High-grade mucoepidermoid carcinoma of the lacrimal gland #F
The present case has been reported in the Korean Journal of Ophthalmology.

A 79-year-old woman presented with progressive ptosis and swelling of the left eyelid for five months. Her best-corrected visual acuity was 20 / 50 in the left eye, with a relative afferent pupillary defect. There was also hypoglobus of the left eye and severely limited upward movement. Exophthalmometry demonstrated a 6-mm proptosis of the left eye.

An orbital CT scan showed a heterogeneous, poorly defined mass occupying the superior orbital area. The mass displaced the left globe inferiorly and caused bony destruction of the lateral wall. A gadolinium-enhanced, fat-suppressed magnetic resonance image showed the orbital mass with heterogeneous enhancement, penetrating the lateral orbital wall and spreading to the temporalis muscle.

An incisional biopsy revealed an intermediate to high-grade mucoepidermoid carcinoma. Ultrasonography demonstrated an intake orbital roof. Systemic evaluations did not reveal signs of metastasis. Lid-sparing exenteration with lateral orbitectomy was then performed. A split-thickness skin graft was harvested from the right thigh and placed into the left eye socket.

A diagnosis of high-grade mucoepidermoid carcinoma (T4cN0M0) was made according to the World Health Organization/Armed Forces Institute of Pathology grading system and the 8th American Joint Committee on Cancer staging system.

The patient received 6,000 cGy of radiation over 6 weeks, and was tumor-free for 13 months. Unfortunately, after 13 months, she developed parotid metastasis. She declined radical neck dissection, parotidectomy, and radiation. She survived for another 14 months.

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