lacrimal presentation that may be use for now

things to learn

1. Enlarged lacrimal gland Two broad categories in the differential Lacrimal Gland Enlargement Hint: NOT ‘benign’ and ‘malignant’— think more broadly than that! 1

2. Neoplastic Inflammatory Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement 2

3. Neoplastic Inflammatory Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement NOT ‘benign’ and ‘malignant’— again, think more broadly than that! 3

4. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Inflammatory 4

5. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Inflammatory 5

6. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign (Finally!) Inflammatory 6

7. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign ? ? Most common within each category? Inflammatory 7

8. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Pleomorphic adenoma Adenoid cystic carcinoma Most common within each category? Inflammatory 8

9. What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid 9

10. What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid 10

11. Lacrimal Gland Enlargement 11 Adenoid cystic carcinoma: Swiss cheese appearance

12. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid 12

13. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid 13

14. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid 14

15. What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential What is the classic pathologic description of adenoid cystic carcinoma? It looks like ‘Swiss cheese’ owing to its cystic nature How is the diagnosis confirmed? Via incisional biopsy There are five subtypes based on histology. All are bad, but which conveys the worst prognosis? Basaloid 15 B asaloid ad

16. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential If pleomorphic adenoma is suspected, should incisional biopsy be performed? No! The tumor should be removed en bloque, without violating its pseudocapsule Why must a pleomorphic adenoma be managed in this way? Incomplete excision increases the risk of recurrence, which can be malignant (a process known as malignant transformation ) 16

17. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential If pleomorphic adenoma is suspected, should incisional biopsy be performed? No! The tumor should be removed en bloque, without violating its pseudocapsule Why must a pleomorphic adenoma be managed in this way? Incomplete excision increases the risk of recurrence, which can be malignant (a process known as malignant transformation ) 17

18. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential If pleomorphic adenoma is suspected, should incisional biopsy be performed? No! The tumor should be removed en bloque, without violating its pseudocapsule Why must a pleomorphic adenoma be managed in this way? Incomplete excision increases the risk of recurrence, which can be malignant (a process known as malignant transformation ) 18

19. If pleomorphic adenoma is suspected, should incisional biopsy be performed? No! The tumor should be removed en bloque, without violating its pseudocapsule Why must a pleomorphic adenoma be managed in this way? Incomplete excision increases the risk of recurrence, which can be malignant (a process known as malignant transformation ) Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential If pleomorphic adenoma is suspected, should incisional biopsy be performed? No! The tumor should be removed en bloque, without violating its pseudocapsule Why must a pleomorphic adenoma be managed in this way? Incomplete excision increases the risk of recurrence, which can be malignant (a process known as malignant transformation ) two words 19

20. If pleomorphic adenoma is suspected, should incisional biopsy be performed? No! The tumor should be removed en bloque, without violating its pseudocapsule Why must a pleomorphic adenoma be managed in this way? Incomplete excision increases the risk of recurrence, which can be malignant (a process known as malignant transformation ) Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential If pleomorphic adenoma is suspected, should incisional biopsy be performed? No! The tumor should be removed en bloque, without violating its pseudocapsule Why must a pleomorphic adenoma be managed in this way? Incomplete excision increases the risk of recurrence, which can be malignant (a process known as malignant transformation ) 20

21. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Fungal Thyroid eye dz Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma NEVER biopsy to make dx Biopsy to make dx Hold on! How can you know beforehand which you’re dealing with, and therefore whether or not to biopsy? These entities are usually distinguishable on the basis of Radiographic Features and Clinical Presentation: 21

22. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma NEVER biopsy to make dx Biopsy to make dx Hold on! How can you know beforehand which you’re dealing with, and therefore whether or not to biopsy? These entities are usually distinguishable on the basis of Radiographic Features and Clinical Presentation : 22

23. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma NEVER biopsy to make dx Biopsy to make dx Adenoid cystic carcinoma: ‘Bony involvement’ 23 Pleomorphic adenoma: ‘Well circumscribed’ Hold on! How can you know beforehand which you’re dealing with, and therefore whether or not to biopsy? These entities are usually distinguishable on the basis of Radiographic Features and Clinical Presentation :

24. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma NEVER biopsy to make dx Biopsy to make dx Pleomorphic adenoma: ‘Well circumscribed’ Adenoid cystic carcinoma: ‘Bony involvement’ 24 Hold on! How can you know beforehand which you’re dealing with, and therefore whether or not to biopsy? These entities are usually distinguishable on the basis of Radiographic Features and Clinical Presentation :

25. Lacrimal Gland Enlargement 25 Adenoid cystic carcinoma vs pleomorphic adenoma: Imaging Adenoid cystic: Bony involvement (invading the orbital wall, arrow) Pleomorphic adenoma: Well-circumscribed

26. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma NEVER biopsy to make dx Biopsy to make dx Pleomorphic adenoma: ‘Well circumscribed’ Adenoid cystic carcinoma: ‘Bony involvement’ Adenoid cystic carcinoma: ‘Rapid growth’ and ‘Painful’ (rate of growth) (pain?) 26 Pleomorphic adenoma: ‘Slow growing’ and ‘Painless’ (rate of growth) (pain?) Hold on! How can you know beforehand which you’re dealing with, and therefore whether or not to biopsy? These entities are usually distinguishable on the basis of Radiographic Features and Clinical Presentation :

27. Malignant Neoplastic Inflammatory Epithelial Lymphoid Benign Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma NEVER biopsy to make dx Biopsy to make dx Pleomorphic adenoma: ‘Well circumscribed’ Adenoid cystic carcinoma: ‘Bony involvement’ Pleomorphic adenoma: ‘Slow growing’ and ‘Painless’ Adenoid cystic carcinoma: ‘Rapid growth’ and ‘Painful’ 27 Hold on! How can you know beforehand which you’re dealing with, and therefore whether or not to biopsy? These entities are usually distinguishable on the basis of Radiographic Features and Clinical Presentation :

28. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Inflammatory 28 Next…

29. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Inflammatory 29

30. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma ? ? Most common within each category? Inflammatory 30

31. Neoplastic Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma Most common within each category? Inflammatory 31

32. Inflammatory Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Neoplastic Epithelial Lymphoid Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 32 Next…

33. Inflammatory Enlarged lacrimal gland Lacrimal Gland Enlargement Infectious Noninfectious Two broad categories in the differential Neoplastic Epithelial Lymphoid Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 33

34. Inflammatory Enlarged lacrimal gland Lacrimal Gland Enlargement Infectious Noninfectious ? ? Two broad categories in the differential ? Types of infections, not specific bugs Neoplastic Epithelial Lymphoid Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 34

35. Inflammatory Enlarged lacrimal gland Lacrimal Gland Enlargement Infectious Noninfectious Viral Fungal Two broad categories in the differential Bacterial Neoplastic Epithelial Lymphoid Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 35

36. Malignant Malignant Neoplastic Inflammatory Epithelial Lymphoid Infectious Noninfectious Benign Benign Viral Bacterial Fungal Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Which virus is the most common cause of acute dacryoadenitis? EBV 36

37. Malignant Malignant Neoplastic Inflammatory Epithelial Lymphoid Infectious Noninfectious Benign Benign Viral Bacterial Fungal Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Which virus is the most common cause of acute dacryoadenitis? Epstein-Barr virus 37

38. Neoplastic Inflammatory Epithelial Lymphoid Infectious Noninfectious Malignant Benign Malignant Benign Viral Bacterial Fungal Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Which bug is the most common cause of bacterial dacryoadenitis? Bartonella 38

39. Neoplastic Inflammatory Epithelial Lymphoid Infectious Noninfectious Malignant Benign Malignant Benign Viral Bacterial Fungal Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Which bug is the most common cause of bacterial dacryoadenitis? Bartonella 39

40. Inflammatory Enlarged lacrimal gland Lacrimal Gland Enlargement Infectious Noninfectious Viral Fungal ? ? ? Two broad categories in the differential Bacterial Three common etiologies Neoplastic Epithelial Lymphoid Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 40

41. Neoplastic Inflammatory Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Infectious Noninfectious Viral Fungal Pseudotumor Sarcoid Thyroid eye dz Two broad categories in the differential Bacterial Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 41

42. Regarding lacrimal gland enlargement, the very general rule of thumb is this: --If the enlargement occurs in an inflammatory context, think orbital pseudotumor first. --If the enlargement occurs in a noninflammatory context, think lymphoproliferative disease first. Neoplastic Inflammatory Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Infectious Noninfectious Viral Fungal Pseudotumor Sarcoid Thyroid eye dz Two broad categories in the differential Bacterial Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 42 two words

43. Neoplastic Inflammatory Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Infectious Noninfectious Viral Fungal Pseudotumor Sarcoid Thyroid eye dz Two broad categories in the differential Bacterial Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 43 Regarding lacrimal gland enlargement, the very general rule of thumb is this: --If the enlargement occurs in an inflammatory context, think orbital pseudotumor first. --If the enlargement occurs in a noninflammatory context, think lymphoproliferative disease first.

44. Neoplastic Inflammatory Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Infectious Noninfectious Viral Fungal Pseudotumor Sarcoid Thyroid eye dz Two broad categories in the differential Bacterial Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 44 Regarding lacrimal gland enlargement, the very general rule of thumb is this: --If the enlargement occurs in an inflammatory context, think orbital pseudotumor first. --If the enlargement occurs in a noninflammatory context, think lymphoproliferative disease first. two other words

45. Neoplastic Inflammatory Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Infectious Noninfectious Viral Fungal Pseudotumor Sarcoid Thyroid eye dz Two broad categories in the differential Bacterial Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 45 Regarding lacrimal gland enlargement, the very general rule of thumb is this: --If the enlargement occurs in an inflammatory context, think orbital pseudotumor first. --If the enlargement occurs in a noninflammatory context, think lymphoproliferative disease first.

