Radiation Therapy for Benign Parotid Lymphoepithelial Cysts in Patients with HIV: A Case Report

Summary: Benign lymphoepithelial cysts (BLEC) of the parotid gland are an uncommon but associated lesion in individuals with HIV infection (1). Data on radiation therapy (RT) for these potentially painful lesions is limited but shows generally favorable outcomes. A 2016 retrospective cohort study of 72 HIV-positive patients with BLEC treated with RT found that a median dose of 24 Gy provided effective long-term cosmetic control without significant toxicity (2). This case presents a rare, benign indication for RT — treating BLEC of the parotid gland in an HIV-positive patient. The case is also unique in that the left parotid gland was treated initially with the intent of treating the right gland sequentially after assessing response. We present a case of a 59-year-old male with bilateral parotid lymphoepithelial cysts secondary to HIV. The patient initially presented in 2017 with painful lumps in the submandibular and parotid glands. Initial imaging, including neck CT and ultrasound, demonstrated nonspecific enlargement of cervical lymph nodes and palatine/lingual tonsils, with subsequent scans showing fluctuating changes. A PET scan revealed moderate lymph node uptake, and US-guided FNA suggested a reactive process. Further workup, including MRI, confirmed bilateral fatty parotid glands without discrete lesions, consistent with lymphoepithelial cysts. Conservative management was attempted, but the patient sought radiotherapy due to persistent discomfort. After shared decision-making, he proceeded with treatment. Following CT simulation, the left parotid gland was treated to 24 Gy in 12 daily fractions, using a 3D conformal technique with two opposed coplanar oblique 6MV photon fields. The patient tolerated RT well, only reporting mild hypogeusia over the course of treatment. The patient denied pain, skin changes, and xerostomia. Left parotid gland swelling was noted to decrease by the end of treatment. This case highlights the potential role of radiotherapy in managing HIV-associated parotid lymphoepithelial cysts, offering an alternative to traditional conservative or surgical approaches, utilizing a delayed sequencing approach to assess benefit and tolerability. Ariel Rosa (he/him/his), n/a (Presenting Author) - Virginia Commonwealth University School of Medicine; Joseph Wilding, MD (Co-Author) - VCU Health; Hann-Hsiang Chao, MD/PhD (Co-Author) - Central Virginia VA Health Care System