BENIGN LYMPHOEPITHELIAL CYSTS IN HIV-INFE CTED PATIENTS

Benign lymphoepithelial cysts (BLC) are rare disorders of salivary gla nds (0,6%). In patients infected by HIV, they are seen more often. In comparison to sporadic BLC, the patients are younger, the diameter of the cysts is up to 5 cm and they are often located bilaterally. At the Department of ENT, Head and Neck Surgery of the Ludwig-Maximilians-Un iversity, Munich, ten HIV-infected patients (two females) showed lymph oepithelial cysts (six times bilaterally). One of these revealed a met astasis of a small cell neoplasma near the cysts, another patient show ed a non-Hodgkin's lymphoma of low grade malignancy (MALT-type), and o ne patient additionally had bilateral Warthin's tumours. The BLCs were mostly located in the parotid tail. In three cases, the cysts were fo und on the inferior border of the parotid and once at the submandibula r gland. The age ranged from 27 to 71 years (medium 45.7 years). The m ode of HIV infection was homosexuality five times, drug abuse twice, h eterosexuality once, and blood products once. In two cases, the channe l of transmission was unknown. The majority of the patients showed min or HIV illness (CDC II [n=2] /CDC III [n=4]); the rest had advanced im munodeficiency (CDC IV [n=4]). All the cysts were examined by ultrason ography and NMR. According to the clinical findings and the general st age of health, BLCs were either enucleated (n=8) or a superficial paro tidectomy (n=5) and selective biopsy of lymph nodes (n=3) suspected to be malignant were performed. HIV-p24 antigen could be detected immuno cytochemically in the germinal centres of the lymphatic follicles loca ted in the wall of the BLCs. Antibodies to HIV and HIV antigen also co uld be demonstrated in the cystic fluid. Bilateral cystic disorders of the great salivary glands are highly suspicious as signs pointing to an HIV infection, and patients should be examined adequately.