HIV infection-associated lymphoepithelial lesions of the parotid gland: aspiration biopsy cytology, histology, and pathogenesis.

Two homosexual men with parotid swellings were shown to be human immunodeficiency virus (HIV)-positive. They initially presented with a painless solitary parotid mass accompanied by diffuse cervical lymphadenopathy. In case 1, the patient further developed bilateral multiple cystic lesions. Aspirate preparations from the cystic lesions contained numerous anucleate squames, and superficial and intermediate squamous cells intermingled with various follicular center cells and lymphocytes. Immunoblasts and active phagocytosis of nuclear debris were also noted. Histologically, the parotid cystic lesions showed squamous epithelium-lined clefts surrounded by abundant hyperplastic lymphoid tissue with prominent germinal centers. The cystic lesions did not involve submandibular and sublingual glands. The combination of bilateral multiple lymphoepithelial lesions of the parotid glands and diffuse cervical lymphadenopathy represents a new condition in patients who are likely to be HIV-positive. At the early stage of the disease, when the lesion is confined to a unilateral parotid gland, the cytologic findings of the parotid mass, in combination with a computed tomographic appearance of multiple cystic lesions, are distinctly different from findings in other neck and facial lesions. The patient should be tested for antibodies to the HIV virus to confirm this diagnosis, so that the appropriate precautions and treatment can be initiated.