HIV with Swollen Lymph Node on Left Facial Cheek

Question

I am caregiver to a friend who has been HIV+ for 17 yrs. He recently has an attack of herpes in the head and neck area successfully treated with Aciclover with a swelling in his left facial cheek front of ear. A fine needle biopsy was taken with the following medical report which I am unable to fully understand. Can you please elaborate in lay terms as to what is the seriousness of the evaluation? What kind of treatment should we expect? How serious is this report? He has been scheduled for surgery to remove the swollen node for another biopsy-is this necessary? Why not treatment without surgery? Thanks for the great service you are providing for the public.

FINAL CYTOLOGIC DIAGNOSIS: A. RT Parotid Gland, Fine Needle Aspiration: B-cell lymphoma, most consistent with marginal zone lymphoma. Comment: The aspirate smears show marked cellularity and consist of a relatively monotonous population of predominantly medium-sized lymphocytes with fewer numbers of larger lymphocytes. To aid in diagnosis, a portion of the sample is sent for flow cytometry, where studies show that the lymhocytes express CD20 (B-cell lineage)and are kappa-restricted, indicating a clonal population. These cytologic and immunophenotypic features are those of lymphoma. The lymphocytes do no show aberrant expression of CD5 or CD10, making CLL/SLL, mantle cell lymphoma, Burkitt's lymphoma or follicular lymphoma less likely. Given the location of the lesion and the overall cytologic and immunophenotypic features, the findings are most consistent with marginal zone lymphoma. However, consideration for complete work-up for lymphadenophathy elsewhere is suggested for staging and classification purposes. /R/1 month history of right parotid swelling with facial nerve paralysis.

Answer

Your friend needs to discuss the situation further with his/her HIV specialist. The biopsy report suggests there may be some form of cancer (lymphoma) in the parotid that will need more evaluation and likely treatment (surgery/radiation/chemotherapy). KH