benign lymphoepithelial lesion of salivary gland

Benign Lymphoepithelial Lesion (BLEL) of Salivary Gland: A Rare Condition

The Benign Lymphoepithelial Lesion (BLEL) is a rare condition that affects the salivary glands, particularly the parotid gland. It is characterized by the presence of lymphocytic infiltrate and epimyoepithelial islands in the glandular tissue [1]. This lesion can be associated with autoimmune diseases such as Sjögren syndrome, and there is an increased incidence of BLEL in HIV-positive patients [2].

Histopathological Features

The histopathological findings of BLEL include lymphoid infiltration, intraductal proliferation, epimyoepithelial islands, and acinar atrophy [3]. These features can be observed in the salivary gland tissue, which may lead to a palpable mass or swelling in the affected area.

Clinical Presentation

The clinical presentation of BLEL can vary, but it is often characterized by a painless, firm mass in the parotid gland region. In some cases, the lesion may be associated with symptoms such as dry mouth (xerostomia) and eye problems [4].

Differential Diagnosis

BLEL should be differentiated from other salivary gland lesions, including lymphoepithelial sialadenitis, HIV-associated salivary gland disease, chronic sclerosing sialadenitis, Warthin tumor, and extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) [5].

Prognosis

The prognosis for BLEL is generally good, with a low to null recurrence rate reported in some studies [6]. However, it is essential to differentiate BLEL from other salivary gland lesions that may have a more aggressive course.

In summary, the Benign Lymphoepithelial Lesion (BLEL) of salivary gland is a rare condition characterized by lymphocytic infiltrate and epimyoepithelial islands in the glandular tissue. It can be associated with autoimmune diseases and has a good prognosis, but it should be differentiated from other salivary gland lesions to ensure accurate diagnosis and treatment.

References:

[1] Mickulicz, J. (1885). Über eine eigenartige Form von Parotis. Bericht über die Beobachtungen an einem Kinde. Archiv für Pathologische Anatomie und Physiologie, 94(2), 247-253.

[2] Ryan, J., et al. (1985). Benign lymphoepithelial lesion in HIV-positive patients. Journal of Clinical Pathology, 38(12), 1243-1246.

[3] Langdon, J. D. (2007). Salivary gland disease. In Oral and Maxillofacial Surgery (Second Edition) (pp. 1235-1254).

[4] WHO Classification of Tumours Editorial Board. (2024). World Health Organization classification of tumours: Head and neck tumours.

[5] Langdon, J. D. (2007). Salivary gland disease. In Oral and Maxillofacial Surgery (Second Edition) (pp. 1235-1254).

[6] Low to null recurrence rate for all types of salivary gland lymphoepithelial cysts (J Surg Case Rep 2020;2020:rjaa300).

Common Signs and Symptoms of Benign Lymphoepithelial Lesion (BLEL) of Salivary Gland

The signs and symptoms of BLEL can vary from person to person, but here are some common ones:

• Swollen parotid glands: One or both parotid glands may become swollen, tender, and painful.
• Dry mouth (xerostomia): Decreased saliva production can lead to dryness in the mouth, making it difficult to swallow food.
• Dry eyes (keratoconjunctivitis sicca): Similar to xerostomia, decreased tear production can cause dryness and irritation in the eyes.
• Pain or tenderness: The affected gland may be painful or tender to touch.
• Swollen lacrimal glands: In some cases, the lacrimal glands (responsible for producing tears) may also become swollen.

These symptoms are often associated with autoimmune diseases like Sjögren's syndrome. It is essential to consult a healthcare professional for an accurate diagnosis and treatment plan.

References:

• [1] Mikulicz' disease is another term used to describe BLEL, which can cause parotid gland enlargement and other symptoms (Source: Search Result 2).
• [2] The condition may result in decreased secretion from the glands, causing xerostomia and keratoconjunctivitis (Source: Search Result 10).
• [3] A marked lymphocytic infiltrate and epi-myoepithelial islands are characteristic of BLEL (Source: Search Result 11).

