Benign lymphoepithelial lesions

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis almost certain


The patient presented with an ongoing headache and left hemiparesis. No documented past history.

Patient Data

Age: 30 years
Gender: Male

In view of the presenting history, there is minimal non-specific microvascular change with negative diffusion imaging excluding a hyperacute/acute or early subacute ischemic event. MRA is normal.S WI demonstrates a right parietal lobe punctate chronic microheamorrhage.

Incidental bilateral parotomegaly with diffuse, bilateral, solid and cystic masses suggestive of benign lymphoepithelial lesions. There is associated nasopharyngeal lymphofollicular hyperplasia. There is minimal anterior cervical lymph adenopathy. There is no associated submandibular or sublingual gland involvement on limited views.

Incidental uncomplicated acute on chronic sinusitis.

Case Discussion

The patient presented acutely to the emergency unit after hours. Initial non-contrast MRI brain confirmed the absence of an intracranial event. The patient refused admission for further biochemical and neurological workup including lumbar puncture and gadolinium administration.

Bilateral parotid enlargement with benign lymphoepithelial lesions and nasopharyngeal lymphofollicular hyperplasia is strongly suggestive of immune suppression and positive HIV status.

The differential diagnosis of Sjogren's syndrome was considered clinically unlikely in this patient

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