HIV-associated benign lymphoepithelial cysts of the parotid glands confirmed by HIV-1 p24 antigen immunostaining

Navigating Parotid Lymphoepithelial Cysts in HIV Patients: A Tale of Two Distinct Scenarios

A rare occurrence in HIV-infected individuals is the development of diffuse infiltrative lymphocytic syndrome (DILS), which is marked by a widespread infiltration of CD8+ lymphocytes in body tissues, persistent elevation of CD8+ lymphocyte levels, as well as bilateral parotid swellings and cervical lymphadenopathy. It is distinct due to its suspected autoimmune origin and is found in about 5-10% of people living with HIV. This retrospective analysis involves two patients admitted to our tertiary care rural hospital with complaints of bilateral parotid swellings, a provisional diagnosis of DILS associated with HIV-positive status and lymphoepithelial cysts, their subsequent management, including conservative treatment and surgical excision of one of our patients. Our goal is to contribute to and advance the knowledge of this rare condition.

Pancreatic lymphoepithelial cyst with concurrent HIV infection: A case report and review of the literature

Pancreatic lymphoepithelial cysts are rare, benign, non-neoplastic unilocular or multilocular cystic lesions. These circumscribed pancreatic lesions are filled with keratinous material grossly and exhibit distinct microscopic features. Pancreatic lymphoepithelial cysts are like the more common lymphoepithelial cysts of the parotid glands, which have been associated with the diffuse infiltrative lymphocytosis syndrome often seen in patients with HIV infection. However, pancreatic lymphoepithelial cysts are rare and their association with HIV infection has not been established. The presence of secondary changes in non-neoplastic cysts such as goblet cell metaplasia that was present in our case is an important feature to be included in the differential diagnosis and not to be interpreted as a mucinous neoplasm, particularly on fine-needle aspiration specimen microscopic evaluation that would impact further management. Here we describe the diagnosis and treatment of lymphoepithelial cysts in a patient who was on highly active antiretroviral therapy for HIV infection and we provide a brief literature review. Defining the clinical characteristics of lymphoepithelial cysts in patients with HIV and determining accurate preoperative diagnostic procedures will be critical for establishing effective surgical and medical approaches to treating these cysts, which differ substantially from other more serious pancreatic cystic lesions.

Parotid Tuberculosis as the Presenting Manifestation of Disseminated Disease in an Otherwise Asymptomatic HIV Patient

Parotid tuberculosis is not widely described in the literature. Even though a rare presentation of a commonly occurring disease, it is still missed as a differential diagnosis and often mistaken for neoplasms, eventually leading to unnecessary surgical resections. Here, we present a case of a young lady with a slowly growing unilateral parotid mass along with matted, non-tender cervical, axillary, and inguinal lymphadenopathy, who was incidentally found to have HIV with a cluster of differentiation 4 (CD4) lymphocyte count of 38 per microliter. Fine needle aspiration revealed acid-fast bacilli and CT thorax showed features of pulmonary tuberculosis, thus suggesting a disseminated tuberculosis infection. She was started on anti-tubercular and anti-retroviral therapy, after which there was a symptomatic improvement.

Immunohistochemical diagnosis of human infectious diseases: a review

BACKGROUND

Immunohistochemistry (IHC) using monoclonal and polyclonal antibodies is a useful diagnostic method for detecting pathogen antigens in fixed tissues, complementing the direct diagnosis of infectious diseases by PCR and culture on fresh tissues. It was first implemented in a seminal publication by Albert Coons in 1941.

MAIN BODY

Of 14,198 publications retrieved from the PubMed, Google, Google Scholar and Science Direct databases up to December 2021, 230 were selected for a review of IHC techniques, protocols and results. The methodological evolutions of IHC and its application to the diagnosis of infectious diseases, more specifically lice-borne diseases, sexually transmitted diseases and skin infections, were critically examined. A total of 59 different pathogens have been detected once in 22 different tissues and organs; and yet non-cultured, fastidious and intracellular pathogens accounted for the vast majority of pathogens detected by IHC. Auto-IHC, incorporating patient serum as the primary antibody, applied to diseased heart valves surgically collected from blood culture-negative endocarditis patients, detected unidentified Gram-positive cocci and microorganisms which were subsequently identified as Coxiella burnetii, Bartonella quintana, Bartonella henselae and Tropheryma whipplei. The application of IHC to ancient tissues dated between the ends of the Ptolemaic period to over 70 years ago, have also contributed to paleomicrobiology diagnoses.

CONCLUSION

IHC plays an important role in diagnostic of infectious diseases in tissue samples. Paleo-auto-IHC derived from auto-IHC, is under development for detecting non-identified pathogens from ancient specimens.

Parotid lymphoepithelial cysts revealing HIV infection in a 12-year-old girl: A case report

INTRODUCTION

and importance: benign lymphoepithelial cysts are benign lesions consisting of one or more cysts of the salivary glands or neck regions that occur in 3-6% of patients with positive HIV serology. The objective of this work is to discuss the link between HIV and benign lymphoepithelial cysts.

CASE PRESENTATION

The authors report a case of benign lymphoepithelial parotid cysts in a 12-year-old girl who underwent a partial parotidectomy. HIV serology was performed in the patient and all her family and was positive only in the girl.

