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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 1: 47-year-old female with parotid mass
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Question 1 of 1
1. Question
Week 2: Case 1
47-year-old female with parotid mass
Correct
Answer: Benign lymphoepithelial cyst
Histology: Within the parotid gland are two cystic structures surrounded by lymphoid tissue containing germinal centers. One nodule resembles a lymph node, whereas in areas the other merges in with the surrounding salivary gland and is less well defined. The lining of the cyst wall consists of squamous epithelium with a heavy infiltrate of benign appearing lymphocytes. Focally, within the lymphoid tissue surrounding one of the cysts are epimyoepithelial islands.
Discussion: Branchial cleft cysts may show a similar appearance with squamous lined cysts surrounded by lymphoid cuffs. Branchial cleft cysts, however, occur in the lateral portion of the neck and do not involve the salivary gland. Warthin’s tumors are also cystic lesions with a lymphoid infiltrate. Their epithelium, however, consists of oncocytic cells. Sjögren’s disease consists of a lymphoid infiltrate with epimyoepithelial islands. The localized nature of the lesion within an otherwise histologically unremarkable salivary gland argues against Sjögren’s disease.
Incorrect
Answer: Benign lymphoepithelial cyst
Histology: Within the parotid gland are two cystic structures surrounded by lymphoid tissue containing germinal centers. One nodule resembles a lymph node, whereas in areas the other merges in with the surrounding salivary gland and is less well defined. The lining of the cyst wall consists of squamous epithelium with a heavy infiltrate of benign appearing lymphocytes. Focally, within the lymphoid tissue surrounding one of the cysts are epimyoepithelial islands.
Discussion: Branchial cleft cysts may show a similar appearance with squamous lined cysts surrounded by lymphoid cuffs. Branchial cleft cysts, however, occur in the lateral portion of the neck and do not involve the salivary gland. Warthin’s tumors are also cystic lesions with a lymphoid infiltrate. Their epithelium, however, consists of oncocytic cells. Sjögren’s disease consists of a lymphoid infiltrate with epimyoepithelial islands. The localized nature of the lesion within an otherwise histologically unremarkable salivary gland argues against Sjögren’s disease.
