51
|
Abstract
Granulomatous inflammation of the major salivary glands is very rare and may be due to obstruction. Little attention has been paid to this condition. The reaction is caused by extravasation of mucus, as seen in the common mucocele of the minor salivary glands. A case of granulomatous inflammation of the submandibular gland caused by obstruction is presented. The etiology of granulomatous sialadenitis is reviewed.
Collapse
|
52
|
|
53
|
Melsom RD, Speight PM, Ryan J, Perry JD. Sarcoidosis in a patient presenting with clinical and histological features of primary Sjögren's syndrome. Ann Rheum Dis 1988; 47:166-8. [PMID: 3355252 PMCID: PMC1003471 DOI: 10.1136/ard.47.2.166] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient presenting with bilateral enlargement of parotid and lacrimal glands, xerostomia, and keratoconjunctiva sicca, whose labial biopsy specimen showed changes consistent with Sjögren's syndrome, is described. The patient was initially misdiagnosed as having primary Sjögren's syndrome (SS). Subsequent investigations, however, performed to exclude an associated lymphoma or sarcoidosis, showed histological changes of the latter. The possibility that early infiltrates of the salivary glands in sarcoid may mimic those of SS is discussed.
Collapse
Affiliation(s)
- R D Melsom
- Department of Rheumatology, London Hospital
| | | | | | | |
Collapse
|
54
|
Lindström FD, Hellquist H, Olofsson J. Evaluation of lip salivary gland biopsy in 21 patients with primary Sjögren's syndrome. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1987; 45:156-65. [PMID: 3499274 DOI: 10.1016/0090-1229(87)90030-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Lip salivary gland biopsy was performed in 21 (20 female) patients, age 26 to 74 years, with primary Sjögren's syndrome. The procedure helped identify a patient group with many autoimmune phenomena, including hypergammaglobulinemia, autoantibodies, autoimmune thyroiditis, vasculitis, and immunocytoma. A marked association with the HLA-DR3 antigen was noted. It is concluded that lip salivary gland biopsy is a simple and safe procedure that makes possible the identification among non-RA patients with sicca symptoms those who have autoimmune disturbance. This patient group deserves close medical supervision in order to detect autoimmune disease that requires treatment, such as autoimmune thyroiditis and lymphoma.
Collapse
Affiliation(s)
- F D Lindström
- Department of Internal Medicine (Division of Rheumatology), University Hospital, Linköping, Sweden
| | | | | |
Collapse
|
55
|
Abstract
We examined eight patients with primary Sjögren's syndrome and uveitis. In all patients, the uveitis was bilateral, chronic, anterior and posterior, and not associated with active chorioretinitis. Seven of the eight patients were women. The diagnosis of primary Sjögren's syndrome was generally based on results of a Schirmer test, minor salivary gland biopsy, and serologic studies. Frequent findings included keratic precipitates, cataract, a pars plana exudate, an increased sedimentation rate, a positive test for antinuclear antibodies in a speckled pattern, and associated systemic disease compatible with the spectrum of Sjögren's syndrome.
Collapse
Affiliation(s)
- J T Rosenbaum
- Department of Medicine, Oregon Health Sciences University, Portland 97201
| | | |
Collapse
|
56
|
Brantley SD, Orzel JA, Weiland FL, Bower JH. Parotid gland biopsy and 67Ga imaging correlation in systemic sarcoidosis. Chest 1987; 91:403-7. [PMID: 3816318 DOI: 10.1378/chest.91.3.403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We correlated the results of parotid gland biopsy, chest roentgenograms, and gallium citrate scintigraphy in 24 patients evaluated for possible systemic sarcoidosis. Of 19 patients ultimately proven to have sarcoidosis, 11 (57.9 percent) had positive parotid gland biopsy. The yield of parotid gland biopsy in patients with abnormal gallium parotid activity was only marginally higher (64.7 percent). Abnormal parotid gland uptake of gallium citrate was seen in 17 of these 19 patients (89.5 percent) and was always associated with abnormal lung or perihilar activity. The parotid gland biopsy is a useful technique for obtaining the tissue diagnosis of sarcoidosis; however, gallium scintigraphy should not be performed to select patients as this will only marginally increase the biopsy yield.
