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Photos courtesy of: Bita Esmaeli, M.D. / M.D. Anderson Cancer Center
Used with permission. Not to be reproduced.

A 24-year-old female presented with an enlarging right lacrimal fossa mass. CT and histology are shown.

1.	The most likely diagnosis is:
	c -- adenoid cystic carcinoma This young adult has an ill-defined lacrimal gland mass that shows the most common cribriform (“swiss cheese”) histologic pattern. Pleomorphic adenoma is typically more well defined and ovoid in shape, and histology shows a mixed pattern of cellular epithelial and myxoid stromal components.
2.	The most common histologic subtype is:
	b -- cribriform See above.
3.	Patients may present with pain due to:
	a -- bony erosion and perineural spread Patients with adenoid cystic carcinoma of the lacrimal gland typically have pain from bony orbital wall erosion or perineural spread. This is a helpful differentiating feature from pleomorphic adenoma which is usually painless.