See TRO, Stålhammar G, Tang T, et al. - Given that primary ductal adenocarcinoma (PDA) is an uncommon epithelial tumor of the lacrimal gland, researchers reported five cases and reviewed 29 published cases of PDA of the lacrimal gland in this analysis. Painless swelling and/or proptosis of their eye was the most common clinical presentation among these five cases. Histopathologic examination showed proliferations of ductal or gland-like cells with vesiculated pleomorphic nuclei and prominent nucleoli. Findings revealed that PDA is a high-grade aggressive epithelial tumor of the lacrimal gland. Although rare, awareness of this malignancy and its recognition are important to help determine prognosis and treatment options.