Diagnostic and Surgical Challenges in Lacrimal Gland Pleomorphic Adenoma: A Case With Prolonged Ptosis and Acute Orbital Changes

Background: Pleomorphic adenoma of the lacrimal gland is a rare benign tumor affecting the orbital area that is usually noninfectious and gradually progressive in nature with painless proptosis. Case Presentation: We describe a case of a 37-year-old woman who presented with an unusual clinical course of ptotic history over five years with proptosis and superolateral orbital fullness emergent in the recent past. MRI showed that the mass originated in the lacrimal gland as a well-circumscribed and heterogeneous mass without bone erosion or intracranial expansion. Laboratory investigations were normal. A bone window lateral orbitotomy was performed on the patient, where the pseudocapsule was not breached, allowing the excision of the encapsulated tumor in its entirety. Pleomorphic adenoma was diagnosed by histopathological examination. Following surgery, the patient completely recovered with regard to ocular motility, proptosis resolution, and visual function. A seven-month follow-up showed the lesion fully resolved, and there was no sign of relapse. Conclusion: This case demonstrates the significance of the ability to identify abnormal manifestations of lacrimal gland pleomorphic adenoma and underlines its total resection as a method to avoid recurrence and malignant conversion. Surveillance over a long period is essential because it is possible that, after treatment several years ago, recurrence can take place.