Teymoortash A, Simolka N, Schrader C, Tiemann M, Werner J A
Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.
Histopathology. 2005 Nov;47(5):493-500. doi: 10.1111/j.1365-2559.2005.02256.x.
Irradiation-induced sialadenitis is a significant cause of morbidity in head and neck cancer patients receiving radiotherapy. Neither the exact aetiopathology of chronic irradiation-induced sialadenitis nor the mechanisms leading to atrophy of the glandular cells associated with an increase in extracellular matrix are understood. The aim of our study was to determine the phenotype of the inflammatory infiltrate and to study its distribution in the affected submandibular glands.
Paraffin-embedded submandibular glands from a homogeneous group of 19 patients with advanced oropharyngeal cancer who received conventional radiotherapy to the primary site and upper neck were analysed. In all patients the radiation dose and field were approximately equal. The submandibular glands were obtained during neck dissection. To characterize the lymphoid infiltrate, all tissue sections were immunostained for T cells (CD3, CD4, CD8), cytotoxic T cells (granzyme B), B cells (CD20), and macrophages (Ki-M1p). A histopathological classification into four grades was established based on the degree of glandular atrophy, fibrosis and lymphocytic infiltration. Phenotypic analysis of submandibular gland sections revealed that the great majority of lymphocytic infiltrates were cytotoxic T cells associated with acinar cell destruction.
The significantly elevated frequencies of cytotoxic cells in the submandibular glands of patients with irradiation-induced sialadenitis suggest that cell-mediated immune mechanisms may play a part in the pathogenesis of this disease.
放射性涎腺炎是头颈部癌患者接受放射治疗后发病的一个重要原因。目前既不清楚慢性放射性涎腺炎的确切病因病理，也不了解导致腺细胞萎缩并伴有细胞外基质增加的机制。我们研究的目的是确定炎性浸润的表型，并研究其在受影响的下颌下腺中的分布。
对19例晚期口咽癌患者的石蜡包埋下颌下腺进行分析，这些患者接受了原发部位和上颈部的常规放疗。所有患者的放射剂量和照射野大致相同。下颌下腺是在颈部清扫术中获取的。为了表征淋巴细胞浸润情况，所有组织切片均进行了T细胞（CD3、CD4、CD8）、细胞毒性T细胞（颗粒酶B）、B细胞（CD20）和巨噬细胞（Ki-M1p）的免疫染色。根据腺萎缩、纤维化和淋巴细胞浸润程度建立了四级组织病理学分类。下颌下腺切片的表型分析显示，绝大多数淋巴细胞浸润是与腺泡细胞破坏相关的细胞毒性T细胞。
放射性涎腺炎患者下颌下腺中细胞毒性细胞的频率显著升高，提示细胞介导的免疫机制可能在该疾病的发病机制中起作用。