CLINICAL DISCUSSION

Benign lymphoepithelial lesions of the parotid gland represent the main parotid pathology associated with HIV infection. They may be the first clinical manifestation of the virus. Diagnosis is often difficult, in most cases after surgical excision and histopathological evaluation of the mass. Treatment options include observation, highly active antiretroviral therapy (HAART), aspiration, sclerotherapy, and surgery.

CONCLUSION

Because of the close relationship between parotid lymphoepithelial cysts and HIV infection, it is important to perform HIV serology in any patient with these types of cysts.

Lymphoepithelial Cyst of the Salivary Gland in a Small Ruminant Lentivirus-Positive Goat

Simple Summary

This study presents the first case of a lymphoepithelial cyst (LEC) adjacent to the salivary gland in a goat seropositive for the small ruminant lentivirus (SRLV). Immunohistochemistry detected the antigen of caprine arthritis-encephalitis virus (CAEV) in the LEC, salivary gland, and lung tissue. In human patients, a LEC of the major salivary gland is an uncommon benign lesion and may be the early clinical manifestation of human immunodeficiency virus (HIV) infection. The present report provides useful information on the comparative aspect of LEC in an animal infected with CAEV, one of the SRLVs usually associated with chronic infection. Although many hypothetic theories were proposed, the etiopathogenesis of LEC is still debated. In this study, we present the histopathological description of LEC, supported by histochemistry and immunohistochemistry.

Abstract

The lymphoepithelial cyst (LEC) of the major salivary gland is a rare lesion described in medical literature. It is found in human immunodeficiency virus (HIV)-infected patients and considered an early manifestation of this infection. Despite the variety of theories, the origin of this lesion remains controversial. No veterinary studies on LEC have been published so far. This study is the first-ever that aims to describe histopathological, histochemical, and immunohistochemical features of a LEC located adjacent to the salivary gland of a goat. The goat proved seropositive for the small ruminant lentivirus, showed clinical signs of caprine arthritis-encephalitis, and had caprine arthritis-encephalitis virus (CAEV)-infected cells in the lung. The histopathology revealed a cystic lesion lined mainly with squamous epithelium surrounded by a lymphoid component, containing a mucus-negative material and a few nonbirefringent structures corresponding to amylase crystalloids. Using immunohistochemistry, CAEV-positive cells were detected in macrophages, LEC epithelial cells, and the salivary gland. The B cells were mainly in the germinal centres, the intraepithelial lymphocytes expressed CD3 and Bcl-2, and the proliferative activity was low. This study showed that LEC had many similar histological and immunohistochemical features to those seen in humans. However, further studies are required in this respect.

Recurrent lymphoepithelial cysts after parotidectomy in an undiagnosed HIV-positive patient

A benign lymphoepithelial cyst (BLEC) is defined as a rare, benign lesion composed of single or multiple cysts found within salivary glands or the lateral cervical area. Increasing reports suggest an association between BLEC and human immunodeficiency virus (HIV), although its pathogenesis remains unclear. We report a 51-year-old male who presented with recurrent bilateral BLECs after initial parotidectomy of cyst. An HIV panel was then performed with a positive result. We review the surgical and medical managements of BLEC while also discussing further treatment recommendations. Clinicians should be aware that BLEC recurrence postparotidectomy may be the initial presenting symptom of HIV in a patient with no risk factors.

Human immunodeficiency virus and salivary gland pathology: an update

Salivary gland disease is a common manifestation of human immunodeficiency virus (HIV) infection, with a significant increase in prevalence over the last two decades. This review summarizes contemporary knowledge of non-neoplastic salivary gland disease in HIV infection. The aim is to update information on and bring attention to those lesions, which are almost exclusive to the salivary glands in the HIV setting. The associated conditions include xerostomia or salivary gland hypofunction; Sjögren syndrome-like illness; salivary gland enlargements, including benign lymphoepithelial cysts (cystic lymphoid hyperplasia); diffuse infiltrative CD8+ lymphocytosis syndrome; and mucous extravasation phenomena, especially ranula. Many of these conditions show considerable overlap, and thus, the term HIV-associated salivary gland disease is used to designate HIV infection with xerostomia or salivary gland hypofunction, enlargement of one or more of the major salivary glands, or both. These manifestations may be related to HIV infection, and therefore, prompt recognition is invaluable in the diagnosis and treatment of both the salivary gland disease and HIV infection.

Contribution of HIV Infection, AIDS, and Antiretroviral Therapy to Exocrine Pathogenesis in Salivary and Lacrimal Glands

The structure and function of exocrine glands are negatively affected by human immunodeficiency virus (HIV) infection and its co-morbidities, including innate and adaptive immune responses. At the same time, exocrine function may also be influenced by pharmacotherapies directed at the infectious agents. Here, we briefly review the role of the salivary glands and lacrimal glands in normal physiology and exocrine pathogenesis within the context of HIV infection and acquired immune deficiency syndrome (AIDS), including the contribution of antiretroviral therapies on both. Subsequently, we discuss the impact of HIV infection and the types of antiretroviral therapy on disease management and therapy development efforts.