Lymphoepithelial Cysts and Ranulas in HIV positive Patients: Non-surgical Approach

Objective: HIV-related salivary gland disease (HIV-SGD), in particular the benign lymphoepithelial cyst (BLEC), is reported. The aim was to assess the effect of antiretroviral drugs (ART or HAART) on BLEC, and on ranulas. Previous treatment modalities for the BLEC were surgery, radiotherapy and sclerotherapy. For ranula, also a SGD, the surgical removal of the cyst and the salivary gland is indicated. With the advent of antiretroviral therapy the approach for the BLEC has changed, however, unknown for ranulas. Methods: A retrospective and prospective research was done. Retrospectively 10 HIV+ patients with enlarged parotid (not started ART), were evaluated (CT, FNA and photographs). Those diagnosed with BLEC were placed on ART and re-evaluated after three months. Prospectively, 10 HIV+ patients diagnosed with a ranula who had not started ART, were evaluated (CT and photographs). They were placed on ART and re-evaluated after three months ART treatment. Both groups were therefore observed for the first three months after the start of antiretroviral therapy. Results: In the retrospective group all 10 BLEC patients displayed a reduction of parotid enlargement. In nine cases the enlargement completely reduced to the initial parotid size. In one case a partial response was observed. However, in the prospective group all 10 ranulas patients displayed a negative result, after three months ART. There was neither a clinical reduction in size, nor a change in the radiological appearances. This study confirmed that ART drugs have a beneficial effect on BLEC of the parotid. It suggests that ART drugs do not have an effect on ranulas. Conclusion: This research revealed that BLEC of parotid and ranulas, both HIV-SGD, respond very differently to ART. However, the question was raised, concerning a causative link between HIV and ranulas, as it appears that more HIV+ patients present with ranulas.