Benign Lymphoepithelial Lesion of the Parotid Gland in the Setting of HAART

MRI findings of sporadic/simple lymphoepithelial cyst of the parotid gland

PURPOSE

This study aimed to determine the MRI features of sporadic/simple lymphoepithelial cyst (SLEC) of the parotid gland.

METHODS

Ten patients (seven men, three women; mean age, 60 years; age range, 38-77 years) with histopathologically and clinically proven SLEC of the parotid gland who underwent MRI before surgical resection were enrolled in this study. No enrolled patient had HIV infection or Sjögren syndrome. MRI findings of SLEC were retrospectively assessed.

RESULTS

We confirmed 10 SLECs larger than 10 mm with a mean maximum diameter of 26.6 mm (range, 12-42 mm). Nine patients (90%) had a single cyst, and one (10%) had a large cyst accompanied by small cysts (<10 mm) within the ipsilateral parotid gland. Eight SLECs (80%) were unilocular, and two (20%) were bilocular, with complete septa. Among seven SLECs (70%) with internal septa, five unilocular SLECs (50%) had incomplete septa. Six SLECs (60%) had eccentric cyst wall thickening, and five (50%) were surrounded by small solid nodules that were isointense relative to lymph node. On T1-weighted images, all cyst contents were homogeneously hyperintense relative to cerebrospinal fluid.

CONCLUSION

SLECs of the parotid gland are usually single unilocular lesions. Internal septa, eccentric cyst wall thickening, and small solid nodules surrounding the lesion were often observed. Cyst contents are always homogeneously hyperintense on T1-weighted images.

Benign Lymphoepithelial Cyst of Parotid Glands in HIV Infected Patients on Anti-Retroviral Therapy: A Narrative Review

Human immunodeficiency virus-associated salivary gland disease is a complication seen in patients infected with the human immunodeficiency virus (HIV), with the commonest manifestation being the benign lymphoepithelial cyst (BLEC). The purpose of this study was to systematically review the effects of antiretroviral therapy (ART) in Human Immune Virus-infected patients with confirmed benign lymphoepithelial cysts of the parotid gland. The review was conducted between August 2020 and December 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Patients infected with a diagnosis of BLEC of parotid gland based were included. Studies from all countries were included with no age, language, and time restrictions. We used Microsoft Excel to create a data extraction form piloted before the official start. Inter-rater agreement was calculated for most of the data collection. The risk of bias was assessed using a Cochrane tool. After reviewing 512 records, 42 met the study criteria with a total of 785 patients. The median sample size of all eligible studies was 10 ranging from 2 to 60. The pooled mean age was 29 years ± 24.2. Studies primarily assessed the effect of ART on BLECs. Patients examined in the studies ranged from children to the elderly. Studies from South Africa had a higher proportion of women while American studies had a higher proportion of men. There is evidence that ARVs are effective in treating BLEC and may be used as first-line therapy for HIV infected patients.

Atypia of undetermined significance in the Milan System for Reporting Salivary Gland Cytopathology: Cystic versus non-cystic masses

The term "Atypia" has been employed to describe a wide spectrum of cytomorphologic features associated with reactive/inflammatory processes as well as those suspicious for neoplasms in cytology. Similar to other cytopathology reporting systems, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has reserved the atypical category for cytology specimens lacking quantitative and/or qualitative cytomorphologic features to be diagnosed with confidence as either non-neoplastic or neoplastic. In MSRSGC, the atypical category is associated with a risk of malignancy and recommendation for clinical management. In this review, we discuss the value of atypical diagnostic category of MSRSGC in both cystic and non-cystic salivary gland lesions by evaluating our institutional case cohort.

Magnetic resonance imaging of salivary gland tumours: Key findings for imaging characterisation

Salivary gland tumours are rare, representing only 3% of all head and neck neoplasms, with the parotid gland being the most common site (80 %). The risk of malignancy is inversely proportional to the size of the gland: lesions arising in the sublingual or minor salivary glands are more likely to be malignant, whereas parotid gland neoplasms are mostly benign. Fine needle aspiration cytology and core needle biopsy are considered the most accurate modalities for the diagnosis of a salivary gland neoplasm; however, they are not always conclusive due to procedural sampling errors and for the presence of a cytological / histological overlap between benign and malignant tumours. Moreover, they cannot be easily performed for parotid deep portion localisation. The role of magnetic resonance imaging (MRI) is growing and advanced techniques (diffusion-weighted and dynamic contrast-enhanced perfusion-weighted imaging) can provide useful additional information for the assessment of salivary gland neoplasms. The aim of this review is to present the main MRI and clinical features of salivary gland tumours to improve their comprehensive evaluation and characterisation.

CT and MR imaging findings of non-neoplastic cystic lesions of the parotid gland

A variety of neoplastic and non-neoplastic lesions of the parotid gland can present with a predominantly cystic architecture, and although radiologists frequently encounter cystic parotid tumors, other non-neoplastic lesions should also be included in the differential diagnoses of cystic parotid lesions. Non-neoplastic cystic lesions are usually classified as either congenital/acquired cystic lesions or inflammatory/infectious lesions. Adequate knowledge about these rare conditions is essential for appropriate diagnosis and optimal treatment strategy. This review article describes CT and MR imaging features of non-neoplastic cystic lesions of the parotid gland and provides helpful suggestions on the differential diagnoses for cystic parotid lesions.