NODAL INCLUSION CYSTS OF THE PAROTID-GLAND AND PARAPHARYNGEAL SPACE -A DISCUSSION OF LYMPHOEPITHELIAL, AIDS-RELATED PAROTID, AND BRANCHIALCYSTS, CYSTIC WARTHINS TUMORS, AND CYSTS IN SJOGRENS-SYNDROME

The purpose of this report is to examine the computed tomography scans , magnetic resonance images, and pathologic findings in 44 patients, 4 2 of whom had inclusion-type cysts of the parotid and parapharyngeal s pace of varying etiologies. Two additional cases of cystic changes in the benign lymphoepithelial lesion (BLEL) of Sjogren's syndrome are hi ghlighted here, since they had unusually large cystic components mimic king acqiuired immunodeficiency syndrome-related parotid cysts (ARPCs) . A retrospective examination identified 18 ARPCs, 3 lymphoepithelial cysts (LECs), 13 cystic Warthin's tumors, 8 branchial cysts, and 2 cas es of cysts in patients with Sjogren's syndrome (BLEL), all of whom ha d imaging studies and pathologic confirmation. There were 30 men and 1 4 women with an age range of 25 to 72 years (median, 46.82 years). Any similarities in the imaging appearances were noted, as were any diffe rences in pathologic detail. On imaging, only the cystic Warthin's tum ors had any focal wall nodularity; the other cysts had smooth walls. W hen multiple parotid cysts were present, the distinguishing feature be tween ARPCs and cysts in BLEL (and some cystic Warthin's tumors) was t he presence of diffuse cervical adenopathy in patients with ARPCs. Ima ging usually could not differentiate between a solitary parotid LEC, a branchial cyst, and some cystic Warthin's tumors. Extraparotid lesion s were either branchial cysts or cystic Warthin's tumors. Physicians s hould be aware of the variety of different inclusion-type cysts that m ay occur in the parotid gland and parapharyngeal space, all of which m ay have similar imaging appearances. Although imaging clearly identifi es these cysts and may suggest a specific diagnosis, it must always be remembered that the precise diagnosis remains in the province of the pathologist.