Introduction: Cystic lymphoid hyperplasia (CLH) is a common yet under recognised entity
affecting the parotid gland in HIV infected patients. This is the largest global
clinicopathological study of CLH to date consisting of 167 cases (85M, 82F).
Aim: To define the clinical parameters, histology and immunopathological features of CLH
with a view to elucidating the aetio-pathogenesis.
Material and Methods: This retrospective study on archival cases of CLH included patient’s
age, race, gender, nature of CLH, HIV status, CD4 counts and viral loads where available. Of
the 167 confirmed cases of CLH, 109 cases were histologically reviewed and 25 cases were
immunohistochemically analysed with CD3, CD20, CD4, CD8 and p24 using standard
procedures. Ethics clearance (M080927 and M080850) was obtained.
Results: CLH mainly affects the parotid gland with a male predominance. Submandibular
gland (p = 0.27) and bilateral parotid involvement favours females (2:1). CLH affects females
at a younger mean age in both the parotid and submandibular glands (36.5, 31 years)
respectively compared to males (40.9, 42.4 years) (p = 0.0032). Intra-lymph nodal origin is
favoured with 76.1% of cases occurring within entrapped salivary gland remnants. P24 staining
reveals ~90% specificity in HIV associated CLH. Immunostaining showed a CD8:CD4 of ~1:1
except in selected cases where CD4 was decreased in the interfollicular areas.
Conclusion: CLH is the preferred term to describe bilateral parotid enlargement in HIV infected
patients. This study strongly supports origin of CLH following ductal ectasia of entrapped
salivary gland inclusions within atypical lymphoid hyperplasia arising within lymph nodes in
the context of an HIV setting. CLH should be classified as an orofacial lesion strongly
associated with HIV and AIDS.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/10830 |
| Date | 23 November 2011 |
| Creators | Dulabh, Shailen |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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