Pleomorphic adenoma of the lacrimal gland: is there a role for biopsy?

AIM: To review the literature on biopsy of lacrimal gland pleomorphic adenoma (LGPA) and to examine the validity of the prohibition against biopsy in LGPA. METHOD: Literature review. RESULTS: LGPA is usually diagnosed preoperatively based on clinical and radiological characteristics, as current teaching advises complete excision without prior incisional biopsy. The caveat against biopsy is based on older studies that reported increased recurrence rates with increased risk of malignant transformation after incomplete excision or biopsy. On the basis of a detailed examination of the literature on biopsy of both LGPA and pleomorphic adenoma of the salivary glands, it appears that there is no clear evidence to support the claim that biopsy increases the risk of recurrence or of malignant transformation of LGPA. CONCLUSION: Lacrimal gland tumours are uncommon lesions and optimal management depends to a great extent on a definite preoperative diagnosis. Preoperative biopsy should therefore be considered in all lacrimal gland mass lesions and management should be tailored to the biopsy findings. If surgical resection is then required, it may be prudent to excise the biopsy tract to ensure complete removal of the tumour.