BENIGN LYMPHOEPITHELIAL PAROTID LESIONS IN HIV-POSITIVE PATIENTS - SPECTRUM OF FINDINGS AT GRAY-SCALE AND DOPPLER SONOGRAPHY

OBJECTIVE. Benign lymphoepithelial lesions are intraparotid nodules th at develop as an early manifestation of HIV infection. The purpose of this study was to describe the spectrum of sonographic and Doppler fin dings of benign lymphoepithelial lesions in HIV-positive patients and to assess whether these findings are specific for the diagnosis of suc h lesions. SUBJECTS AND METHODS. Nine HIV-positive patients with swell ing of the parotid gland caused by single or multiple parotid nodules were evaluated. Fourteen nodules were identified sonographically and p roved to be benign lymphoepithelial lesions at cytologic examination. They were assessed with gray-scale, duplex, color Doppler, and power D oppler sonography. For each nodule, the echogenicity, grade and patter n of vascularity, and spectral tracings were evaluated. RESULTS. Benig n lymphoepithelial lesions manifested as parotid nodules with a wide s pectrum of sonographic appearances, ranging from simple cysts to mixed masses with predominantly solid components. Cystic lesions (10/14) we re not purely anechoic; they had an internal network of thin septa sup plied by vessel pedicles and, in four of 10 cases, a solid mural nodul e. On the other hand, mixed nodules (4/14) had a higher conspicuity of solid tissue and thicker stromal septa, thus resembling a parotid neo plasm more than a cyst. The overall grade of vascularity of benign lym phoepithelial lesions varied from avascular to intensely hypervascular . Generally, mixed nodules were more hypervascular than were the cystl ike ones. Spectral analysis showed slow velocity (peak systolic veloci ty range, 8-28 cm/sec; mean, 20 cm/sec) and low impedance (resistive i ndex range, 0.36-0.70; mean, 0.57) arterial flows. CONCLUSION. The spe ctrum of sonographic and Doppler features of benign lymphoepithelial l esions in HIV-positive patients is broad. Sonographic findings are non specific for the diagnosis of such lesions, especially in cases of mix ed solid-cystic isolated nodules.