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Pathologic Classification and Current Understanding

Ezekiel Weis, MD, MPH; Jack Rootman, MD; Thomas J. Joly, MD, PhD; Kenneth W. Berean, MD; Hind M. Al-Katan, MD; Sylvia Pasternak, MD; Giulio Bonavolontà, MD; Diego Strianese, MD; Peerooz Saeed, MD; Kenneth A. Feldman, MD; Sumalee Vangveeravong, MD; Jocelyne S. Lapointe, MD; Valerie A. White, MD, MHSc

Arch Ophthalmol. 2009;127(8):1016-1028.

Objective  To apply the updated epithelial salivary gland classification scheme to a large cohort of lacrimal gland tumors so as to provide an updated lacrimal gland tumor classification scheme.

Methods  A retrospective multicenter cohort study of 118 cases of epithelial neoplasia was undertaken. Main outcome measures included pathologic analysis, subtyping, and survival.

Results  Of 118 cases, 17 (14%) were reclassified using the proposed expanded classification scheme based on the current World Health Organization classification of salivary gland tumors. The most frequent neoplasms were pleomorphic adenoma and adenoid cystic carcinoma, of which we highlight more unusual histologic features. Three tumors were found to be unclassifiable with the updated scheme, with 2 having histologically malignant features. Deficiencies and variations in pathologic assessment were noted. Variation in the histologic findings of pleomorphic adenoma and assessment of the extent of invasion of carcinoma ex pleomorphic adenoma were highlighted.

Conclusions  The use of the more histologically diverse classification of salivary gland tumors can be successfully applied to the epithelial lacrimal gland neoplasms. This expanded classification system led to reclassifying 14% of cases. Currently, there are no consistent pathologic standards for processing and evaluating these lesions.

Author Affiliations: Department of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada (Dr Weis); Departments of Ophthalmology and Visual Science (Drs Weis, Rootman, Joly, and White), Pathology and Laboratory Medicine (Drs Rootman, Berean, and White), and Radiology (Dr Lapointe), Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia, Canada; Department of Ophthalmology, Security Forces Hospital, Riyadh, Saudi Arabia (Dr Al-Katan); Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada (Dr Pasternak); Department of Ophthalmology, University of Naples, Naples, Italy (Drs Bonavolontà and Strianese); Department of Ophthalmology, University of Amsterdam, Amsterdam, the Netherlands (Dr Saeed); Department of Ophthalmology, Kaiser Permanente Medical Center, Harbor City, California (Dr Feldman); and Department of Ophthalmology, Siriraj Hospital, Bangkok, Thailand (Dr Vangveeravong).

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