Unusual Site for a White Nodule on the Palatine Tonsil: Presentation, Differential Diagnosis, and Discussion

Introduction. Palatine tonsils are part of the mucosa-associated lymphoid tissue, located in the oropharyngeal region. Although these tissues protect the body from foreign intruders, they are more prone to infections due to their anatomical structure and location. For instance, the differential diagnosis of a white lesion on the palatine tonsil can range from benign to malignant lesions. Oral lymphoepithelial cysts commonly arise as painless, yellowish nodules on the floor of the mouth and the ventral or lateral surface of the tongue. Case Presentation. This paper presents a rare case of an unusual site of a lymphoepithelial cyst (LEC) in the oral cavity. The lesion was located in the tonsil of a 20-year-old woman with a chief complaint of a painless, white lump in the back of the mouth for nine months. Discussion. The differential diagnosis of a white lesion on the palatine tonsil is caused by several factors, such as bacterial, viral, and fungal infections; trauma; stones; cysts; abscess; or cancer. In this case, both the clinical presentation and extra- and intraoral examinations were highly associated with LEC. Oral LEC etiopathogenesis is uncertain, and several theories have been proposed to discuss the causes of LEC. In addition, oral LEC could be monitored without surgical intervention if the nodule is asymptomatic. Conclusion. We emphasize the importance of a thorough clinical examination of oral and oropharyngeal lesions, which are usually neglected.

Literature Review of Sebaceous and Non-Sebaceous Lymphadenoma

Lymphadenoma of the salivary gland is a rare form of tumor that can be branched into Sebaceous Lymphadenoma (SLA) and Non-Sebaceous Lymphadenoma (NSLA). It is painless, hyperdense, shiny yellowish/brownish unicystic or multicystic mass which is encapsulated and well defined having lymphocytic and/or lymphoid follicles background present with or without sebaceous differentiation. Both SLA and NSLA are predominantly located in parotids with occasional case appearing in minor salivary glands and has <100 and <50 reported cases respectively in English literature. We have attempted to compile reported case studies on SLA and NSLA and tried to make analysis on the basis of findings. Our analysis revealed that both SLA and NSLA are often non-malignant in nature but feature of malignancy cannot be completely ruled out. Data also found that SLA and NSLA has a significant gender bias towards males but NSLA is more likely to appear at an early age as compared to SLA which often emerge after the 5th decade of life. Further, differential diagnosis should be considered to distinguish SLA and NSLA from Warthin’s tumor, pleomorphic adenoma, mucoepidermoid carcinoma, cystadenoma, lymphoepithelial cysts, myoepithelial sialadenitis, malignant lymphoma and metastatic adenocarcinoma of lymph node. This review discusses various techniques used in the past studies that can be helpful in making differential diagnosis.

Lymphoepthelial cyst of submandibular region: a case report

Background The oral lymphoepithelial cyst (LEC) is a rare, soft-tissue, developmental cyst, initially presented by Gold in 1962 as a “branchial cleft cyst”. It may occur in the pancreas, tongue, neck, and other regions of the oral cavity. No study has been reported in Pakistan and Karachi reporting a case of lymphoepithelial cyst in the submandibular region. This rare case of LEC has been reported to help the clinicians to bring LEC into their differential diagnosis for lesions affecting the submandibular region. Case presentation We report a case of 57 years old female reported to the Maxillofacial OPD of a tertiary care hospital with the complaint of swelling on the right side of the neck for 3 weeks which was rapidly increasing in size. She was having difficulty in mastication. On extra-oral examination, there was swelling on the right side in the submandibular area. The overlying skin is normal with no evidence of pus and discharge. On palpation, the swelling was soft, non-tender, non-fluctuant, non-displaceable into the submandibular area. Lymph nodes were impalpable. Excision of the lesion performed under general anesthesia and biopsy revealed lymphoepithelial cyst associated with submandibular gland. Here we present an attention-grabbing case of swelling in the right submandibular region which was provisionally diagnosed as a malignant submandibular lymph node however later evidence histopathologically as a lymphoepithelial cyst of the submandibular gland. Conclusion An unusual cause of swelling in the neck is lymphoepithelial cysts. Submandibular gland appearance is not usual and can prove to be a clinical problem.

Lymphoepithelial Cyst of the Pancreas: Can Common Imaging Features Help to Avoid Resesction?

