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Muniz VRVM, Altemani A, Freitas VS, Pires BC, de Santana DA, Couto LA, Cangussu MCT, Gomez RS, de Souza SCOM, Vargas PA, Cury PR, de Araújo IB, Chaves RRM, Fonseca FP, Dos Santos JN. Chronic Sclerosing Sialadenitis of the Submandibular Gland and its Histopathological Spectrum in the IgG4-Related Disease: a Series of 17 Cases. Head Neck Pathol 2024; 18:42. [PMID: 38735890 PMCID: PMC11089028 DOI: 10.1007/s12105-024-01651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE This study aimed to characterize the histopathological immunohistochemical features of chronic sclerosing sialadenitis, emphasizing the IgG4-related disease. METHODS Seventeen cases of chronic sclerosing sialoadenitis were examined for histopathological aspects, (inflammation, fibrosis, glandular parenchyma, and lymphoid follicles) and immunohistochemistry (BCL2, CD3, CD20, CD34, CD163, p63, cyclin D1, mast cell, SMA, S100A4, IgG, and IgG4) which were scored. IgG4-related disease features were investigated. Demographic and clinical data were also collected. RESULTS Males predominated (10:7), with an average lesion size of 3.9 cm. Common histopathological findings included reduced acinar parenchyma, lymphoid follicle formation, and ductular proliferation. CD3-positive T lymphocytes and CD34- and SMA-positive stromal fibroblasts were abundant. Nine cases (53%) showed sialoliths and three cases met the criteria for IgG4-related disease. CONCLUSION CSS of the submandibular gland represents a reactive pattern rather than IgG4-RD as only 3 cases seemed to be related to IgG4-RD. The immunohistochemical profile revealed an abundant population of CD3-positive T lymphocytes, as opposed to regulatory proteins such as cyclin D1, demonstrating that populations of CD34- and SMA-positive stromal fibroblasts contribute to the fibrosis characteristic of CSS. In addition, our results provide a comprehensive insight into the study of CSS and its relationship with IgG4-RD.
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Affiliation(s)
| | - Albina Altemani
- Department of Pathology, School of Medical Sciences, State University of Campinas, Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Valéria Souza Freitas
- Department of Health, School of Dentistry, State University of Feira de Santana (UEFS), Feira de Santana, Feira de Santana, Bahia, Brazil
| | | | - Dandara Andrade de Santana
- Department of Biological Sciences, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | - Larissa Abbehusen Couto
- Department of Biological Sciences, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | | | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Pablo Augustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Patrícia Ramos Cury
- Department of Biological Sciences, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | - Iguaracyra Barreto de Araújo
- Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Roberta Rayra Martins Chaves
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Jean Nunes Dos Santos
- Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.
- Faculdade de Odontologia - UFBA, Laboratório de Patologia Oral e Maxilofacial, Avenida Araújo Pinho, 62, Canela, Salvador, 40110-150, Bahia, Brazil.
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Zhu WX, Zhang YY, Gao Y, Chen Y, Zhang ZY, Hua H, Yu GY. Primary Hyper-IgE-Related Salivary Gland Disease: A New Disease Entity. Laryngoscope 2022; 132:2132-2138. [PMID: 35199865 DOI: 10.1002/lary.30064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 02/08/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To clarify the clinicopathological characteristics of primary hyper-IgE-related salivary gland disease (PHIESD), which is a newly proposed entity. METHODS Fifteen consecutive patients pathologically diagnosed with chronic sialadenitis were enrolled, and their clinicopathological features were comprehensively analyzed. INCLUSION CRITERIA (1) multiple salivary gland enlargement; (2) elevated serum IgE and/or IgE-positive cell infiltration in salivary gland tissues; (3) histology-confirmed lymphoplasmacytic infiltration; (4) exclusion of other known diseases. RESULTS The male-to-female ratio was 5:10. The median age was 21 (range, 3-63) years. The average number of affected glands was 3.7 ± 1.4. Submandibular, parotid, and sublingual glands were involved in 15, 8, and 2 patients, respectively. Comorbid diseases included allergic diseases in seven patients and autoimmune diseases in two. Elevated serum IgE (median 175 kU/L) was seen in all patients. Serum IgG4 was slightly elevated in three patients. Histologically, most patients had mild lesions, including mild lymphocyte infiltration (60%) and focal fibrosis (66.7%). Lymphoid follicular formation (53.3%), moderate to severe lymphocytic inflammation (40%) and severe fibrosis (33.3%) were also observed. Immunohistochemically, IgE-positive cells infiltrated mainly around the ducts, with scattered infiltration of IgG4-positive, mast, and interleukin-4 positive cells. During follow-up (median, 46 months) of ten patients without intervention and two with immunosuppressive therapy, no significant changes in gland size or serum IgE level were noted. CONCLUSIONS PHIESD manifests as homogeneous enlargement of multiple salivary glands and elevated serum IgE. Histopathology further verifies the diagnosis. It might be associated with anaphylaxis or autoimmune dysfunction. Conservative treatment is suggested. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Wen-Xuan Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Yan-Yan Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Yan Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Yan Chen
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Zu-Yan Zhang
- Department of Oral Radiology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
