Benign parotid lymphoepithelial cysts associated with HIV infection

HIV infections are often related with lymphoepithelial benign cysts of the parotid gland; these lesions are uncommon and other salivary glands are rarely involved. The diagnosis, often difficult, is based on imaging techniques, like computed tomography, and pathologic techniques, like fine needle aspiration biopsy. The therapeutic approach can be performed by simple aspiration, surgical resection, pharmacotherapy, or radiotherapy. Three cases of HIV-related lymphoepithelial benign cysts of the parotid gland observed at the Department of Maxillofacial Surgery of the "Federico II" University of Naples and at the Department of Oral and Maxillofacial Surgery of "La Paz" Hospital of the Universitad Autonoma of Madrid are described.     

HIV parotid gland lymphoepithelial cysts. Review and case reports.

Lymphoepithelial cysts of the parotid gland are frequently associated with cervical lymphadenopathy. These unique cysts have recently been recognized as another manifestation of HIV disease. Proliferation of lymphocytes and salivary gland tissue contained within intra-parotid lymph nodes is observed. The lymphoepithelial cyst is the end product. Ultrasound imaging serves as an excellent technique to demonstrate the existence of these cysts.     

Multiple parotid lymphoepithelial cysts in patients with HIV-infection: report of two cases

OBJECTIVE: Bilateral and multiple lymphoepithelial cysts (LECs) of major salivary glands, in particular of parotid glands, are quite rare and have been reported in human immunodeficiency virus (HIV) infected patients with an incidence of about 3-6%. These lesions represent an early manifestation of HIV infection and are rarely found in patients with advanced acquired immunodeficiency syndrome. MATERIALS: Two cases of parotid LECs, the first occurring in a middle-age white woman and the second in a young white boy, both in advanced phases of HIV infection, are reported. RESULTS: Clinical, cytological, histological and immunohistochemical (cytokeratin AE1/AE3, CD20, CD45RA, CD8, kappa and lambda immunoglobulin light chains, S-100, MLA and Ki67) features are described. CONCLUSIONS: Fine needle aspiration (FNA), a relatively non-traumatic procedure, could represent both a diagnostic and a therapeutic tool in parotid LECs. No surgical therapy is usually required for these lesions and aspiration of cystic fluid with FNA is quite resolutive, although evidence of further relapses does exist. Surgical excision may become necessary when pain, because of persistent and progressive swelling of the parotid gland, occurs.     

腮腺恶性淋巴上皮病变（附2例报告）

目的探讨腮腺恶性淋巴上皮病变的临床病理特征、发病机制及鉴别诊断。方法对2例腮腺恶性淋巴上皮病变进行病理组织学观察与免疫组化检测,并复习文献34例进行讨论。结果该病的组织病理学特征为肿瘤细胞呈大小不等的团巢状分布,间质大量淋巴细胞浸润;免疫组化显示细胞角蛋白和上皮膜抗原阳性。结论腮腺恶性淋巴上皮病变是一种低分化鳞状细胞癌,好发年龄40～49岁,其形成与EB病毒感染有关。     

Immunohistochemical and histologic study of cervical lymphoepithelial cysts

Four cases of lateral cervical cysts were reported. All cyst walls were lined with keratinized stratified squamous epithelium, and contained lymph follicles with well-defined germinal centers. Ectopic salivary gland tissue was found in one case. Histochemical examination by the immunoperoxidase method revealed the existence of carcinoembryonic antigen (CEA). However, alpha-feto protein (AFP) and amylase were not detected in any of the cysts. The cyst fluid contained high levels of CEA and high titers of salivary type amylase, but AFP was negative. These results do not support any one of the theories concerning the etiology of cervical lymphoepithelial cysts. It seems likely that cysts derive from both epithelial remnants of the branchial apparatus and from salivary gland inclusions in lymph nodes.     

Branchiogenic parotid cysts]

The authors describe 4 cases of branchiogenic cyst of the parotid gland which belong to the rarest developmental disturbances in the region of the first brachial arch. In the first case, there was a cyst formation with articulate surface; the other cysts were solitary ones. In two patients, the upper lobule of gland was removed together with the cyst. In the third case, simple etirpation was performed. In the last case, the posterior part of the parotid gland was resected together with the cyst. The embryological and anatomical acquaintances and the histopathological criteria relating to the diagnosis of this congenital cyst formation are outlined in the present paper.     

Benign lymphoepithelial lesion with large cysts: case report

A case of benign lymphoepithelial lesion with two large cysts and many foci of duct dilatation is reported. Clinical features, except for absence of dry eyes, indicated the case was Sjogren's syndrome. The cysts were found in the left parotid gland of a 60-yr-old woman and were surgically removed. The size of each cyst was 20 mm in diameter and one of them was located in the lymph node. Because of the HLA-DR expression by the epithelium, the cysts are considered to have formed as a result of duct dilatation due to autoimmune response. As for one cyst, it is also possible that the pre-existing lymphoepithelial cyst might be involved in the autoimmune phenomenon because of its relation to the lymph node.     