46. Neoplastic Inflammatory Epithelial Lymphoid Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Malignant Benign Malignant Benign Two broad categories in the differential Infectious Noninfectious Viral Fungal Pseudotumor Sarcoid Thyroid eye dz Two broad categories in the differential Bacterial Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma 46 If a pt presents with bilateral and symmetrical lacrimal gland enlargement, which condition is the most likely cause?

47. Neoplastic Inflammatory Epithelial Lymphoid Infectious Noninfectious Malignant Benign Malignant Benign Viral Bacterial Fungal Pseudotumor Sarcoid Thyroid eye dz Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential 47 If a pt presents with bilateral and symmetrical lacrimal gland enlargement, which condition is the most likely cause? Sarcoid

48. Lacrimal Gland Enlargement 48 Bilateral lacrimal gland enlargement in sarcoid

49. Neoplastic Inflammatory Epithelial Lymphoid Infectious Noninfectious Malignant Benign Malignant Benign Viral Bacterial Fungal Pseudotumor Sarcoid Thyroid eye dz Pleomorphic adenoma Adenoid cystic carcinoma Benign lymphoproliferative disease Lymphoma Two broad categories in the differential Two broad categories in the differential Enlarged lacrimal gland Lacrimal Gland Enlargement Two broad categories in the differential Two broad categories in the differential Two broad categories in the differential (Sarcoid-induced lac gland enlargement gets its own set of slides…) 49 If a pt presents with bilateral and symmetrical lacrimal gland enlargement, which condition is the most likely cause? Sarcoid

50. Q Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement % % 50

51. A Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement 51

52. Q Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement % % 52

53. A Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement 53

54. Q Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement Enlargement of the lacrimal and salivary glands + keratoconjunctivitis sicca = Mikulicz syndrome eponym 54

55. A Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement Enlargement of the lacrimal and salivary glands + keratoconjunctivitis sicca = Mikulicz syndrome 55

56. Q Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement For what population is the incidence of ophthalmic involvement far higher--around 90%? Very young (<4 years old) children, in whom it is known as early-onset sarcoid . Early-onset sarcoid presents classically with a triad of signs/symptoms—what are they? -- Uveitis -- Arthritis -- Rash . Early-onset sarcoid is difficult to distinguish from what other immunologic dz of childhood? JRA--juvenile rheumatoid arthritis (aka juvenile idiopathic arthritis, or JIA) 56

57. A Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement For what population is the incidence of ophthalmic involvement far higher--around 90%? Very young (<4 years old) children, in whom it is known as early-onset sarcoid . Early-onset sarcoid presents classically with a triad of signs/symptoms—what are they? -- Uveitis -- Arthritis -- Rash . Early-onset sarcoid is difficult to distinguish from what other immunologic dz of childhood? JRA--juvenile rheumatoid arthritis (aka juvenile idiopathic arthritis, or JIA) 57

58. Q Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement For what population is the incidence of ophthalmic involvement far higher--around 90%? Very young (<4 years old) children, in whom it is known as early-onset sarcoid . Early-onset sarcoid presents classically with a triad of signs/symptoms—what are they? -- Uveitis -- Arthritis -- Rash . Early-onset sarcoid is difficult to distinguish from what other immunologic dz of childhood? JRA--juvenile rheumatoid arthritis (aka juvenile idiopathic arthritis, or JIA) 58

59. A Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement For what population is the incidence of ophthalmic involvement far higher--around 90%? Very young (<4 years old) children, in whom it is known as early-onset sarcoid . Early-onset sarcoid presents classically with a triad of signs/symptoms—what are they? -- Uveitis -- Arthritis -- Rash . Early-onset sarcoid is difficult to distinguish from what other immunologic dz of childhood? JRA--juvenile rheumatoid arthritis (aka juvenile idiopathic arthritis, or JIA) 59

60. Q Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement For what population is the incidence of ophthalmic involvement far higher--around 90%? Very young (<4 years old) children, in whom it is known as early-onset sarcoid . Early-onset sarcoid presents classically with a triad of signs/symptoms—what are they? -- Uveitis -- Arthritis -- Rash . Early-onset sarcoid is difficult to distinguish from what other immunologic dz of childhood? JRA--juvenile rheumatoid arthritis (aka juvenile idiopathic arthritis, or JIA) 60

61. A Sarcoid patients Half have ophthalmic involvement Half have no ophthalmic involvement Half have lacrimal gland involvement Half have no lacrimal gland involvement For what population is the incidence of ophthalmic involvement far higher--around 90%? Very young (<4 years old) children, in whom it is known as early-onset sarcoid . Early-onset sarcoid presents classically with a triad of signs/symptoms—what are they? -- Uveitis -- Arthritis -- Rash . Early-onset sarcoid is difficult to distinguish from what other immunologic dz of childhood? JRA--juvenile rheumatoid arthritis ( aka juvenile idiopathic arthritis, JIA) 61