Benign lymphoepithelial cysts of the parotid: long-term surgical results

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.

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.

Benign Lymphoepithelial Cyst: An Unusual Cause of Parotid Swelling in Two Immunocompetent Patients

BACKGROUND:

Lymphoepithelial cysts, which are benign and slow-growing tumours, usually involve the head and neck regions. Benign lymphoepithelial cysts (BLECs) are the most common cause of parotid swelling in human immunodeficiency virus (HIV)-positive patients and are less common in immunocompetent patients.

CASE PRESENTATION:

Here, we present two cases of immunocompetent patients with long-standing, progressively enlarging parotid swelling. Postoperative histopathological examination of these patients revealed features of BLEC.

CONCLUSION:

Wide surgical excision is the gold standard for treatment and recurrences is rare. These cases are of particular interest because of the rarity of BLEC in HIV-negative patients and highlight an important differential diagnosis of parotid swelling.

[Pediatric salivary gland tumors and tumor-like lesions]

Salivary gland tumors and tumor-like lesions in the pediatric population are uncommon. They comprise a heterogeneous group of infectious/inflammatory and neoplastic conditions. Pediatric salivary neoplasms include benign tumors of mesenchymal or epithelial origin as well as malignancies of epithelial (carcinomas), mesenchymal (sarcoma) or hematolymphoid (lymphoma) derivation. Infectious/inflammatory conditions and hematolymphoid malignancies may represent either genuine parenchymal pathology or conditions involving intraglandular lymph nodes of the parotid glands (intraglandular lymphadenopathy and intraglandular nodal lymphomas). Pediatric sialadenitis may be of diverse etiologies including viral (mumps, CMV, HIV, etc.), bacterial, autoimmune (juvenile Sjögren syndrome) or idiopathic (chronic recurrent juvenile sialectatic sialadenitis). Angiomatous lesions (juvenile capillary hemangioma, lymphangioma and vascular malformation) and pleomorphic adenomas represent the most common pediatric benign mesenchymal and benign epithelial tumors, respectively. The vast majority of salivary gland carcinomas in children and adolescents represent low-grade mucoepidermoid carcinomas followed by acinic cell and adenoid cystic carcinomas (together >80% of carcinomas). Other malignant neoplasms include (rhabdomyo-) sarcomas, malignant lymphomas and very rarely sialoblastomas. This long differential diagnosis list of etiologically and biologically highly heterogeneous entities, their shared clinical presentation as "salivary gland enlargement" and the significant differences in their therapeutic strategies and prognosis underline the need for careful assessment to identify the correct diagnosis. Diagnosis is mainly based on a set of typical clinical and imaging features, serological/microbiological findings and, in selected cases, histomorphological characteristics in biopsy specimens.

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

Approximately 1%–10% of patients with HIV infection have been reported to have salivary gland enlargement. Parotid swelling in patients with HIV is often associated with salivary gland disease, including benign lymphoepithelial cysts (BLECs). The presence of BLEC can serve as an indicator of HIV infection, and the diagnosis of HIV-associated BLEC is usually based on clinical course, HIV confirmatory blood testing, such as western blot or viral detection, and imaging studies, but not on biopsies or immunostaining. To exclude other diseases such as tuberculosis and malignant lymphoma and to further improve the diagnostic accuracy of BLEC, the detection of the HIV-1 p24 antigen by immunohistochemistry is a useful diagnostic method. We report a case of a 65-year-old Japanese man with swelling of the parotid glands and HIV-associated BLEC confirmed via HIV-1 p24 immunohistochemical staining.

Lymphoepithelial Cyst of Parotid in an Immunocompetent Patient with Chronic Otitis Media

Lymphoepithelial cysts of parotid are known to occur in HIV patients. In the present report, lymphoepithelial cyst of parotid was diagnosed in a middle aged immunocompetent patient, along with chronic otitis media. The source of infection and treatment options are summarized.

Management algorithm for HIV-associated parotid lymphoepithelial cysts

We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.

Salivary gland diseases in children

Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment.

The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized.

Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and some­times in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience.

Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach.