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Benign Lymphoepithelial Cysts of HIV
Philip R. Chapman, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Benign lymphoepithelial cysts associated with HIV (BLEC-HIV)
                • Benign lymphoepithelial lesions associated with HIV (BLEL-HIV)
              • Synonyms

                • Cystic lymphoid hyperplasia
                • Intraductal epithelial proliferation with cyst formation
                • HIV-associated parotid cysts
                • AIDS-related parotid cysts (ARPC)
                  • Patient need only be HIV-positive to manifest BLEL
                    • BLEC-HIV can exist without AIDS
                    • Avoid ARPC synonym
              • Definitions

                • BLEC-HIV
                  • One of most common pathologies of parotid encountered in HIV-positive patients in typical clinical and radiologic practice
                  • Generally manifests as painless bilateral parotid enlargement with clinical, radiologic, or pathologic evidence of cyst formation
                • BLEL-HIV
                  • Considered part of spectrum of same entity as BLEC-HIV with similar histopathologic findings of lymphoepithelial proliferation but absence of macroscopic cyst formation
                  • Terms BLEL-HIV and BLEC-HIV are used interchangeably by many authors
                  • Some authors prefer term BLEL-HIV when lymphoid aggregates predominate and lesion is predominantly solid
                • Broad term HIV-associated salivary gland disease encompasses malignant, benign, infectious, and potentially autoimmune lesions associated with salivary gland dysfunction &/or salivary enlargement
                  • Parotid gland affected mostly
                  • Spectrum of nonneoplastic pathologic processes that occur in parotid gland in association with HIV
                  • Variable and overlapping clinical, histologic, and radiologic manifestations
                    • No consensus regarding precise terminology of HIV-associated salivary gland disease

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                • Immunohistochemistry

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Iro S et al: Parotid lymphoepithelial cysts revealing HIV infection in a 12-year-old girl: a case report. Ann Med Surg (Lond). 67:102338, 2021
                                                2. Meer S: Human immunodeficiency virus and salivary gland pathology: an update. Oral Surg Oral Med Oral Pathol Oral Radiol. 128(1):52-9, 2019
                                                3. Meer S et al: Human immunodeficiency virus-associated cystic lymphoid hyperplasia: an immunohistochemical description. Indian J Pathol Microbiol. 60(3):336-40, 2017
                                                4. Sekikawa Y et al: HIV-associated benign lymphoepithelial cysts of the parotid glands confirmed by HIV-1 p24 antigen immunostaining. BMJ Case Rep. 2017:bcr2017221869, 2017
                                                5. Mourad WF et al: Management algorithm for HIV-associated parotid lymphoepithelial cysts. Eur Arch Otorhinolaryngol. 273(10):3355-62, 2016
                                                6. Sanan A et al: Rare parotid gland diseases. Otolaryngol Clin North Am. 49(2):489-500, 2016
                                                7. Meer S et al: Cystic lymphoid hyperplasia: an orofacial lesion strongly associated with HIV and AIDS. Histopathology. 62(7):1067-74, 2013
                                                8. Mourad WF et al: 25-year follow-up of HIV-positive patients with benign lymphoepithelial cysts of the parotid glands: a retrospective review. Anticancer Res. 33(11):4927-32, 2013
                                                9. Sujatha D et al: Parotid lymphoepithelial cysts in human immunodeficiency virus: a review. J Laryngol Otol. 127(11):1046-9, 2013
                                                10. Kreisel FH et al: Cystic lymphoid hyperplasia of the parotid gland in HIV-positive and HIV-negative patients: quantitative immunopathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(4):567-74, 2010
                                                11. Wu L et al: Lymphoepithelial cyst of the parotid gland: its possible histopathogenesis based on clinicopathologic analysis of 64 cases. Hum Pathol. 40(5):683-92, 2009
                                                12. Dave SP et al: The benign lymphoepithelial cyst and a classification system for lymphocytic parotid gland enlargement in the pediatric HIV population. Laryngoscope. 117(1):106-13, 2007
                                                13. Marsot-Dupuch K et al: Head and neck lesions in the immunocompromised host. Eur Radiol. 14 Suppl 3:E155-67, 2004
                                                14. Mandel L: Ultrasound findings in HIV-positive patients with parotid gland swellings. J Oral Maxillofac Surg. 59(3): 283-6, 2001
                                                15. Uccini S et al: The benign cystic lymphoepithelial lesion of the parotid gland is a viral reservoir in HIV type 1-infected patients. AIDS Res Hum Retroviruses. 15(15): 1339-44, 1999
                                                16. Chetty R: HIV-associated lymphoepithelial cysts and lesions: morphological and immunohistochemical study of the lymphoid cells. Histopathology. 33(3): 222-9, 1998
                                                17. Craven DE et al: Response of lymphoepithelial parotid cysts to antiretroviral treatment in HIV-infected adults. Ann Intern Med. 128(6): 455-9, 1998
                                                18. Kooper DP et al: Management of benign lymphoepithelial lesions of the parotid gland in human immunodeficiency virus-positive patients. Eur Arch Otorhinolaryngol. 255(8): 427-9, 1998
                                                19. Maiorano E et al: Lymphoepithelial cysts of salivary glands: an immunohistochemical study of HIV-related and HIV-unrelated lesions. Hum Pathol. 29(3): 260-5, 1998
                                                20. Martinoli C et al: Benign lymphoepithelial parotid lesions in HIV-positive patients: spectrum of findings at gray-scale and Doppler sonography. AJR Am J Roentgenol. 165(4): 975-9, 1995
                                                21. Som PM et al: Nodal inclusion cysts of the parotid gland and parapharyngeal space: a discussion of lymphoepithelial, AIDS-related parotid, and branchial cysts, cystic Warthin's tumors, and cysts in Sjogren's syndrome. Laryngoscope. 105(10): 1122-8, 1995
                                                22. Kirshenbaum KJ et al: Benign lymphoepithelial parotid tumors in AIDS patients: CT and MR findings in nine cases. AJNR Am J Neuroradiol. 12(2):271-4, 1991
                                                23. Holliday RA et al: Benign lymphoepithelial parotid cysts and hyperplastic cervical adenopathy in AIDS-risk patients: a new CT appearance. Radiology. 168(2):439-41, 1988
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Abbreviations

