Anatomy and physiology of the eye: pleomorphic adenoma of the lacrimal gland: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Anatomy and physiology of the eye: pleomorphic adenoma of the lacrimal gland

Sample item

A 40-year-old woman has a painless mass in the superolateral orbit with slow, progressive downward and inward displacement of the globe. CT shows a smooth, well-circumscribed oval lesion in the lacrimal gland fossa with bone remodelling but no destruction. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. En bloc excision with the capsule intact, without prior biopsy

A smooth, well-circumscribed lacrimal fossa mass with bone moulding is a pleomorphic adenoma, the commonest epithelial tumour of the lacrimal gland. Biopsy or piecemeal removal breaches the pseudocapsule, seeds tumour into the orbit and risks recurrence and malignant change, so it is excised intact.

Option by option

  • A. Primary external-beam radiotherapy

    Radiotherapy is not the treatment for a benign encapsulated tumour that is surgically resectable.

  • B. A four-week course of systemic corticosteroids

    Corticosteroids treat inflammatory lesions such as dacryoadenitis, which shows diffuse enlargement with pain rather than a smooth bone-moulding mass.

  • C. Incisional biopsy followed by definitive excision

    An incisional biopsy violates the pseudocapsule and predisposes to recurrence and malignant transformation.

  • D. En bloc excision with the capsule intact, without prior biopsy (correct)

    Correct. Removal with an intact capsule and no preoperative biopsy prevents seeding and recurrence.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is D, En bloc excision with the capsule intact, without prior biopsy. A smooth, well-circumscribed lacrimal fossa mass with bone moulding is a pleomorphic adenoma, the commonest epithelial tumour of the lacrimal gland.

Why is "Primary external-beam radiotherapy" not the answer?

Radiotherapy is not the treatment for a benign encapsulated tumour that is surgically resectable.

Why is "A four-week course of systemic corticosteroids" not the answer?

Corticosteroids treat inflammatory lesions such as dacryoadenitis, which shows diffuse enlargement with pain rather than a smooth bone-moulding mass.

Why is "Incisional biopsy followed by definitive excision" not the answer?

An incisional biopsy violates the pseudocapsule and predisposes to recurrence and malignant transformation.

What concept does this question test?

It tests Anatomy and physiology of the eye: pleomorphic adenoma of the lacrimal gland in Ophthalmology. Biopsy or piecemeal removal breaches the pseudocapsule, seeds tumour into the orbit and risks recurrence and malignant change, so it is excised intact.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anatomy and physiology of the eye: pleomorphic adenoma of the lacrimal gland?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.