Background: Differentiation of cystic pancreatic neoplasms remains a challenging task for radiologists with main aim of characterizing malignant and premalignant conditions. Purpose: The study aimed to compare radiological features of lymphoepithelial cysts (LEC) with other cystic pancreatic lesions, which could help to differentiate them in order to avoid unnecessary resection and optimize surveillance.Material and Methods: We retrospectively reviewed 12 cases of resected and histopathological confirmed LECs in last 12 years, for 10 patients imaging studies were available. 20 patients with mucinous cystic neoplasms (MCN) and 20 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) were selected consecutively to serve as control groups. Imaging findings as well as clinical data were analyzed. Results: Three imaging subtypes of LEC were identified: simple cystic morphology (20%) and mixed cystic-solid lesions (80%) with either diffuse subsolid component (30%) or mural nodule (50%). All lesions revealed exophytic location with strong male predominance (9:1). MCNs were presented exclusively in middle-aged woman and IPMN in both sexes showing slight male predominance (13:7). Mean patient age in IPMN (70.5+7.7 years) was significantly higher compared to other groups (p<0.001 for LEC, p=0.005 for MCN). Unenhanced CT-attenuation of LEC was higher than MCNs (p=0.025) and IPMNs (p=0.021). Conclusion: The present study provides three imaging subtypes of LEC with key features for the differentiation from other cystic pancreatic lesions such as increased native attenuation, absence of connection to main pancreatic duct (MPD) and exophytic location. Clinical data, such as male predominance in LEC, is crucial in differentiating cystic pancreatic lesions.

Recurrent lymphoepithelial cysts after parotidectomy in an undiagnosed HIV-positive patient

A benign lymphoepithelial cyst (BLEC) is defined as a rare, benign lesion composed of single or multiple cysts found within salivary glands or the lateral cervical area. Increasing reports suggest an association between BLEC and human immunodeficiency virus (HIV), although its pathogenesis remains unclear. We report a 51-year-old male who presented with recurrent bilateral BLECs after initial parotidectomy of cyst. An HIV panel was then performed with a positive result. We review the surgical and medical managements of BLEC while also discussing further treatment recommendations. Clinicians should be aware that BLEC recurrence postparotidectomy may be the initial presenting symptom of HIV in a patient with no risk factors.

Lymphoepithelial cyst of the parotid in HIV negative individual: a case report

Benign Lymphoepithelial cyst (BLEC) of parotid gland are more common in HIV positive patients and is rare in HIV negative individuals. We present a 16-year-old HIV negative female who pre­sented with a painless, gradually increasing swelling in the left parotid region. Excisional biopsy was done and HPE showed benign lymphoepithelial cysts. The rarity of this lesion in a HIV negative patient is the main reason for reporting this case.

Benign Lymphoepithelial Cyst: An Unusual Cause of Parotid Swelling in Two Immunocompetent Patients

BACKGROUND: Lymphoepithelial cysts, which are benign and slow-growing tumours, usually involve the head and neck regions. Benign lymphoepithelial cysts (BLECs) are the most common cause of parotid swelling in human immunodeficiency virus (HIV)-positive patients and are less common in immunocompetent patients. CASE PRESENTATION: Here, we present two cases of immunocompetent patients with long-standing, progressively enlarging parotid swelling. Postoperative histopathological examination of these patients revealed features of BLEC. CONCLUSION: Wide surgical excision is the gold standard for treatment and recurrences is rare. These cases are of particular interest because of the rarity of BLEC in HIV-negative patients and highlight an important differential diagnosis of parotid swelling.

Thyroid Lymphoepithelial Cysts Mimicking Calcified or Solid Nodules on Ultrasonography

Thyroid lymphoepithelial cysts (TLECs) are rare, and detailed ultrasonography (US) findings have not been reported. This study aimed to examine in detail the US findings for 32 TLECs and to clarify the diagnostic problems associated with them.We examined 32 TLECs resected from 21 patients at the Kuma hospital between January 2008 and April 2018. All patients underwent US before resection. From the patients’ medical records, we retrospectively assessed US reports and photographs of TLECs.The following four types of TLECs were classified: cystic, mixed solid and cystic, pseudo-solid, and pseudo-calcified types. The incidences were 50.0%, 12.5%, 12.5%, and 25.0%, respectively. Among the four types, pseudo-calcified TLECs were the smallest in size (mean: 7.1 mm). Of 24 nodules that had been interpreted in US reports, 11, 9, 1, 2, and 1 were benign, very low, low, intermediate, and high, respectively. Calcification and intramural solid growth were not identified by histological examination.We should be aware that approximately half of TLECs do not exhibit US appearances typical of simple cysts, and TLECs may mimic calcified or solid nodules on US, although the reason remains unknown.