Lymphocytic sialadenitis in the major and minor glands: a correlation in postmortem subjects.
TL;DR: The degree of lymphocytic infiltration in the labial salivary glands is positively correlated with the level of focal lymphocytics adenitis in the submandibular glands in the same subject.
Abstract: In the present investigation, the prevalence of focal lymphocytic adenitis in the submandibular salivary gland was observed in a series of 116 postmortem subjects after suitable exclusions had been made. Focal lymphocytic adenitis could not be demonstrated in the labial salivary glands. The degree of lymphocytic infiltration in the labial salivary glands is positively correlated with the level of focal lymphocytic adenitis in the submandibular glands in the same subject. Lymphocytic foci and lymphocytic infiltrations found under these circumstances are probably related. This finding provides conceptual support for the examination, by biopsy, of the labial glands in patients suspected of Sjogren's syndrome.
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University of Pisa1, Autonomous University of Barcelona2, University of Manchester3, University of Erlangen-Nuremberg4, Royal National Hospital for Rheumatic Diseases5, University of Copenhagen6, University of Bristol7, Sheba Medical Center8, University of Ioannina9, University of Padua10, Sapienza University of Rome11
TL;DR: Using the findings of this prospective multicenter European study, general agreement can be reached on the diagnostic procedures to be used for patients with SS.
Abstract: Objective. Different sets of diagnostic criteria have been proposed for Sjogren's syndrome (SS), but none have been validated with a large series of patients or in a multicenter study. We conducted the present study involving 26 centers from 12 countries (11 in Europe, plus Israel), with the goals of reaching a consensus on the diagnostic procedures for SS and defining classification criteria to be used in epidemiologic surveys and adopted by the scientific community.
Methods. The study protocol was subdivided into two parts. For part I, questionnaires regarding both ocular and oral involvement were developed; they included 13 questions and 7 questions, respectively. For part II a limited set of diagnostic tests was selected, and the exact procedure to be followed in performing these tests was defined. Part I of the study ipcluded 240 patients with primary SS and 240 age- and sex-matched controls. Two hundred forty-six patients with primary SS, 201 with secondary SS, 113 with connective tissue diseases but without associated SS, and 133 control patients were studied in part II.
Results. The study resulted in (a) the validation of a simple 6-item questionnaire for determination of dry eyes and dry mouth, which showed good discriminant power between patients and controls, to be used in the initial screening for sicca syndrome; and (b) the definition of a new set of criteria for the classification of SS. The sensitivity and specificity of the criteria in correctly identifying patients with either the primary or the secondary variant of SS were also determined.
Conclusion. Using the findings of this prospective multicenter European study, general agreement can be reached on the diagnostic procedures to be used for patients with SS. Final validation of the preliminary classification criteria for SS is underway.
1,487 citations
TL;DR: The clinical and laboratory features of patients referred for evaluation of sicca symptoms are reviewed, and the need for care in choosing the site for minor salivary gland biopsy is emphasized, and histologic features that aid in the evaluation of these biopsy specimens are described.
Abstract: The term "Sjogren's syndrome" (SS) is frequently used to describe the occurrence of keratoconjunctivis sicca and xerostomia in association with an autoimmune disorder. However, well-defined criteria for the classification of SS have not been established, and this diagnosis is being applied to a wide spectrum of conditions, ranging from clear "autoimmune" disease in some patients, to sicca complaints without evidence of a systemic immune process in elderly patients. Here, we review the clinical and laboratory features of patients referred for evaluation of sicca symptoms. In particular, we emphasize the need for care in choosing the site for minor salivary gland biopsy, and we describe the histologic features that aid in the evaluation of these biopsy specimens. In an attempt to identify a population of patients whose conditions might have a common etiopathogenesis and, thus, a common treatment program, we propose the following criteria for a diagnosis of SS: 1) objective evidence of keratoconjunctivis sicca, as documented by rose bengal or fluorescein dye staining; 2) objective evidence of diminished salivary gland flow; 3) minor salivary gland biopsy, obtained through normal mucosa, with the specimen containing at least 4 evaluable salivary gland lobules, and having an average of at least 2 foci/4 mm2; 4) evidence of a systemic autoimmune process, as manifested by the presence of autoantibodies, such as rheumatoid factor and/or antinuclear antibody. The diagnosis of "definite SS" would be made when all 4 criteria are met; the diagnosis of "possible SS" would be made when 3 criteria are present. Specific exclusions for this diagnosis are preexisting lymphoma, graft-versus-host disease, sarcoidosis, and acquired immunodeficiency disease.(ABSTRACT TRUNCATED AT 250 WORDS)
676 citations
TL;DR: Labial salivary gland biopsy specimens from seventy-five patients evaluated for Sjogren's syndrome showed the most marked histologic change, and focus score was found to be the most useful histologic index of severity of the disease.
