Lymphoepithelial Cysts

Epidemiology

Head and neck findings in patients with acquired immune deficiency syndrome (AIDS) are common. It has been reported that over 40% of patients with AIDS will have head and neck manifestations on initial presentation. Lymphoepithelial cysts (LECs) are associated with AIDS and represent the “classic” triad of head findings that occur in patients with human immunodeficiency virus (HIV) disease. The other two findings are enlarged cervical lymph nodes and enlarged adenoidal tissue in Waldeyer’s ring. The pathogenesis of benign LECs has not been completely determined. These lesions probably represent a reactive phenomenon that results in intranodal inclusions within intraparotid lymph nodes.

Clinical Findings

LEC typically occurs in patients who are HIV positive. The cysts may be unilateral or bilateral and may be associated with diffuse cervical adenopathy. These patients usually present with a nonpainful enlarging neck mass. It may be difficult to differentiate an intraparotid LEC from an enlarging cervical lymph node based on palpation.

Pathology

Grossly, there is nodular or diffuse salivary gland enlargement. Histologic examination reveals dilatation of salivary gland ducts with extensive lymphocytic infiltration and replacement of ducts by solid islands of epithelial and myoepithelial cells.