MINISTRY OF EDUCATION
AND TRAINING
MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY
HA THI THU HA
RESEARCH ON CLINICAL, SUBCLINICAL
CHARACTERISTICS AND TREATMENT RESULTS
OF LACRIMAL GLAND TUMOURS
Specialism: Ophthalmology
Code: 62720157
ABSTRACT OF THESIS
HÀ NỘI - 2022
The thesis has been completed at
HANOI MEDICAL UNIVERSITY
Supervisors:
Supervisor1: A.Prof. Pham Trong Van
Supervisor 2: PhD. Nguyen Quoc Anh
Reviewer 1:
Reviewer 2:
Reviewer 3:
The thesis will be present in front of board of university examiner
and reviewer lever at on 2022
The thesis can be found at:
National Library
National Medical Informatics Library
Library of Hanoi Medical University
THE LIST OF WORKS HAS PUBLISHED AND
RELATED TO THE THESIS
1. Ha Thi Thu Ha, Nguyen Thi Thanh Huong, Nguyen Quoc Anh,
Pham Trong Van (2020). “Clinical features and computed
tomography of lacrimal gland tumors”. Journal of Vietnamese
Medicine, issues 1&2 in 2020, pp. 173 - 176.
2. Ha Thi Thu Ha, Nguyen Quoc Anh, Nguyen Ngoc Mai, Tran
Hong Nhung, Pham Trong Van (2020). “Correlation between
clinical features, computed tomography images and histology of
lacrimal gland tumors”. Journal of Practical Medicine, 2nd issue,
2020, pp. 12 - 15.
3. Ha Thi Thu Ha, Nguyen Thi Thanh Huong, Nguyen Quoc Anh,
Pham Trong Van (2021). “Results of treatment of lacrimal gland
tumors”. Journal of Vietnamese Medicine, No. 1, 2021, pages
149 - 154.
1
INTRODUCTION
A lacrimal gland tumor is a polymorphic lesion with characteristic clinical features,
pathology and therapeutic results. Classification of lacrimal adenomas is based on the World
Health Organization (WHO) 1991 classification of salivary gland tumors. Lacrimal adenomas
account for 3% to 18% of orbital tumors. Tumors are divided into two groups: epithelial (20-
45%) and non-epithelial (55-80%). The lacrimal adenocarcinoma consists of 55% of the
benign (the most common mixed lacrimal gland tumor) and 45% of malignant (the most
common and the most adenoid cystic carcinoma, accounting for 66% of the malignancies).
Lacrimal gland cancer is the one with high malignancy, especially adenoid cystic carcinoma
with high local recurrence and distant metastases, usually poor therapeutic result, with a
mortality rate of about 50%. The lacrimal non-epithelial neoplasms are mainly lymphoid
lesions including benign lymphoid hyperplasia, atypical lymphoid hyperplasia, and malignant
lymphoma. In Vietnam, there are no report on the incidence of lacrimal gland tumors. Early
detection and diagnosis of malignant lacrimal adenomas are relevant for the monitoring,
management, prognosis and survival rates of patients. Diagnosis is based on clinical features,
computed tomography images and pathology. And, clinical features and oriented computed
tomography diagnosis and pathology have definite diagnostic value.
In recent years, the understanding of the pathogenesis of lacrimal gland tumors has been
improved, treatment method brings about better results. Treatment of benign epithelial tumors
is surgical resection of the entire tumor. In contrast, the treatment of lacrimal adenocarcinoma
remains controversial. Eye-sparing and radiation therapy combined with chemotherapy are the
main trends in the treatment of lacrimal carcinoma.
Targeted therapy studies aimed at oncogenes will have been used in the treatment of
adenoid cystic carcinoma, particularly of value in recurrent or metastatic cancer. Treatment of
lymphoma includes monitoring, systemic corticosteroids, local radiation therapy, or
chemotherapy.
