Benign lymphoepithelial lesions
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At the time the article was created Frank Gaillard had no recorded disclosures.View Frank Gaillard's current disclosures
At the time the article was last revised Ashesh Ishwarlal Ranchod had no financial relationships to ineligible companies to disclose.View Ashesh Ishwarlal Ranchod's current disclosures
Benign lymphoepithelial lesions (BLL or BLEL), also misleadingly known as AIDS-related parotid cysts (ARPC), are mixed solid and cystic lesions that enlarge the parotid glands, and are usually associated with cervical lymph node enlargement, and nasopharyngeal lymphofollicular hyperplasia.
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Benign lymphoepithelial lesions refer specifically to a histopathological finding that is non-specific and seen in the context of lymphoepithelial sialadenitis (typical of Sjögren syndrome) and HIV-associated salivary gland disease 5. This article focuses on the findings in the latter condition.
Despite their aforementioned alternative name, benign lymphoepithelial lesions are seen usually in HIV-positive patients without AIDS and are not an AIDS-defining illness. It is relatively common in the HIV population, with 5% of patients eventually developing benign lymphoepithelial lesions.
Thought to arise from dilatation of intraglandular ducts from obstruction due to lymphoid hypertrophy. They are bilateral in ~20% of cases.
Benign lymphoepithelial lesions most commonly arise in the parotid gland and are only rarely seen in the submandibular glands or sublingual glands.
- well-circumscribed cystic spaces
- may demonstrate thin rim enhancement on postcontrast MRI
- ultrasound demonstrates these 'cystic' lesions to actually have multiple small septations, and commonly also small mural nodules (40%)
- a vascular pedicle may be seen entering the cystic region
Benign lymphoepithelial lesions are usually seen associated with other sites of lymphoid hyperplasia 4, including:
- prominent nasopharyngeal adenoidal tissue: seen in 35% of HIV positive patients 4
- posterior triangle lymphadenopathy
- abnormal bone marrow signal
On imaging consider
- first branchial cleft cyst
- Warthin tumor
- Sjogren syndrome
- necrotic intraparotid lymph nodes
- 1. Martinoli C, Pretolesi F, Del bono V et-al. Benign lymphoepithelial parotid lesions in HIV-positive patients: spectrum of findings at gray-scale and Doppler sonography. AJR Am J Roentgenol. 1995;165 (4): 975-9. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Bialek EJ, Jakubowski W, Zajkowski P et-al. US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls. Radiographics. 26 (3): 745-63. doi:10.1148/rg.263055024 - Pubmed citation
- 3. Holliday RA, Cohen WA, Schinella RA et-al. Benign lymphoepithelial parotid cysts and hyperplastic cervical adenopathy in AIDS-risk patients: a new CT appearance. Radiology. 1988;168 (2): 439-41. Radiology (abstract) - Pubmed citation
- 4. Yousem DM, Loevner LA, Tobey JD et-al. Adenoidal width and HIV factors. AJNR Am J Neuroradiol. 1997;18 (9): 1721-5. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 5. Ellis GL. Lymphoid lesions of salivary glands: malignant and benign. (2007) Medicina oral, patologia oral y cirugia bucal. 12 (7): E479-85. Pubmed