647 citations
TL;DR: The salivary component of SS should be redefined as the presence of LSG focal sialadenitis, an objective criterion and a more disease-specific feature of SS than xerostomia or any other feature of Salivary disease.
Abstract: Xerostomia is an unsatisfactory diagnostic criterion for the salivary component of Sjogren'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 >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 < 0.0005 and P < 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.
564 citations
TL;DR: Xerostomia is the subjective sensation of oral dryness that is most commonly associated with salivary gland dysfunction, but it may also occur with normal gland activity.
Abstract: The dentist is usually the first health professional to hear a complaint about oral dryness and is critical to the evaluation of the cause
504 citations
References
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Book•
01 Jan 1956
TL;DR: This is the revision of the classic text in the field, adding two new chapters and thoroughly updating all others as discussed by the authors, and the original structure is retained, and the book continues to serve as a combined text/reference.
Abstract: This is the revision of the classic text in the field, adding two new chapters and thoroughly updating all others. The original structure is retained, and the book continues to serve as a combined text/reference.
35,552 citations
TL;DR: The labial biopsy is shown to be a further valuable investigative procedure in patients with Sjögren's disease and was used to study 40 patients with connective tissue disease and 60 postmortem subjects.
Abstract: A labial biopsy technique is described and was used to study 40 patients with connective tissue disease and 60 postmortem subjects. More than one focus of lymphocytes per 4 sq mm of minor salivary tissue was found to be a consistent finding in patients with Sjogren's disease. The labial biopsy is shown to be a further valuable investigative procedure in such patients.
921 citations
79 citations
TL;DR: The hypothesis that foci of lymphatic infiltration seen in salivary and lacrimal glands might be more common than was realized, that they might represent a focal form of Sj6gren's syndrome and that they may have the same associations with systemic disease entities as Sjogren's syndrome is investigated.
Abstract: The mechanism of production of Sjogren's syndrome (of which an oral manifestation is commonly dryness of the mouth) has been tentatively linked with that of rheumatoid arthritis by Morgan (1954) and with that of a 'broader spectrum of auto-immune disease' by Bunim (1961). The present work was designed to investigate the hypothesis that foci of lymphatic infiltration seen in salivary and lacrimal glands might be more common than was realized, that they might represent a focal form of Sj6gren's syndrome and that they might have the same associations with systemic disease entities as Sjogren's syndrome. The problem was approached in two ways: (1) by examination of post-mortem material and (2) by experimental attempts to reproduce the lesions in two species of laboratory animal. In regard to terminology: the view of Bunim (1961) that the term Sjogren's syndrome should be used in a comprehensive sense and should include 'Mikulicz's disease' is accepted. Focal adenitis of salivary and lacrimal glands will be defined as chronic inflammation of these glands apparently unconnected, at least until late in the process, with suppuration or duct obstruction and manifested by the presence of microscopical foci of lymphocytes, histiocytes and a few plasma cells, usually in association with small veins. Gland lobules, whether containing otherwise acceptable foci or not, in which polymorphonuclear leucocytes were found in any site outside blood vessels or in which there was any duct dilatation were specifically excluded from consideration.
62 citations