treatment has to be evaluated. In order to differentiate histologically between a reactive lymphoid hyperplasia and a malignant lymphoma, immunofluorescent studies on non-fixed tissue are necessary in close collaboration with an immuno-pathologist. Because the benign pleomorphic adenoma of the lacrimal gland has to be treated by a different surgical approach than the adenoid cystic carcinoma, a proper diagnosis has to be made before any intervention; a requirement we could not always fulfill. Those mistakes made us conclude that even in the era of CT scan, MRI and angiography, the radiological diagnoses are often hypotheses which have to be confirmed by discussion.(ABSTRACT TRUNCATED AT 250 WORDS)