it presents as a painless and slowly growing mass and also as exophthalmoses like in orbital masses .
this study aims to identify the clinical course , surgical treatment and histopathologic properties of pleomorphic adenoma diagnosed in a patient who had painless exophthalmia with an intraorbital mass .
a 62-year - old male patient referred to our clinic due to painless exophthalmia of his right eye for the last 2 years . on neurological examination of the patient
, there was no abnormality except for the up - gaze restriction and severe exophthalmia .
cranial magnetic resonance imaging ( mri ) revealed an isointense mass on the superolateral part of right orbita in the coronal intersections and it was contrasted homogenously ( fig . 
2a and b ) . the existing score of our patient according to rose and wright was + 8 points
histological examination of the surgical specimen covered the epithelial and stromal components that formed the glandular structures .
figure  1:(a and b ) computerized tomography revealed a homogenously contrasted intraorbital mass in the right eye . 

figure  2:(a and b ) cranial mri revealed a homogenously contrasted mass on the superolateral part of the right orbita . 

figure  3:(a and b ) postoperative computerized tomography revealed the replacement of the eye . 

figure  4:(a ) four times h - e biphasic tumor composed of epithelial and stromal components .
( b ) ten times h - e fibromyxoid stroma and epithelium that form glandular structures .
( a and b ) computerized tomography revealed a homogenously contrasted intraorbital mass in the right eye .
( a and b ) cranial mri revealed a homogenously contrasted mass on the superolateral part of the right orbita .
( a ) four times h - e biphasic tumor composed of epithelial and stromal components .
( b ) ten times h - e fibromyxoid stroma and epithelium that form glandular structures .
although the orbital tumors originate primarily from vascular , muscle , cartilage , neural tissues , lacrimal glands and lymphoid structures , they can also originate from the surrounding structures and ( low possibility of ) metastasis .
epithelial tumors account for 30% of the lacrimal gland lesions , while 12% of epithelial tumors are pleomorphic adenoma .
the term pleomorphic ( benign mixed tumor ) was first defined and used by willis .
malignant transformation can occur in 1020% of pleomorphic adenomas of the lacrimal gland [ 5 , 6 ] .
seventy - five percent of pleomorphic adenomas transform into pleomorphic adenocarcinoma , while the rest transform into cystic carcinoma .
pleomorphic adenoma must be considered for the patients whose clinical course lasts for 12 months .
malignancy must be considered for cases with pain and progredien symptoms . in his study , wright reported that 39 of 40 cases diagnosed with primary malignant lacrimal gland tumors had a painful mass .
in addition to pain , neoplasm of the lacrimal gland , which destroys the bones , can be interpreted as malignancy .
while pleomorphic adenomas do not destroy the bones , malignant neoplasm does [ 9 , 10 ] .
although pleomorphic adenomas constitute 49% of all orbital tumors , their morbidity is very high .
displacement of the mass without its capsule and malignant transformations following the incisional biopsies prior to the diagnosis of pleomorphic adenoma increase the morbidity . to this end , rose and wright developed a scoring system to evaluate the lacrimal gland masses [ 6 , 9 ] ( table  1 ) . according to this scoring system ,
if the value obtained from this table  is below + 2 , the value may indicate carcinoma and thus incisional biopsy can be performed .
the values + 3 and higher may indicate pleomorphic adenoma and thus , incisional biopsy must not be performed .
the success of the treatment depends on the displacement of the mass with its capsule .
it can also lead to malignant transformation of pleomorphic adenoma . the existing score of our patient according to rose and wright was + 8 points .
table  1:management of lacrimal gland masses according to rose and wrightclinicalscore1  + 1duration of acute symptoms<10 months>10 monthspersistent painpresentabsentsensory losspresentabsentradiological1  + 1well - defined round or oval massabsentpresentmoulding of mass to globe or along the lateral orbital wallpresentabsenttumor calcificationpresentabsentinvasion of bonepresentabsentduration of symptoms in relation to tumor sizeshort symptomslong symptoms management of lacrimal gland masses according to rose and wright pleomorphic adenoma of the lacrimal gland must be considered in the presence of long - term painless exophthalmoses . for the patients
suspected to have pleomorphic adenoma , incisional biopsy should not be performed in order to prevent the likelihood of a relapse to occur .
the displacement of the mass with its capsule can extend the patients ' lives and improve their quality of life .
 we present a case of a 62-year - old male patient with pleomorphic adenoma and painless solid mass in his right eye . 
 computerized tomography demonstrated a mass with a diameter of 2.5 cm located in the right lacrimal gland . 
 the mass was removed completely by combined orbitofrontal craniotomy through a transcranial approach . 
 histopathologic examination revealed pleomorphic adenoma of the lacrimal gland . 
 orbital tumors originate primarily from vascular , muscle , cartilage , neural tissues , lacrimal glands and lymphoid structures . 
 five percent of all intraorbital masses originate from the lacrimal gland . 
 pleomorphic adenoma presents as a painless and slowly growing mass and also as exophthalmoses . 
 pleomorphic adenoma has a high morbidity . 
 morbidity increases due to the total displacement of the tumor without its capsule and incisional biopsy for the purpose of diagnosis . 
 the success of the treatment depends on the removal of the tumor with its capsule . 
INTRODUCTION
CASE REPORT
DISCUSSION