GATA3-positive primary ductal adenocarcinoma of the lacrimal gland with calcification: a case report

Primary ductal adenocarcinoma of the lacrimal gland (PDALG) is a rare epithelial malignancy of the ocular adnexa. A man in his 50s presented with painless swelling of the right upper eyelid and was found to have a right lacrimal gland mass with punctate hyperdense foci on computed tomography (CT) and low signal intensity on both T1- and T2-weighted magnetic resonance imaging. Histopathology of the tumor revealed nest-like, cribriform, and tubular proliferation of atypical epithelial cells, with fibrotic and hyalinized stroma, comedo necrosis, and calcification. Immunohistochemistry showed positivity for androgen receptor, HER2, and GATA3, while GCDFP-15 was negative. Positron emission tomography-computed tomography showed no systemic lesions, supporting the diagnosis of PDALG. Elastica van Gieson staining demonstrated venous invasion, and adjuvant radiotherapy was performed after complete excision. This case illustrates the diagnostic value of correlating punctate hyperdensity on CT with pathologic calcification and integrating GATA3/HER2 findings with the systemic exclusion of metastatic breast carcinoma. At 1 year of follow-up, no local recurrence or distant metastasis had been detected; however, given the potential for late metastasis in this pathology, long-term close observation is required.