Cystic lymphoid hyperplasia: an orofacial lesion strongly associated with HIV and AIDS.

AIMS: Cystic lymphoid hyperplasia (CLH) frequently affects the parotid gland in human immunodeficiency virus (HIV)-infected patients. This clinicopathological study, comprising 167 cases, aims to define the clinical-pathological parameters of CLH in order to elucidate the aetiopathogenesis.

METHODS AND

RESULTS

This retrospective study of 167 archival cases of CLH recorded patients' age, race and gender, and the nature, site and symptoms of CLH. A total of 109 cases were reviewed histologically and analyzed for HIV-1 p24 antigen immunopositivity using standard procedures. CLH of the parotid gland showed a male predominance, whereas submandibular gland (P = 0.27) and bilateral parotid involvement favoured females (2:1). CLH occurred at a younger mean age in females than males in the parotid gland (P = 0.0035) and in the submandibular gland (P = 0.0032). Intra-lymph nodal origin was favoured, with 76.1% of cases occurring within entrapped salivary gland remnants. P24 staining revealed ~90% sensitivity in HIV-associated CLH.

CONCLUSION

CLH should be used preferentially to describe parotid enlargement in HIV-infected patients. This study strongly supports the hypothesis that CLH develops following ductal ectasia of entrapped salivary gland inclusions arising within lymph nodes. CLH should be classified as an orofacial lesion associated strongly with HIV and AIDS.