Oral swelling in Sjögren's syndrome

Minor salivary gland swelling in patient with Sjögren's syndrome

A case of Sjögren's syndrome with an unusual minor salivary gland swelling is reported. The patient was a 63-year-old female with a chief complaint of palatal swelling and dry mouth. Clinical examination revealed diffuse swelling of the hard palate and bilateral parotid regions, and sialographic examination of the parotid gland showed evidence of sialoangiectasia. Histopathological findings of the palatal and parotid lesions revealed intense lymphoid cell infiltration replacing the salivary gland parenchyma, and scattered epimyoepithelial islands throughout the lesions. Although it is well known that major salivary gland swelling caused by marked lymphoid cell infiltration is one of the common features in patients with Sjögren's syndrome, a similar swelling in the region of the minor salivary glands is not usually apparent.

Benign lymphoid hyperplasia of the palate

Seven patients with benign lymphoid hyperplasia of the palate are reported. Clinically, these lesions presented as painless non-ulcerated masses that were unilateral in 6 of the cases and bilateral in one. Microscopically, the lesions were characterized by a mixed lymphoid infiltrate, germinal centres and vascular channels with hyperplasia of endothelial cells. The patients were followed for 3-10 years subsequent to diagnosis. One patient had 2 sequential lesions on opposite sides of the palate. Another patient with lesions of both submandibular salivary glands in addition to the palate developed rheumatoid arthritis, xerophthalmia and serologic changes consistent with systemic autoimmune disease. To date, none of the patients developed signs and symptoms of lymphoma or leukemia. The etiology of these lesions is unknown. Their distinction from lymphoma of the palate, as well as their possible relationship to the benign lymphoepithelial lesion of palatal mucous glands, is discussed.

Follicular lymphoid hyperplasia of the hard palate: a benign lymphoproliferative process

Follicular lymphoid hyperplasia of the hard palate is a reactive lymphoid proliferation which closely simulates the palatal lymphomas, both clinically and histologically. It is therefore imperative that the pathologist be familiar with the features that separate these two conditions. In equivocal cases like the present one, immunologic analysis would seem to be indicated to determine whether the lesion is monoclonal (neoplastic) or polyclonal (reactive).

Follicular lymphoid hyperplasia of the hard palate simulating lymphoma

Follicular lymphoid hyperplasia of the hard palate is a slowly growing, soft, nontender swelling that may grow to involve the entire hard palate. The overlying mucosa is normal. This appearance naturally prompts biopsy, and both clinically and microscopically might be confused with lymphoma. Four case histories are presented with histologic description: normal palatal submucosal structures are replaced with benign reactive lymphoid tissue replete with well-developed germinal centers. Surrounding these centers are dense populations of small, regular, bland lymphocytes. Minor salivary glands, except for some atrophied residue, are notably absent; also absent are the epimyoepithelial islands characteristic of the benign lymphoepithelial lesion (Mikulicz's disease). Etiologic factors remain obscure. One of our patients had two recurrences following local excision; in another patient nodules of benign lymphoid hyperplasia developed in the cheek and upper neck. These four patients are alive and free of any malignant process 4, 7, 9, and 12 years after the onset of their palatal swellings. We urge caution in distinguishing these lesions from palatal lymphoma, and recommend local excision as the treatment of choice.