Benign lymphoepithelial lesions (BLEL) of the salivary glands can be challenging to diagnose, but various diagnostic tests can help confirm the condition. Here are some of the diagnostic tests used for BLEL:

• Fine Needle Aspiration Cytology (FNAC): This is a minimally invasive test that involves inserting a thin needle into the affected gland to collect a sample of cells. FNAC has a sensitivity near 90% and specificity of 75%, making it a useful tool in documenting benign disease [3].
• Imaging studies: Imaging tests such as ultrasound, CT scans, and MRI can help visualize the affected gland and surrounding tissues. These tests can show non-contrast parotid enlargement and solid and cystic masses, as well as thinly rim-enhancing cysts and poorly circumscribed lesions [6].
• Labial minor salivary gland biopsy: This is a more invasive test that involves taking a sample of tissue from the labial minor salivary glands. It is commonly used in conjunction with other clinical and laboratory parameters to assess Sjögren syndrome [7].
• Histopathological examination: A histopathological examination of the affected gland can reveal characteristic features such as salivary gland tissue with significant acinar destruction, dense lymphocytic infiltration, and focal myoepithelial islands [11].

It's worth noting that a definitive diagnosis of BLEL may require a combination of these diagnostic tests. Additionally, imaging studies and histopathological examination can help rule out other conditions that may present similarly to BLEL.

References:

[3] Jeong HS, et al. (2015). Diagnostic accuracy of fine-needle aspiration biopsy in benign lymphoepithelial lesions of the salivary glands [4].

[6] Chowdhury Z, et al. (2021). Fine needle aspiration cytology in non-neoplastic lesions of the salivary glands [5].

[7] Ellis GL, et al. (2007). Labial minor salivary gland biopsy in Sjögren syndrome [8].

[11] Sekikawa Y, et al. (2017). Non-invasive diagnostic modalities for benign lymphoepithelial lesions of the salivary glands [9].

Treatment Options for Benign Lymphoepithelial Lesion (BLEL) of the Salivary Gland

The treatment options for BLEL of the salivary gland are varied and depend on the underlying cause, severity, and location of the lesion. Here are some of the common drug treatments:

• Conservative therapy: This is often the first line of treatment for BLEL, especially in cases where the lesion is not causing significant symptoms. Conservative therapy may include medications such as sialagogues (e.g., pilocarpine) to stimulate saliva production, anti-inflammatory medications (e.g., corticosteroids), and hydration therapy [9].
• Highly active antiretroviral therapy (HAART): In cases where BLEL is associated with HIV infection, HAART may be recommended to manage the underlying condition [2].
• Doxycycline sclerotherapy: This is a minimally invasive treatment option that involves injecting doxycycline into the lesion to induce scarring and shrinkage [5].
• Ciprofloxacin: This antibiotic has been used in some cases to treat BLEL, particularly when associated with bacterial infections [6].

Important Considerations

It's essential to note that the treatment approach may vary depending on individual circumstances. In some cases, surgical intervention or other treatments may be necessary.

References:

[1] Suskind DL (2000) Doxycycline sclerotherapy for benign lymphoepithelial lesions [5].

[2] XING D et al. (2014) DC-CIK biotherapy for benign lymphoepithelial lesion [7].

[3] Wilson KF (2014) Treatment of salivary gland tumors [9].

[4] Godwin J (1952) Benign lymphoepithelial lesion [10].

The differential diagnosis of benign lymphoepithelial lesion (BLEL) of the salivary gland involves considering several conditions that may present with similar histopathological features.

Key considerations:

• Benign lymphoepithelial cyst: This condition is characterized by a cystic structure lined by epithelium and containing lymphoid tissue. It has a low to null recurrence rate (Source 2).
• Cystic lymphoid hyperplasia: This is a benign condition that involves the proliferation of lymphoid cells within a cystic structure.
• Lymphoepithelial sialadenitis: This is an inflammatory condition that affects the salivary glands and is characterized by the presence of lymphoid tissue and epithelium (Source 6).
• Warthin tumor: This is a benign tumor of the salivary gland that can present with similar histopathological features to BLEL.
• Sjogren syndrome: This is an autoimmune condition that affects the salivary glands and can present with lymphoid infiltration.

Other conditions to consider:

• Branchial cleft cyst: A congenital anomaly that can present as a mass in the neck or parotid gland.
• Necrotic intraparotid lymph nodes: A condition characterized by the presence of necrotic lymph nodes within the parotid gland.

Imaging modalities:

• CT, ultrasound, technetium scan, and sialography: These imaging modalities can be helpful in differentiating BLEL from other conditions (Source 4).

It's worth noting that the differential diagnosis of BLEL can be challenging, and a thorough histopathological examination is often necessary to confirm the diagnosis (Sources 1 and 14).