In Vietnam, the actual rate of cancer, including orbital cancer in general and
lacrimal gland cancer in particular, is increasingly reported. At the National Institute of
Ophthalmology, many patients with lacrimal gland cancer come for examination and
treatment at a metastatic stage. Therefore, the treatment results are very poor, even
death within a short time since the disease is detected. Lacrimal gland tumors are very
diverse in clinical morphology, the diagnosis of lacrimal gland tumor type, benign and
malignant nature of the tumor and treatment prognosis are still challenging for
clinicians. Up to date, the studies on lacrimal gland tumors in Vietnam are still
incomplete and the systematic and limited treatment methods have not caught up with
the world trend. We conducted the thesis "Research on clinical, subclinical
characteristics and treatment results of lacrimal gland tumors" with three
objectives:
1. Description of clinical and subclinical characteristics of lacrimal gland tumors at
the National Institute of Ophthalmology.
2. Evaluation of treatment results of lacrimal gland tumors of the study group of
patients.
3. Analysis of some factors related to the results of treatment of lacrimal gland tumors.
2
THE SCIENTIFIC AND PRACTICAL CONTRIBUTION OF THESIS
For the first time in Vietnam, there is a summary study on a large number of
patients with lacrimal gland tumors.
Describe the clinical and paraclinical features of two types of lacrimal gland tumors,
namely epithelial and non-epithelial neoplasms (mainly lymphoid lesions), showing the
relationship between clinical and subclinical signs.
Evaluate the results of treatment methods for each different type of lacrimal gland
tumor and analyze the factors affecting the treatment outcome of each method.
Based on research, ophthalmologists have more knowledge in the diagnosis,
treatment indications and prognosis with different types of lacrimal gland tumors.
STRUCTURE OF THE THESIS
The thesis is presented 156 pages: Introduction 2 pages, Overview 33 pages, Meth
odology 20 pages, Results 49 pages, Discussion 46 pages, Conclusion 2 pages,
Contribution of Thesis 1 page, The direction of further research of the thesis 1 page,
Recommendation 1 page with 175 Vietnamese and English references.
CHAPTER 1: OVERVIEW
1.1. Clinical and paraclinical features of lacrimal gland tumors
1.1.1. Outline of lacrima gland
1.1.2. Classification of lacrimal gland tumors based on histopathology
The four most common types of lacrimal adenomas are benign lacrimal gland mixed
tumor, lacrimal gland carcinoma, lymphoid hyperplasia and malignant lymphoma.
1.1.3. Clinical and subclinical characteristics of some common lacrimal gland tumors
* Benign lacrimal gland mixed tumor
Mixed lacrimal gland tumor is the most common epithelial tumor of the lacrimal
gland, accounting for 10-20% of lacrimal gland lesions and 1% of orbital tumors, usually
originating from the orbital lobe, sometimes from the eyelid lobe (10%). The tumor
usually grows slowly, without pain, the first sign is facial disproportion, ocular deviation,
with limited ocular movement or diplopia. On computed tomography, the tumor usually
presents as a round or oval mass, smooth, well-demarcated, smooth shell, ocular
displacement or deformity, mild to moderate attenuation. Histopathology is often cortical,
clearly demarcated, characterized by epithelial and parenchymal proliferation that varies
according to tumor morphologies.
* Lacrimal gland carcinoma
Lacrimal gland carcinoma includes adenoid cystic carcinoma, carcinoma ex
pleomorphic adenom, adenocarcinoma... Adenoid cystic carcinoma is the second most
common form of epithelial lacrimal gland tumour and is the most common malignant
carcinoma of the lacrimal gland, accounting for about 1.6% of orbital tumors and 3.8%
of primary orbital tumors. The disease occurs in both sexes. The average age of patients
is about 40 (6.5 - 79 years old). Clinical features include pain, eyeball displacement,
eyelid swelling, and eyelid numbness. Computed tomography showed a spherical,
round, or elongated tumor, running along the outer orbital wall, dilated lacrimal fossa
with bony infiltrates, serrated margins, and irregular density. On the bony window there
may be tumor infiltrates into the dura mater and intracranially. In terms of
histopathology, the gross tumor size can be small or large, the density is firm, often
multi-size, the limit is unknown, the face is rough and invasive.The tumour-section is