Benign lymphoepithelial lesions

Benign lymphoepithelial lesions (BLL or BLEL), also misleadingly known as AIDS-related parotid cysts (ARPC), are mixed solid and cystic lesions that enlarge the parotid glands, and are usually associated with cervical lymph node enlargement, and nasopharyngeal lymphofollicular hyperplasia.

Benign lymphoepithelial lesions refer specifically to a histopathological finding that is nonspecific and seen in the context of lymphoepithelial sialadenitis (typical of Sjögren syndrome) and HIV-associated salivary gland disease 5. This article focuses on the findings in the latter disease.

Despite their aforementioned alternative name, BLL are seen usually in HIV positive patients without AIDS, and are not an AIDS defining illness. It is relatively common in the HIV population, with 5% of patients eventually developing BLL.

Thought to arise from dilatation of intraglandular ducts from obstruction due to lymphoid hypertrophy. They are bilateral in ~20% of cases. 

BLLs most commonly arise in the parotid gland, and are only rarely seen in the submandibular glands or sublingual glands.

  • well circumscribed cystic spaces
  • may demonstrate thin rim enhancement on post contrast MRI
  • ultrasound demonstrates these 'cystic' lesions to actually have multiple small septations, and commonly also small mural nodules (40%)
  • a vascular pedicle may be seen entering the cystic region

BLLs are usually seen associated with other sites of lymphoid hyperplasia 4, including:

  • prominent nasopharyngeal adenoidal tissue: seen in 35% of HIV positive patients 4
  • posterior triangle lymphadenopathy
  • abnormal bone marrow signal

On imaging consider

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Article information

rID: 977
System: Head & Neck
Tag: parotid
Synonyms or Alternate Spellings:
  • BLEL
  • BLL
  • Benign lymphoepithelial lesion

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Cases and figures

  • Case 1: HIV associated with lymphoid hyperplasia
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  • Case 1: HIV associated with lymphoid hyperplasia
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  • Case 2: axial
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  • Case 2: 3D reconstruction
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