Collapse
|
57
|
van der Walt JD, Leake J. Granulomatous sialadenitis of the major salivary glands. A clinicopathological study of 57 cases. Histopathology 1987; 11:131-44. [PMID: 3570176 DOI: 10.1111/j.1365-2559.1987.tb02617.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fifty-seven of 469 major salivary glands excised for various reasons were found to contain granulomas. The aetiologies were tuberculosis (eight parotid, one sublingual), sarcoidosis (two parotid), calculous duct obstruction (34 submandibular), carcinomatous duct obstruction (four submandibular, one sublingual) and undetermined (four submandibular, three parotid). The tuberculous glands showed caseation in the majority of cases but two cases consisted predominantly of discrete granulomas with minimal necrosis. The sarcoid granulomas were typically non-caseating but a few were centrally necrotic. The cases of calculous and carcinomatous duct obstruction contained single to multiple small granulomas which contained mucin and were related to ruptured ducts. It is suggested that the frequency of calculi and the mixture of serous and mucous acini in the submandibular gland account for the distribution of obstructive granulomas. This study establishes calculous sialadenopathy as a major cause of granulomatous sialadenitis.
Collapse
|
58
|
Verheijen-Breemhaar L, de Man K, Zondervan PE, Hilvering C. Sarcoidosis with maxillary involvement. Int J Oral Maxillofac Surg 1987; 16:104-7. [PMID: 3104487 DOI: 10.1016/s0901-5027(87)80038-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A case of sarcoidosis with maxillary involvement is presented. The patient complained of loose teeth in the upper anterior region, while radiographs revealed a poorly defined radiolucent area round the midline of the anterior maxilla. The diagnosis was verified by histopathologic examination.
Collapse
|
59
|
|
60
|
|
61
|
|
62
|
|
63
|
Abstract
Sarcoidosis, a multisystem disease of unknown cause characterized by the formation of noncaseating granulomas, may involve any organ of the body, but the commonest sites of predilection are the lungs, lymph nodes, skin, and eyes. Sarcoidosis can be associated with polyclonal hyperglobulinemia, hypercalcemia, hypercalciuria, circulating immune complexes, cutaneous anergy, and in vitro depressed cell-mediated immunity. Recent studies of the cellular composition and cellular interactions of sarcoid-involved tissue have resulted in some insight into the pathophysiology of the disease. In early stages the predominance of activated T-helper cells in affected sites may account for many of the immunologic aberrations. The production of macrophage chemotactic substances by these cells may be the initial stimulus for the formation of the granuloma. The natural history of the disease is highly variable; the acute forms tend to resolve spontaneously, whereas the chronic forms rarely involute. Although multiple therapeutic modalities have been used and some have reportedly been effective, systemic corticosteroids remain the most effective available therapeutic agents.
Collapse
|
64
|
Abstract
Because the eye is involved in about 25% of patients with active sarcoid, the ophthalmologist is often the first physician to see these patients. Although clinical findings may suggest sarcoid, laboratory tests (e.g., x-ray, skin tests, blood chemistries, etc.) may be normal or inconclusive. Thus, it is important that the ophthalmologist be aware of the availability and limitations of the various biochemical, immunological, radiological, and histopathological tests that contribute to the early diagnosis of sarcoidosis. The authors review diagnostic procedures and present a flowchart detailing indications for each.
Collapse
|
65
|
Daniels TE. Labial salivary gland biopsy in Sjögren's syndrome. Assessment as a diagnostic criterion in 362 suspected cases. ARTHRITIS AND RHEUMATISM 1984; 27:147-56. [PMID: 6696772 DOI: 10.1002/art.1780270205] [Citation(s) in RCA: 362] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Xerostomia is an unsatisfactory diagnostic criterion for the salivary component of Sjögren's syndrome (SS). To determine the diagnostic usefulness of the presence of focal sialadenitis in labial salivary gland (LSG) biopsy specimens, 362 patients suspected of having SS prospectively underwent a unique LSG biopsy procedure. The pattern and severity of LSG inflammation were compared with measurements of parotid flow rate, and the presence or absence of symptomatic xerostomia, major salivary gland enlargement, keratoconjunctivitis sicca (KCS), and other connective tissue diseases (CTD). LSG biopsy focus scores of greater than 1 correlated more closely with the diagnoses of KCS alone and with KCS plus a CTD than did either reduced parotid flow rate or symptoms of xerostomia (P less than 0.0005 and P less than 0.05, respectively). Focal sialadenitis in an adequate LSG specimen is an objective criterion and a more disease-specific feature of SS than xerostomia or any other feature of salivary disease. The salivary component of SS should be redefined as the presence of LSG focal sialadenitis.
