BENIGN LYMPHOEPITHELIAL LESION

Dimatulac, Kevin

Benign Lymphoepithelial Lesion

Is an autoimmune disorder characterized by diffuse and bilateral enlargement of salivary and lacrimal glands.

This pathologic state sometimes, but not always, associated with “Sjogren’s Syndrome”

Historically, bilateral parotid and lacrimal gland enlargement was characterized by the term “Mikulicz’s Disease” if the enlargement appeared apart from other diseases.

If it was secondary to another disease, such as tuberculosis, sarcoidosis, lymphoma, and Sjogren’s Syndrome, the term used was Mikulicz’s Syndrome.

Both names derive from Jan Mikulicz-Radecki, the Polish surgeon best known for describing these conditions.

LOCATIONS: In 80% of the cases the following

locations are:

-The Parotid Gland and;-Lacrimal Gland

CHARACTERISTIC: The gland affected has a diffuse swelling

in which the swelling can be asymptomatic, but mild pain can also be associated.

Most cases of benign lymphoephitelial lesions appear in conjunction with Sjogren’s Syndrome.

When the syndrome is present, the swelling is usually bilateral. Otherwise, the affected glands are usually only on one side of the body.

This conditions is most likely to occur in adults around 50 years of age.

There is a predilection for gender with 60% - 80% being female.

In many cases, a biopsy is needed to distinguish benign lymphoephitelial lesions from sialadenosis

Contrast: thinly rim-enhancing cysts and poorly circumscribed solid lesions; cervical and tonsilar enlargement may be noted as well

T1 gives low signal in cysts and intermediate signal in solid components

ETIOLOGY/EPIDEMIOLOGY: Benign lymphoepithelial lesions may be

primary or caused by an underlying disease

A primary Benign lymphoepithelial lesions is a clinical rarity and occurs predominately in middle-aged or older women.

Secondary causes include Sjogren syndrome, which is characterized by xerostomia, keratoconjunctivitis, and a collagen vascular disease.

Rarely, benign lymphoepithelial lesions occurs in association with tubercolosis, syphilis, sarcoidosis, AIDS, leukemia, lymphomas.

HISTOLOGY: There is a marked lymphoplasmacytic

infiltration. Lymphoid follicles surround solid

epithelial nests, giving rise to the “epimyoephitelial islands”, that are mainly composed of ductal cells with occasional myoepithelial cells.

Excess hyaline basement membrane material is deposited between cells, and there is also acinar atrophy and destruction.

Histopathologic image of focal lymphoid infiltration in the minor salivary gland associated with Sjögren

syndrome. Lip biopsy. H & E stain

TREATMENT: Treatment usually consists of observation

unless the patient has concern, there is pain, drainage, or other symptoms related to the lesions

Surgical removal of the affected gland would be recommended in those cases.

Another treatment option would be aspiration, which can be repeated multiple times.

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