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.

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.