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Let's review the pathology of the orbital appendages,

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starting with lacrimal sac disease.

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Lacrimal sac disease includes neoplasms that are malignant

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such as squamous cell carcinoma, melanoma,

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lymphoma, and transitional cell carcinoma.

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The lacrimal sac, like all parts of the orbit,

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may also be involved with idiopathic orbital inflammation.

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There are benign tumors that can occur in the lacrimal sac,

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including polyps and fibromas.

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The other thing that can happen with the lacrimal

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sac is that we can have obstruction.

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Obstruction can lead to dacryocystoceles.

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These are cysts that occur either at the lacrimal sac or

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at the valves where the fluid will be passing from the

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lacrimal sac into the nasolacrimal duct, and from the

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nasolacrimal duct into the inferior turbinate

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and inferior nasal cavity.

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Sclerosis and stenosis of the nasolacrimal

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duct can lead to frequent epiphora,

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for this treatment often is balloon dilatation or

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stent placement into the nasolacrimal duct.

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Inflammatory disease,

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including IgG4 disease and orbital pseudotumor,

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may also cause inflammation of the lacrimal sac.

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With respect to lacrimal gland masses,

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the most common are going to be the granulomatous

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lymphoproliferative diseases,

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of which lymphoma is going to be the most common tumor.

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However,

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the granulomatous diseases again can include sarcoidosis,

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orbital pseudotumor,

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idiopathic orbital inflammation,

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and IgG4 related ophthalmic disease.

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These are more common than the epithelial

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lesions of salivary gland derivative,

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of which adenoid cystic carcinoma is the most common,

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as a malignancy,

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and pleomorphic adenoma as the benign tumor.

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With mucoepidermoid carcinoma

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and adenocarcinoma also occurring.

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The adenocarcinoma may be due to malignant

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degeneration of a pleomorphic adenoma.

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There are congenital lesions that can occur in

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association with the lacrimal gland, as well.

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And those include epidermoids and dermoids.

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So, if one sees a cystic lesion associated with the

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lacrimal gland or a cystic lesion that

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has dermal appendages containing fat,

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one would suggest the diagnosis of a dermoid

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associated with the lacrimal gland.

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Almost all of these look very similar,

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in that they do show

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avid contrast enhancement with regard to the

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granulomatous and the salivary gland tumors.

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However, dermoids and epidermoids

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do not show contrast enhancement.

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When one considers any of the spaces of the orbit,

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one should think about this mnemonic, VITAMIN C and D for

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Vascular, Infectious, Traumatic, Acquired, Metabolic,

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Idiopathic, Neoplastic,

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Congenital, and Drug-related diseases

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that can affect this region.