Oculoplastics · practice question
Why is an incisional biopsy avoided in this situation?
Imaging of a lacrimal-fossa mass shows a well-defined lesion with smooth bony expansion and no bone destruction, present painlessly for over a year. Why is an incisional biopsy avoided in this situation?
Show the answer and explanationAnswer and explanation
Answer: A. It suggests a pleomorphic adenoma
A painless, chronic, smoothly bony-expanding lacrimal-fossa mass suggests a pleomorphic adenoma, which is removed intact en-bloc because incising it seeds recurrence and risks malignant change. By contrast, a painful, bone-destroying, or diffuse lesion (suspected carcinoma or lymphoma) is biopsied. Imaging pattern determines whether to biopsy.
Clinical pearl: Benign orbital lesions remodel and expand bone with well-defined margins, while malignant lesions erode and destroy bone irregularly; "smooth expansion, no biopsy; destruction, biopsy" captures the lacrimal-fossa decision at a glance.