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Zhu WX, Chen Y, Liu DG, Yu GY. Eosinophilic Sialodochitis: A Type of Chronic Obstructive Sialadenitis Related to Allergy. Laryngoscope 2020; 131:E800-E806. [PMID: 32621541 DOI: 10.1002/lary.28772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To investigate the clinical, laboratory, radiological, histopathological, and immunohistochemical features, and the expression of allergy-related cytokines in eosinophilic sialodochitis (ES). METHODS Thirty-eight patients diagnosed with chronic obstructive sialadenitis (COS) who had undergone glandular excision or incisional biopsy were enrolled. Seventeen patients with comorbid atopic disease and increased ductal tissue eosinophils comprised the ES group, while 21 patients comprised the COS group. The clinicopathological features and allergy-related cytokine expression were compared between groups. RESULTS The ES group frequently involved multiple, bilateral major salivary glands, and the number of glands was significantly greater than the COS group (2.8 ± 1.1 vs. 1.2 ± 0.4, P < .001). Serum immunoglobulin (Ig) E was elevated in 91% of patients in ES group (419 ± 357 kU/L) and peripheral blood eosinophil was significantly greater compared with the COS group (7.6% ± 4.6% vs. 2.5% ± 1.4%, P < .001). Histologically, eosinophil infiltration in ES group was observed around the main and interlobular ducts (50 ± 39/high power field [HPF]). Follicular hyperplasia (76%), epithelial mucous metaplasia (82%), and mucus plugs with eosinophils (41%) were observed. IgE-positive cell count was 20.7 ± 18.3/HPF and tryptase-positive mast cell count was 23.5 ± 15.1/HPF, which was significantly greater than the respective cell counts in COS group, which mainly infiltrated around the ducts. The levels of interleukin-4, interleukin-13, and eotaxin in tissue were significantly greater in ES than the COS group. CONCLUSIONS The clinicopathological characteristics of ES are significantly different from COS and ES might have an allergy-related pathogenesis. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E800-E806, 2021.
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Affiliation(s)
- Wen-Xuan Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yan Chen
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Deng-Gao Liu
- Department of Oral Radiology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Henriques ÁCG, Freitas RDA, Pires BC, Gurgel CA, Santos JND. Histochemical and immunohistochemical differences between solitary oral fibroma and fibrous papule of the face. An Bras Dermatol 2017; 91:589-594. [PMID: 27828630 PMCID: PMC5087215 DOI: 10.1590/abd1806-4841.20165077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/09/2015] [Indexed: 11/30/2022] Open
Abstract
Background The morphological similarities between fibrous papules of the face and
multiple sporadic oral fibromas were mentioned long ago and a relationship
between them has been reported in the literature. Objective The aim of this study was to evaluate the participation of mast cells,
elastin and collagen in a series of oral fibromas and fibrous papules of the
face in order to better understand the possible role of these factors in
fibrosis and the formation of these lesions. Methods Thirty cases of oral fibroma involving the buccal mucosa and 30 cases of
fibrous papules of the face were selected. Tissue samples were submitted to
picrosirius red staining and immunohistochemistry using anti-elastin and
anti-tryptase antibodies. Results The percentage of tryptase-positive mast cells and expression of elastin were
higher in cases of fibrous papules of the face (p < 0.05). In contrast, a
higher intensity of collagen deposition was observed in oral fibromas. The
results showed mast cell accumulation and higher elastin synthesis in
fibrous papules of the face, and mast cell accumulation with higher collagen
fiber synthesis in oral fibromas. Conclusion These findings support the hypothesis that mast cells influence the
development and growth of these lesions through different mechanisms.
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Minor salivary glands of the lips: a novel, easily accessible source of potential stem/progenitor cells. Clin Oral Investig 2013; 18:847-56. [PMID: 23900792 DOI: 10.1007/s00784-013-1056-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/15/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Cells with stem/progenitor properties have been detected in major salivary glands, but no data are available on their presence within minor salivary glands (MSGs). This study aimed to isolate and characterize potential stem/progenitor cells from human MSGs. MATERIALS AND METHODS MSGs of the lower lip were surgically obtained during biopsy for Sjogren's syndrome investigation that finally proved to be histologically normal. The established MSG cultures were assessed for morphology, proliferation, colony-forming-unit efficiency, multipotentiality, and immunophenotypic characteristics. RESULTS A mixed population of fibroblast-like and a few flat-shaped epithelial-like cells was obtained. These cells were capable for osteogenic, adipogenic, and neurogenic differentiation. Evidence for strong stem cell potency was observed by the detection of early stem cell markers, like Nanog, Oct-3/4, and SSEA-3. These cells also expressed characteristic mesenchymal stem cell markers, including CD90-Thy1, CD105, CD49f, CD81, nestin, CD146, and Stro-1, but were negative for CD117/C-KIT, CD45, and CD271/NFG. In addition, positivity for keratins 7/8 in part of the population was indicative of an epithelial phenotype, whereas these cells were negative for aquaporin-1 expressed in acinar/myoepithelial cells during development. CONCLUSIONS Based on these data, a cell population with stem/progenitor characteristics was primarily isolated from labial MSGs. The morphologic and immunophenotypic features indicated that this population is mixed with mesenchymal (mainly) and epithelial characteristics. CLINICAL RELEVANCE Due to their large number and superficial distribution in labial mucosa, MSGs may be proposed as a potential easily accessible source of adult stem/progenitor cells for regenerative therapies of glandular organs with parenchymal pathology.
