Adenoid cystic carcinoma of the lacrimal gland metastasising to the liver: report of a case

We report a rare case of an isolated liver metastasis from a lacrimal gland adenoid cystic carcinoma 20 years after resection of the primary tumour. The patient presented with right upper quadrant pain radiating to the back and shortness of breath of 3 months duration. No local recurrence was detected during a 15 year follow-up with computerized tomography (CT) of the head. Abdominal CT scan demonstrated a solitary liver tumour with no other primary source, and the bone scan was normal. The patient was treated with an extended right hemihepatectomy. The histology revealed a predominantly cribriform tumour with focal areas of basaloid type metastatic lacrimal gland adenoid cystic carcinoma.This case illustrates the unpredictable behaviour of adenoid cystic carcinoma and the need for a life long follow up for these patients after treatment. The possibility of surgical resection for liver metastasis from adenoid cystic carcinoma should always be considered.Adenoid cystic carcinomas (ACC) of the lacrimal gland are rare malignant tumours accounting for 1.6% of all orbital tumours [1-3]. Despite their rarity they are the second most frequent epithelial neoplasms occurring in the lacrimal gland after pleomorphic adenomas [4].They are slow growing tumours, which tend to spread to adjacent structures and occasionally metastasise via haematogenous spread to lungs, brain and bone in decreasing order of frequency [5-8].There are few studies and reports on lacrimal gland ACC describing time interval to presentation of metastases and length of follow-up required [9,10]. The liver is considered a rare site of distant metastasis and when it is involved is usually as part of disseminated disease [7]. To our knowledge, neither solitary liver metastasis, nor metastatic liver resection from a lacrimal gland ACC has been reported.We present a case of an isolated liver metastasis occurring 20 years after initial surgery for lacrimal gland ACC, with no evidence of loco regional, synchrono