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Year : 2014 | Volume : 2 | Issue : 2 | Page : 121 - 122  


Letter to the Editor
Benign Lymphoepithelial Cyst of the Parotid: An Indicator of Early Stage HIV Infection

Kandukuri Mahesh Kumar1, Ravikanth Soni2, Bheemavathi A3, Chinthakindi Sravan4

 

1Assistant Professor, Dept. of Pathology, Malla Reddy Institute Of Medical Sciences, Suraram, Hyderabad

2Medical Officer, Blood Bank, Banjara Hills, Hyderabad

3Consultant Pathologist, SRL Diagnostics, Hyderabad

4 Consultant Pathologist, Vijaya Diagnostics, Hyderabad

 

Sir,

Human immunodeficiency (HIV) infection may present with a wide range of symptoms. About 40% of HIV positive patients have head and neck related signs and symptoms. Benign lymphoepithelial cysts are a widely recognized cause of parotid gland swelling in patients infected with the human immunodeficiency virus (HIV). These cysts are pathognomonic for HIV.

A 32-year-old male with human immunodeficiency virus (HIV) infection presented with complaints of swelling on the right side of the cheek since 2.5 years. Patient underwent all the investigations and incidentally found to be HIV and HBsAg positive. Patient was apprehensive and did not turn up for surgery. Later after 14 months he came with the similar complaints and increased size of the swelling. Fine needle aspiration cytology (FNAC) yielded only brownish fluid constituting cyst macrophages and lymphocytes in a dirty background, diagnosis was given as Benign cystic lesion with possibility of Warthin’s tumor. Ultrasound diagnosis given was Warthin’s tumor. Patient was operated and a cyst was excised and sent for Histopathological examination (HPE). We received a cystic lesion measuring 3.5 x 2 x 0.5cm. Cut-section of the cyst shows brownish material. Microscopically, sections showed cyst wall lined by flattened epithelium with sub-epithelial stroma showing lymphoid follicles with germinal centers and few congested blood vessels. Final diagnosis of Benign Lymphoepithelial cyst (BLEC) of the parotid was made.

 

It is postulated that parotid enlargement results from HIV replication within the embryological derived lymph nodes within the parotid, causing lymphoproliferation. [1] The T cell population within the cyst has been found to be CD8 positive and CD4 negative. [2] The transient expansion of the CD8+ T cell pool normally occurs in the early phase of HIV infection. However, persistent expansion of this pool is observed, and it is related to two settings: diffuse infiltrative lymphocytic syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome. The parotids normally are affected bilaterally with occasional reports of unilateral swellings. We report a similar case of rare unilateral parotid cystic swelling.

The histopathogenesis of parotid lymphoepithelial cysts is still not clear. The parotid swellings originate either as hyperplastic activity of intraglandular lymphocytes, and/or as an extraglandular infiltration into the salivary gland tissue. Ihler et al [3] demonstrated a secondary lymphatic infiltration of salivary parenchyma provokes a lymphoepithelial lesion of the striated ducts with basal cell hyperplasia. DiGiuseppe et al [4, 5] and other researchers showed benign lymphoepithelial lesions of the parotid gland associated with HIV infection results from the involvement of intra parotid lymph nodes by persistent generalized lymphadenopathy. [6]

Treatment of this particular pathology has been widely debated in the literature. Previous treatments for BLEC have included repeated fine-needle aspiration and drainage, radiotherapy, sclerotherapy, and conservative therapy with institution of highly active antiretroviral therapy (HAART) medications and surgical excision. Surgical excision of the cyst is the gold standard treatment and prevents recurrence.

References

  1. Tripathi AK, Gupta N, Ahmad R, Bhandari HS, Kalra P. HIV Disease Presenting as Parotid Lymphoepithelial Cysts: A Presumptive Diagnosis of Diffuse Infiltrative Lymphocytic Syndrome (DILS). J Assoc Physicians India. Nov 2004;52:921-3.
  2. Exposito Delgado AJ, Vallejo Bolanos E, Martos Cobo EG. Oral manifestations of HIV infection in infants: a review article. Med Oral Patol Oral Cir Bucal 2004;9(5):415-20; 410-5.
  3. Ihrler S, Zietz C, Riederer A, Diebold J, Löhrs U. HIV related lymphoepithelial cysts. Immunohistochemistry and 3-D reconstruction of surgical and autopsy material with special reference to formal apthogenesis. Virchows Arch 1996 Oct;429(2-3):139-47.
  4. DiGiuseppe JA, Corio RL, Westra WH. Lymphoid infiltrates of the salivary glands: pathology, biology and clinical significance. Curr Opin Oncol. 1996 May;8(3):232-7.
  5. DiGiuseppe JA, Wu TC, Corio RL. Analysis of Epstein-Barr virus coded small RNA 1 expression in benign lymphoepithelial salivary gland lesions. Mod Pathol. 1994 Jun;7(5):555-9.
  6. Ihrler S, Steger W, Riederer A, Zietz C, Vogl I, Löhrs U. HIV associated cysts of the parotid glands. An histomorphologic and magnetic resonance tomography study of formal pathogenesis. 1996 Nov;75(11):671-6.

 

Dr. Kandukuri Mahesh Kumar,

Assistant Professor,

Department of Pathology,

Malla Reddy Institute of Medical Sciences,

Suraram, Hyderabad.

Email: doctormaheshgoud@gmail.com

Source of Support: Nil. Conflict of Interest: None.

 

 

Cite this article as: Mahesh Kumar K, Ravikanth S, Bheemavathi A, Sravan C. Benign Lymphoepithelial Cyst of the Parotid: An Indicator of Early Stage HIV Infection. MRIMS J Health Sciences 2014;2(2):121-122.

 

 

 

 

 

 

 

 

 

 

 





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