Collapse
|
66
|
de Wilde PC, Slootweg PJ, Hené RJ, Baak JP, Kater L. Multinucleate giant cells in sublabial salivary gland tissue in Sjögren's syndrome. A diagnostic pitfall. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1984; 403:247-56. [PMID: 6428039 DOI: 10.1007/bf00694901] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The presence of multinucleate giant cells in the sublabial salivary gland tissue in Sjögren's syndrome is an unusual phenomenon which can give rise to differential diagnostic problems. We found in 4 cases of 55 patients with Sjögren's syndrome multinucleate giant cells. In 2 of these 4 patients epimyoepithelial islands were also present. The combination of both multinucleate giant cells as epimyoepithelial islands can mimic the histological picture of a non- caseating granulomatous disease. To discriminate between an epimyoepithelial island and an epithelioid granuloma the immunoperoxidase technique with antibodies directed against muramidase appeared an useful tool. The epithelioid cells contain muramidase whereas the cells in the epimyoepithelial island do not contain this enzyme. Thus, multinucleate giant cells are a rare phenomenon in Sjögren's syndrome, therefore restricting its diagnostic significance. When they occur in Sjögren's syndrome staining for muramidase can be of help to avoid a false positive diagnosis of diseases in which non- caseating granulomatous inflammation occur, such as in sarcoidosis.
Collapse
|
67
|
Kilpi A, Konttinen YT, Malmström M, Bergroth V, Reitamo S, Helve T. Immunocompetent cells in labial salivary glands in secondary Sjögren's syndrome associated with SLE. JOURNAL OF ORAL PATHOLOGY 1983; 12:465-72. [PMID: 6418868 DOI: 10.1111/j.1600-0714.1983.tb00358.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
T and B lymphocyte (sub)populations were identified by monoclonal hybridoma antibodies (the avidin-biotin-peroxidase complex method), in the periductal lymphocyte-rich infiltrates in the labial salivary glands of 8 patients with secondary Sjögren's syndrome (2 degrees SS) associated with systemic lupus erythematosus (SLE). 59 +/- 7% and 17 +/- 3% of inflammatory round cells in situ were T3-positive and surface(SIg)- or cytoplasmic(CIg) immunoglobulin-positive, respectively. This suggests a local T lymphocyte dominance in salivary glands in 2 degrees SS associated with SLE. The local ratio of cells expressing T inducer/helper: T suppressor/cytotoxic phenotype was 3.5 +/- 0.8 (range 0.9-7.6) indicating large variations between individual patients. 46 +/- 9% of all inflammatory cells in situ were endogenous peroxidase-negative, Ia-positive cells, suggesting an active role for the locally accumulated T lymphocytes.
Collapse
|
68
|
Oakley JR, Lawrence DA, Fiddian RV. Sarcoidosis associated with Crohn's disease of ileum, mouth and oesophagus. J R Soc Med 1983; 76:1068-71. [PMID: 6672200 PMCID: PMC1439525 DOI: 10.1177/014107688307601219] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
69
|
Malmström M, Seppä A, Konttinen YT, Helve T, Reitamo S. Sjögren's syndrome in systemic lupus erythematosus and rheumatoid arthritis: immune effector cells in salivary glands. Rheumatol Int 1983; 3:1-5. [PMID: 6604304 DOI: 10.1007/bf00541224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A simultaneously capturing azo dye method for acid alpha-naphthyl acetate esterase was used to characterize the cellular infiltrate in labial salivary glands in 25 patients with Sjögren's syndrome (SS). There was no significant difference in the T-pattern lymphocyte percentage in situ between the untreated group with SS and the group treated with 10 +/- 2 mg prednisone/day. There was a significant correlation (P less than 0.05) between the T-pattern lymphocyte percentage in situ and the focus-score value. In secondary (2 degrees) SS in cases of systemic lupus erythematosus (SLE) and rheumatoid arthritis, respectively, 55% +/- 4% (range 41-69) and 43% +/- 7% (range 15-80) of all inflammatory cells in the periductal lymphocyte-rich infiltrates were T-pattern lymphocytes. In other SS patients the corresponding value was 28% +/- 7% (range 4-50). The T-pattern lymphocyte percentage in situ was dependent on the disorder associated with SS (P = 0.07). The present results indicate the dominance of T-lymphocytes in situ in 2 degrees SS with SLE and suggest that there are differences in cell-mediated immunity in different clinical subgroups of SS.
