Fine Needle Aspiration (FNA) of 486 Human Immunodeficiency Virus (HIV)-Related Lesions of the Major Salivary Glands
L Pantanowitz, BJ Dezube, P Michelow. Baystate Medical Center, Tufts University School of Medicine, Springfield, MA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa
Background: Salivary gland disease is an important manifestation of HIV infection. There are limited studies investigating the cytopathology of HIV-related salivary gland disease. The aim of this study was to evaluate the findings in a series of salivary gland FNA in South African HIV+ patients.
Design: A retrospective review at the National Health Laboratory Service in Johannesburg, South Africa was performed of 3501 confirmed HIV+ patients who had an FNA of various body sites. FNA of only major salivary glands were further evaluated for patient age and gender, lesion (laterality, clinical signs), antiretroviral therapy use, specimen adequacy, and cytologic diagnosis.
Results: There were 486 (14%) procedures including 253 (52%) parotid and 233 (48%) submandibular gland FNAs. Patients were of average age 34 years (range, 3-63) with a female:male ratio of 1:0.6. There were 43 (9%) inadequate FNAs and 22 (5%) contained only normal gland constituents. Most diagnoses were due to 123 (25%) lymphoepithelial lesions/cysts and 114 (23%) cases of reactive lymphadenopathy. Lymphoepithelial lesions/cysts occurred in patients ranging from 6-63 years of age, 7% of whom had antiretrovirals, measured 2 to 8.5cm in greatest diameter, involved the parotid (n=94) and submandibular glands (n=81), and were bilateral in only 7% of patients. Cases also included 81 (17%) diagnoses with tuberculosis and 58 (12%) abscesses, 2 found to have associated mycobacterium infection. Neoplasms accounted for 17 (4%) of diagnoses, including pleomorphic adenoma (n=9), lymphoma (n=7) and squamous cell carcinoma (n=1). Those with pleomorphic adenomas were of average age 38 years (range, 32-44). There were 13 (3%) atypical cases (possible neoplasms) and 13 miscellaneous diagnoses (10 non-specific sialadenitis, 3 epidermal inclusion cysts).
Conclusions: These data indicate that FNA is useful to evaluate salivary gland lesions in a HIV+ population and may reduce their need for surgery, an important consideration in an underfunded public health care system. HIV-related salivary gland disease in South Africa is mainly due to benign conditions including lymphoepithelial lesions/cysts, reactive lymphadenopathy, and coinfection like tuberculosis. Neoplasms account for only a minor component of diagnoses in this HIV+ population.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 55, Wednesday Afternoon