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HIV lymphoepithelial parotid cysts — DTM&H MCQ

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HardHIV in TropicsHIV lymphoepithelial parotid cystsDTM&H

An adult with untreated HIV has slowly progressive painless bilateral parotid enlargement. Ultrasound shows multiple thin-walled intraparotid cysts with cervical lymphoid hyperplasia and no solid dominant mass. What is the most likely diagnosis?

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Correct answer: A — HIV-associated benign lymphoepithelial cysts

The best answer is “HIV-associated benign lymphoepithelial cysts”. The combination of HIV, painless bilateral swelling, multiple intraparotid cysts and lymphoid hyperplasia is characteristic of benign lymphoepithelial cysts. Solid, painful, suppurative or obstructive presentations would favour the alternatives; atypical or dominant solid features still require assessment for malignancy.

Reference: Benign lymphoepithelial cyst of the parotid in HIV: narrative review: https://pmc.ncbi.nlm.nih.gov/articles/PMC10235290/