Collapse
|
70
|
Izutsu KT, Schubert MM, Truelove EL, Shulman HM, Sale GE, Morton TH, Ensign WY, Mersai T, Sullivan KM, Oberg S, Thomas ED. The predictive value of elevated labial saliva sodium concentration: its relation to labial gland pathology in bone marrow transplant recipients. Hum Pathol 1983; 14:29-35. [PMID: 6339354 DOI: 10.1016/s0046-8177(83)80043-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Labial minor gland salivary flow rate and sodium concentration were analyzed in relation to 1) histologic findings in labial biopsy specimens and 2) the occurrence of chronic graft-versus-host disease (GVHD) in patients who received bone marrow transplants. Biopsy specimens and samples were obtained from 61 recipients of marrow transplants (including three twins) 51 to 1,260 days post transplantation. Labial saliva sodium concentrations were elevated in some patients, and these increases were associated with inflammation and destruction of minor salivary gland acini and ducts by chronic GVHD or other factors. The predictive value of the salivary sodium changes in evaluating labial salivary gland pathologic changes was 91 per cent, and the sensitivity was 74 per cent. Thus, if a transplant recipient is found to have an elevated labial saliva sodium level, then the probability that he has pathologic labial gland changes is 91 per cent. When analyses were restricted to include only patients who received no irradiation during transplantation, then elevated labial saliva sodium concentration was significantly associated with the occurrence of chronic GVHD. The sensitivity of this relationship was 42 per cent, but the predictive value was 100 per cent. Thus, if a nonirradiated transplant recipient is found to have an elevated labial saliva sodium concentration, then it is virtually certain that he has chronic GVHD. We found no significant changes in labial saliva flow rates in these bone marrow transplant recipients.
Collapse
|
71
|
Batsakis JG. The pathology of head and neck tumors: the lymphoepithelial lesion and Sjögren's syndrome, Part 16. HEAD & NECK SURGERY 1982; 5:150-63. [PMID: 6763017 DOI: 10.1002/hed.2890050211] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The clinical disorder Sjögren's syndrome and its putative histologic marker in salivary tissues, the lymphoepithelial lesion, have been and continue to be sources of confusion as well as the subjects of extensive immunologic and pathologic research. At the present time, Sjögren's syndrome is defined as a lymphocyte-mediated exocrinopathy but definition does little justice to the profound immunogenetic basis of the syndrome. This report presents a contemporary review of the lymphoepithelial lesion and the syndrome and presents a hypothesis of pathogenesis based on a graft vs host disease-like disorder. The hypothesis incorporates the immunogenetic, immunoregulatory, and neoplastic aspects of Sjögren's syndrome.
Collapse
|
72
|
|
73
|
|
74
|
van Maarsseveen AC, van der Waal I, Stam J, Veldhuizen RW, van der Kwast WA. Oral involvement in sarcoidosis. INTERNATIONAL JOURNAL OF ORAL SURGERY 1982; 11:21-9. [PMID: 6811453 DOI: 10.1016/s0300-9785(82)80044-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
75
|
Hanno R, Callen JP. Sarcoidosis: a disorder with prominent cutaneous features and their interrelationship with systemic disease. Med Clin North Am 1980; 64:847-66. [PMID: 7432044 DOI: 10.1016/s0025-7125(16)31570-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|