Benign lymphoepithelial lesion of the parotid gland with sebaceous differentiation

The salivary duct system in the setting of chronic sialadenitis is predisposed to undergo a variety of cellular modifications. This report documents a rare type of metaplasia of a parotid benign lymphoepithelial lesion. Epimyoepithelial islands showing focal sebaceous differentiation and pure sebaceous cell nests in addition to their usual histologic appearance were noted throughout the lesion. The possible pathogenesis is discussed through a review of the literature.     

Branchial cleft or cervical lymphoepithelial cysts: etiology and management

BACKGROUND: The cervical lymphoepithelial or branchial cleft cyst is a developmental cyst that has a disputed pathogenesis. The objective of this article is to provide a brief review of the literature and to define diagnostic terms related to this anomaly, as well as to describe its etiology, clinical presentation and treatment. CASE DESCRIPTION: The cervical lymphoepithelial or branchial cleft cyst usually presents as a unilateral, soft-tissue fluctuant swelling that typically appears in the lateral aspect of the neck, anterior to the sternocleidomastoid muscle, and becomes clinically evident late in childhood or in early adulthood. Clinicians can diagnose the cyst with appropriate imaging to assess the extent of the lesion before definitive surgical treatment. The authors describe a patient who underwent excision of a well-encapsulated cystic structure that was diagnosed as a branchial cleft cyst. CLINICAL IMPLICATIONS: The cervical lymphoepithelial or branchial cleft cyst can be easily misdiagnosed as a parotid swelling or odontogenic infection. It is imperative that clinicians make an accurate diagnosis so that appropriate treatment (that is, surgical excision) can be performed. If the cysts are treated properly, recurrences are rare.     

单侧腮腺同发良恶性肿瘤1例及文献回顾

本文报道了1例于同侧腮腺区同发多行性腺瘤和淋巴上皮癌的罕见病例。通过系统回顾与之相关的单侧唾液腺同发良恶性肿瘤的文献,阐述其诊治要点与特殊性,以期具有更好的临床指导意义。     

Benign cysts of the parotid gland

Benign cysts of the parotid gland are not frequently diagnosed. They occur in any portion of the parotid gland and may be difficult to diagnose. They present with considerable histological variation in their linings. Three cases are presented of unilocular benign cystic lesions of the parotid gland that have been treated by superficial parotidectomy. Two of them were lined by a single or pseudostratified layer of cuboidal epithelium and were diagnosed as retention cysts. The third was a lympho-epithelial cyst and was lined by stratified squamous and partially by pseudostratified ciliated columnar epithelium. A review of the relevant literature is also presented.     

Unusual MRI appearance of a lymphoepithelial cyst in the parotid gland

Lymphoepithelial cysts, which are also known as branchial cleft cysts, commonly occur in the lateral cervical region. Lymphoepithelial cysts arising in the parotid gland are rare and must be distinguished from parotid gland tumors. Magnetic resonance imaging (MRI) is useful for diagnosing parotid gland lesions, and MR images of lymphoepithelial cysts typically display a cystic mass that appears homogeneously hypointense on T1-weighted images and homogeneously hyperintense on T2-weighted images. However, some parotid gland tumors that retain fluid in their inner sections show similar MRI findings to lymphoepithelial cysts. Furthermore, lymphoepithelial cysts are sometimes modified by inflammation, and these cases are hard to diagnose. We report the case of a 59-year-old female with a lymphoepithelial cyst that arose in the parotid gland. The cyst had been affected by inflammation and displayed atypical imaging findings, i.e., heterogeneous signal intensity of the liquid component and the presence of a well-enhanced capsule-like structure surrounding the liquid component. In addition, we compare the MRI findings of this case with those of two other cervical lymphoepithelial cysts.     

腮腺淋巴上皮癌22例临床分析

目的探讨腮腺淋巴上皮癌的诊断方法、治疗方式及预后情况,为临床提供参考。方法 2012年至2019年期间收治的腮腺淋巴上皮癌病例22例,对患者的临床表现、影像学检查、治疗方式及随访结果进行回顾性分析。结果 22例患者中,男性8例,女性14例;年龄26~61岁,主诉病程3天~18年,单侧腮腺区多发肿块1例,其余21例均为腮腺区单侧单发肿块。所有患者均行术前螺旋CT检查,CT所示腮腺组织内软组织肿块影,其内密度影欠均匀,CT值26~81 HU,15例表现为类圆形,界限尚清晰;7例表现为结节状,界限稍不清晰或部分不清晰。所有病例诊断最终依据病理学检查,HE染色图像可见肿瘤细胞边界清楚,上皮细胞生长活跃伴有异型性,可见核分裂像,肿瘤间质可见丰富的淋巴细胞浸润。22例患者均接受手术治疗,其中9例患者未行颈淋巴清扫。20例患者术后接受辅助放疗,其中10例同时行辅助化疗;1例患者术后仅行化疗,1例患者术后未行其他任何辅助治疗。所有病例均得到回访,21例无瘤生存13个月~8年,1例患者术后16个月因肝转移死亡。结论腮腺淋巴上皮癌是临床上较为罕见的恶性肿瘤,病理仍是诊断腮腺淋巴上皮癌的金标准。根治性手术切除肿瘤是首选治疗方法,根据临床检查及影像学检查及颈部情况进行选择性颈淋巴清扫,术后辅助放化疗可获得较好的治疗效果。     

45例腮腺囊肿临床病理分析

目的:探讨腮腺囊肿的临床病理特点和治疗方法.方法:选取2000年1月-2014年6月中国医科大学附属盛京医院口腔颌面外科45例腮腺肿物切除患者,术后病理确诊为腮腺囊肿.回顾分析不同腮腺囊肿的临床病理特点.结果:男25例,女20例,中位年龄51岁.囊肿位于左侧腮腺21例,右侧腮腺24例.临床症状以腮腺区无痛性肿大为主,囊肿大小0.8 cm×0.6 cm×0.5 cm～10 cm×2.8 cm×0.6 cm.腮腺囊肿伴疼痛9例,无疼痛36例;腮腺囊肿伴淋巴结肿大4例,无淋巴结肿大41例.治疗以单纯腮腺囊肿切除为主,术后均无面神经损伤.随访1～10 a,未见复发.45例术后经组织病理学检查,单纯性囊肿29例(64.4％),表皮样囊肿9例(20％),淋巴上皮囊肿7例(15.6％).除常见的病理表现外,镜下还可见一些非特异性改变,例如腮腺囊肿伴纤维组织瘤样增生,腮腺囊肿伴炎症,腮腺囊肿伴钙化,腮腺囊肿伴滑膜囊肿样改变,腮腺囊肿伴异物巨细胞反应,腮腺囊肿伴肉芽肿样改变.结论:腮腺囊肿的症状以渐进性肿大为主,治疗以单纯囊肿切除为主,无面神经损伤,无复发.病理类型主要为单纯性囊肿、淋巴上皮囊肿和表皮样囊肿.     

Association of HIV and parotid cysts]

Parotid cystics are included in salivary glands affection, found with persons infected by the human immunodeficiency virus. This study reports 28 cases registered in the oto-rhino-laryngology service of Brazzaville university hospital. The interested age is between 32 and 57 years old. The HIV profile reveals a prevailing of HIV1 (20 cases). The dia-gnosis is clinical, echographic and by the exploratory puncture. The therapeuratic approach (iterative puncture and compressive dressing) adopted to these brittle patients and with limited resource, permitted to get satisfactory results.     

Incidental finding of subgemmal neurogenous plaque upon retrospective evaluation of oral lymphoepithelial cysts

Purpose

We aimed to compare the histomorphological features of oral lymphoepithelial cysts (OLC) in different locations of the oral cavity and to verify the association between oral lymphoepithelial cysts and subgemmal neurogenous plaque (SNP) on biopsies from the lateral border of the tongue.

Methods

All cases diagnosed as OLC from the Oral Pathology Service at the School of Dentistry/University of São Paulo were retrieved. For all the cysts located in the tongue, their association to SNP was analyzed. Immunohistochemical staining against S100 was performed to confirm the diagnosis of SNP.

Results

Thirty-one cases were selected for morphological analysis and SNP was identified in 40% of cases, all of them positive for S100. In these cases, macroscopic analysis demonstrated two independent fragments. Microscopic analysis showed that cysts located in the floor of the mouth and ventral surface of the tongue showed less intense exocytosis, less formation of lymphoid follicles, and predominantly a moderate inflammatory infiltrate.

Conclusions

OLC have a similar histological pattern regardless the location within the oral cavity and. In some cases, the biopsy specimen may be accompanied by a SNP as an adjacent independent structure.

     

Differentiating HIV-1 parotid cysts from papillary cystadenoma lymphomatosum

BACKGROUND: Patients with parotid cystic lesions may first be seen in the dental office. These conditions most often represent either papillary cystadenoma lymphomatosum, or PCL, or lymphoepithelial cysts associated with human immunodeficiency virus, or HIV, disease. The authors present a case report to illustrate the differential diagnosis. CASE DESCRIPTION: PCL represents a benign, usually unilateral, circumscribed parotid tumor with cystic elements. HIV-associated lymphoepithelial cysts of the parotid gland usually are seen bilaterally, create cosmetic concerns and are hallmarked by an associated cervical lymphadenopathy. Therapy for PCL demands surgical excision, while patients with HIV-associated lymphoepithelial cysts may be treated with antiviral therapy and undergo periodic monitoring by a physician. CLINICAL IMPLICATIONS: As a member of the health care team, the dentist must be familiar with head and neck swellings. Early clinical recognition of parotid swellings leads to successful treatment.     

HIV相关性腮腺囊性淋巴样增生1例报告及文献复习

HIV相关性腮腺囊性淋巴样增生是一种罕见病,其临床表现不典型,可通过组织病理学和免疫组织化学染色检查明确诊断。本文报告1例单侧HIV相关性腮腺囊性淋巴上皮增生病例,并结合相关文献分析其临床病理特点、治疗方法及预后。