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A perspective of comparative salivary and breast pathology. Part I: microstructural aspects, adaptations and cellular events. Eur Arch Otorhinolaryngol 2013; 271:647-63. [PMID: 23649507 DOI: 10.1007/s00405-013-2488-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
This is the first part of a review comparing the pathology of salivary and mammary glands. Here, less obvious similarities and differences in functional histology and their influences on pathology are examined with emphasis on myoepithelial cells, stromal components, analogues of mucosa-associated lymphoid tissue, steroid receptors, and intraparenchymal cells of monocytic lineage. Particular cell phenotypes (oncocytic, apocrine, neuroendocrine and clear) are critically evaluated and responses to atrophy, infarction and fine-needle aspiration biopsy procedures are highlighted together with aspects of metaplasia, regeneration, ageing and microcalcification. Areas of controversy or uncertainty which may benefit from further investigations are also discussed.
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Abstract
Chronic sclerosing sialadenitis is an uncommon cause of salivary gland enlargement mainly occurring in the fifth and seventh decade of life. In the Western population, chronic sclerosing sialadenitis has been characterized as an IgG4-related disease. Although rare, this lesion occurs in children. To increase awareness about this entity in the pediatric age group, we report the case of an 11-year-old boy with a hard, 4.0-cm circumscribed mass in the right submandibular gland. Histologically there was marked distortion of the gland architecture by a dense lymphocytic infiltrate and extensive fibrosis with septa that crossed and distorted the gland, leaving atrophic acini and dilated, irregular ducts. The lymphoid infiltrate formed multiple follicles with active germinal centers, numerous plasma cells, and areas with diffuse arrangement. Immunophenotyping showed abundant CD20- and CD3-positive lymphocytes; cytokeratin AE1/AE3 highlighted the distorted architectural pattern; IgG staining showed large numbers of positive cells infiltrating the interstitium and surrounding the atrophic acini and ducts. IgG4 staining revealed a large proportion of positive infiltrating elements. Küttner tumor belongs to the group of IgG4-related sclerosing diseases. The differential diagnosis includes pleomorphic adenoma and other salivary gland neoplasms. Its recognition in children is important clinically because this entity is amenable to steroid treatment, and additional work up and follow up is warranted to stave off other IgG4-related diseases/complications.
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Tenascin-C in chronic sclerosing sialadenitis. Head Neck Pathol 2011; 5:221-5. [PMID: 21559807 PMCID: PMC3173529 DOI: 10.1007/s12105-011-0265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
Abstract
Tenascin-C is an extracellular matrix glycoprotein that has been implicated in the development of fibrosis in certain chronic inflammatory/sclerosing conditions. This study was undertaken to expand our understanding of the processes involved in fibrosis that occurs in chronic sclerosing sialadenitis (CSS) by investigating the distribution of tenascin-C. Fifteen specimens of CSS with varying degrees of fibrosis and five normal submandibular glands were retrospectively examined immunohistochemically for the distribution of TNC. Linear deposition of TNC was found around collecting ducts in normal glands and around collecting ducts without surrounding fibrotic tissue in CSS; percentage incidences were not statistically different. In contrast, broader, band-like deposition of TNC was found in the fibrous tissue around collecting ducts in CSS with widespread degree of fibrosis compared to little or no fibrosis; the percentage incidence was statistically different. In addition, deposition of TNC was found around duct-like structures and extremely atrophic acini but, interestingly, however, was not found in fibrotic interlobular septa. The results of this investigation suggest that TNC is likely involved in the fibrosis that occurs around collecting ducts in CSS.
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Harrison JD, Epivatianos A. Immunoprofile of Küttner Tumor (Chronic Sclerosing Sialadenitis). Int J Surg Pathol 2010; 18:443. [DOI: 10.1177/1066896910376768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Barth PJ, Westhoff CC. Fibroblasts in chronic submandibular sialadenitis. Oral Dis 2008; 14:671; author reply 672. [PMID: 19076551 DOI: 10.1111/j.1601-0825.2008.01453.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Epivatianos A, Zaraboukas T, Poulopoulos A, Harrison JD. Author’s reply to letter from Professor Barth and Dr Westhoff. Oral Dis 2008. [DOI: 10.1111/j.1601-0825.2008.01454.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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