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Polito E., Picchirri P.
Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy
Primary epithelial tumors account for approximately one-third of all lacrimal gland pathology. About 55% of lacrimal gland epithelial tumors are benign. Benign tumors of the lacrimal gland present clinically as painless, slow-growing masses in the upper lateral orbit with symptoms of proptosis and inferomedial displacement of the globe. Eye motility abnormality and diplopia are rare. On the other hand, clinical suspicion for lacrimal gland malignancy is raised by a recent rapid onset of symptoms, pain, and radiographic evidence of bone destruction. The finding of calcification is often considered a sign of malignancy, through being observed in various benign conditions. These different features help us in therapeutic planning and surgical approach. The treatment of lacrimal gland benign tumors, above all for pleomorphic adenoma, is the complete surgical excision of the mass, with an intact capsule. In difficult cases, when biopsy is required for diagnosis, it should be followed by complete excision including the biopsy tract, to ensure complete removal. Whereas, the optimal treatment of malignant tumor remains controversial and different treatment modalities have been compared to evaluate their impact in long-term survival. Despite the type of the treatment, the local recurrence and distant metastasis are frequent, above all when there is late diagnosis and the tumor is in an advanced clinical stage.