                                                              • Benign lymphoepithelial cysts associated with HIV (BLEC-HIV)
                                                              • Benign lymphoepithelial lesions associated with HIV (BLEL-HIV)
                                                            • Synonyms

                                                              • Cystic lymphoid hyperplasia
                                                              • Intraductal epithelial proliferation with cyst formation
                                                              • HIV-associated parotid cysts
                                                              • AIDS-related parotid cysts (ARPC)
                                                                • Patient need only be HIV-positive to manifest BLEL
                                                                  • BLEC-HIV can exist without AIDS
                                                                  • Avoid ARPC synonym
                                                            • Definitions

                                                              • BLEC-HIV
                                                                • One of most common pathologies of parotid encountered in HIV-positive patients in typical clinical and radiologic practice
                                                                • Generally manifests as painless bilateral parotid enlargement with clinical, radiologic, or pathologic evidence of cyst formation
                                                              • BLEL-HIV
                                                                • Considered part of spectrum of same entity as BLEC-HIV with similar histopathologic findings of lymphoepithelial proliferation but absence of macroscopic cyst formation
                                                                • Terms BLEL-HIV and BLEC-HIV are used interchangeably by many authors
                                                                • Some authors prefer term BLEL-HIV when lymphoid aggregates predominate and lesion is predominantly solid
                                                              • Broad term HIV-associated salivary gland disease encompasses malignant, benign, infectious, and potentially autoimmune lesions associated with salivary gland dysfunction &/or salivary enlargement
                                                                • Parotid gland affected mostly
                                                                • Spectrum of nonneoplastic pathologic processes that occur in parotid gland in association with HIV
                                                                • Variable and overlapping clinical, histologic, and radiologic manifestations
                                                                  • No consensus regarding precise terminology of HIV-associated salivary gland disease

                                                            IMAGING

                                                            • General Features

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              • Immunohistochemistry

