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During the period in which we had sort of the AIDS

0:03

epidemic, there were a number of patients who were

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HIV positive who presented with bilateral enlarged,

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painful parotid glands.

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And we started to use the terms

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AIDS-related cysts or ARC.

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We've since redirected our nomenclature to calling

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these benign lymphoepithelial lesions because what

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we found was both cysts and nodules within the

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parotid glands of patients who are

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HIV positive or who have AIDS.

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And so these are now benign lymphoepithelial lesions

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analogous to those that we see in Sjogren's syndrome.

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So they need not just be cysts.

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And here are two different patients.

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This one has multiple cysts within the parotid gland

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and has relatively little in the

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way of solid nodularity.

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This one just microcysts as well as a solid nodule

0:59

here at the junction between the deep and

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superficial portion of the left parotid gland.

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Another nodule over here.

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So these are benign lymphoepithelial lesions.

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You may hear the term Bells as they may be referred

1:12

to. The patients will have swollen achy glands.

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Turns out that when you give them their triple

1:19

antiviral drugs, this usually dampens down the

1:23

inflammation that occurs in the parotid glands.

1:26

As I mentioned with my discussion with Sjogren

1:28

syndrome patients who have AIDS and these lympho

1:33

epithelial lesions do have a higher rate of

1:36

degeneration to lymphoma than

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the general population.

1:40

In addition to lymphoepithelial lesions, you may include

1:45

such things as Kaposi's sarcoma that can occur in the

1:48

parotid gland or candidiasis. These are much,

1:51

much less common nowadays and very

1:53

uncommon in the parotid gland.

1:58

So parotids and benign lymphoproliferative

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usually enlargement, sometimes painless.

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I refer to this as being painful here that are

2:09

swollen and achy glands, but you can have those

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individuals on a chronic basis that have a painless

2:15

bilateral enlargement, and these may include lymphoid

2:19

hyperplasia in the gland, cystically dilated

2:22

ducts in the gland that account for the

2:24

benign lymphoepithelial lesions.

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If they are particularly discomforting to the

2:30

patient, they can be treated directly with low-dose

2:33

radiation therapy or sclerotherapy for

2:35

these lymphoepithelial lesions.

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And I showed a previous example of a solitary,

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large lymphoepithelial lesion in

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a patient who was HIV positive.

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Those lesions may be aspirated and then put

2:49

sclerosing agents within the cyst that recur.

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You may also find parotitis in patients

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who are HIV positive from

3:00

cytomegalovirus.

3:05

Here are a couple of different patients who were HIV

3:09

positive showing things like cysts within the gland

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as well as nodularity cysts within the

3:17

gland with peripheral nodularity,

3:20

nodules within the gland from lymphoid hyperplasia

3:25

in the benign lymphoepithelial lesions,

3:27

cysts as well as nodules within the gland.

3:30

And it's not uncommon to also see nasopharyngeal

3:34

adenoidal enlargement and cervical lymphadenopathy

3:37

associated with patients who have the

3:40

benign lymphoepithelial lesions.

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Here's one where I would be a little bit concerned.

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Cysts and nodules.

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But it looks like there's a dominant mass

3:49

potentially in this parotid gland

3:51

that I would recommend

3:52

aspirations, probably the same patient here at the

3:55

tail of the parotid gland with a dominant mass.

3:58

Want to rule out lymphoma in the

4:00

patients who are HIV positive.