Learning objectives
LEARNING OBJECTIVES
• disclose the main problems which lead to misdiagnosis and mistreatment of patients suffering from HIV-associated salivary gland diseases (HIV-SGD),
especially the cystic ones;
• distinguish between different entities of HIV-associated cystic salivary gland diseases;
• distinguish between other non-related HIV pathologies which can affect salivary glands and therefore can mimic HIV-SGDs.
Background
INTRODUCTION
salivary gland swelling is the most common salivary gland presentation in HIV-infected patients,
which can be attributed to acute sialadenitis or with HIV-associated salivary gland disease (HIV-SGD)1;
HIV-SGD is empirically considered to be an AIDS-defining condition;
most common HIV-SGDs are BLEC (Benign Lymphoepithelial Cysts),
BLEL (benign lymphoepithelial lesions),
Sjogren’s syndrome (both primary SS associated with HIV or SS-like illness), DILS (Diffuse infiltrative lymphocytosis syndrome),
viral sialadenitis,
sialadenosis,
etc.
the majority of HIV-SGDs are located in the parotid gland because it is the only salivary...
Findings and procedure details
-after a close review of the specialty literature,
some of the issues found need to be mentioned:
the nomenclature: in the past,
regardless of their nature and histopathological mechanism,
all HIV related salivary gland lesions containing cysts were considered altogether as being ARPC (AIDS-related parotid cysts)5. This term can cause confusion because it doesn’t specify which type of HIV-SGD (BLEC,
BLEL or another salivary lesion which later developed cysts) refers to,
and by considering two or more pathologies as being the same one it can...
Conclusion
- if a lymphoepithelial lesion appears at a patient with unknown HIV status,
it should be tested right away;
- it is important to differentiate between different types of lesions compounded in HIV-SGD because each one has a different management approach;
- it is essential to differentiate between the two entities of ARPC (BLEC and BLEL) because each one has a different long-term implication regarding their malignant progression;
- the cosmetic aspect cannot be neglected so the appropriate diagnostic and management should be implemented quickly.
References
. Koch BL,
Hamilton BE,
Hudgins PA,
Harnsberger HR.
Diagnostic Imaging: Head and Neck.
Elsevier Health Sciences; 2016.
1348 p.
2. Ebrahim S,
Singh B,
Ramklass SS.
HIV-associated salivary gland enlargement: a clinical review.
SADJ.
2014 Oct;69(9):400–3.
3. Schiødt M,
Dodd CL,
Greenspan D,
Daniels TE,
Chernoff D,
Hollander H,
et al.
Natural history of HIV-associated salivary gland disease.
Oral Surg Oral Med Oral Pathol.
1992 Sep;74(3):326–31.
4. Sekikawa Y,
Hongo I.
HIV-associated benign lymphoepithelial cysts of the parotid glands confirmed by HIV-1 p24 antigen...