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Iro S et al: Parotid lymphoepithelial cysts revealing HIV infection in a 12-year-old girl: a case report. Ann Med Surg (Lond). 67:102338, 2021
                                                                                              2. Meer S: Human immunodeficiency virus and salivary gland pathology: an update. Oral Surg Oral Med Oral Pathol Oral Radiol. 128(1):52-9, 2019
                                                                                              3. Meer S et al: Human immunodeficiency virus-associated cystic lymphoid hyperplasia: an immunohistochemical description. Indian J Pathol Microbiol. 60(3):336-40, 2017
                                                                                              4. Sekikawa Y et al: HIV-associated benign lymphoepithelial cysts of the parotid glands confirmed by HIV-1 p24 antigen immunostaining. BMJ Case Rep. 2017:bcr2017221869, 2017
                                                                                              5. Mourad WF et al: Management algorithm for HIV-associated parotid lymphoepithelial cysts. Eur Arch Otorhinolaryngol. 273(10):3355-62, 2016
                                                                                              6. Sanan A et al: Rare parotid gland diseases. Otolaryngol Clin North Am. 49(2):489-500, 2016
                                                                                              7. Meer S et al: Cystic lymphoid hyperplasia: an orofacial lesion strongly associated with HIV and AIDS. Histopathology. 62(7):1067-74, 2013
                                                                                              8. Mourad WF et al: 25-year follow-up of HIV-positive patients with benign lymphoepithelial cysts of the parotid glands: a retrospective review. Anticancer Res. 33(11):4927-32, 2013
                                                                                              9. Sujatha D et al: Parotid lymphoepithelial cysts in human immunodeficiency virus: a review. J Laryngol Otol. 127(11):1046-9, 2013
                                                                                              10. Kreisel FH et al: Cystic lymphoid hyperplasia of the parotid gland in HIV-positive and HIV-negative patients: quantitative immunopathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(4):567-74, 2010
                                                                                              11. Wu L et al: Lymphoepithelial cyst of the parotid gland: its possible histopathogenesis based on clinicopathologic analysis of 64 cases. Hum Pathol. 40(5):683-92, 2009
                                                                                              12. Dave SP et al: The benign lymphoepithelial cyst and a classification system for lymphocytic parotid gland enlargement in the pediatric HIV population. Laryngoscope. 117(1):106-13, 2007
                                                                                              13. Marsot-Dupuch K et al: Head and neck lesions in the immunocompromised host. Eur Radiol. 14 Suppl 3:E155-67, 2004
                                                                                              14. Mandel L: Ultrasound findings in HIV-positive patients with parotid gland swellings. J Oral Maxillofac Surg. 59(3): 283-6, 2001
                                                                                              15. Uccini S et al: The benign cystic lymphoepithelial lesion of the parotid gland is a viral reservoir in HIV type 1-infected patients. AIDS Res Hum Retroviruses. 15(15): 1339-44, 1999
                                                                                              16. Chetty R: HIV-associated lymphoepithelial cysts and lesions: morphological and immunohistochemical study of the lymphoid cells. Histopathology. 33(3): 222-9, 1998
                                                                                              17. Craven DE et al: Response of lymphoepithelial parotid cysts to antiretroviral treatment in HIV-infected adults. Ann Intern Med. 128(6): 455-9, 1998
                                                                                              18. Kooper DP et al: Management of benign lymphoepithelial lesions of the parotid gland in human immunodeficiency virus-positive patients. Eur Arch Otorhinolaryngol. 255(8): 427-9, 1998
                                                                                              19. Maiorano E et al: Lymphoepithelial cysts of salivary glands: an immunohistochemical study of HIV-related and HIV-unrelated lesions. Hum Pathol. 29(3): 260-5, 1998
                                                                                              20. Martinoli C et al: Benign lymphoepithelial parotid lesions in HIV-positive patients: spectrum of findings at gray-scale and Doppler sonography. AJR Am J Roentgenol. 165(4): 975-9, 1995
                                                                                              21. Som PM et al: Nodal inclusion cysts of the parotid gland and parapharyngeal space: a discussion of lymphoepithelial, AIDS-related parotid, and branchial cysts, cystic Warthin's tumors, and cysts in Sjogren's syndrome. Laryngoscope. 105(10): 1122-8, 1995
                                                                                              22. Kirshenbaum KJ et al: Benign lymphoepithelial parotid tumors in AIDS patients: CT and MR findings in nine cases. AJNR Am J Neuroradiol. 12(2):271-4, 1991
                                                                                              23. Holliday RA et al: Benign lymphoepithelial parotid cysts and hyperplastic cervical adenopathy in AIDS-risk patients: a new CT appearance. Radiology. 168(2):439-41, 1988