Seki Nobuhiko, Yamazaki Norikazu, Kondo Atsushi, Nomura Kazuaki, Himi Tetsuo
Department of Otolaryngology, Sapporo Medical University, Japan.
Auris Nasus Larynx. 2012 Apr;39(2):212-5. doi: 10.1016/j.anl.2011.01.025. Epub 2011 May 14.
Chronic sclerosing sialadenitis, which clinically resembles a salivary gland tumor, is considered a salivary gland lesion of the IgG4-related inflammatory disease. Corticosteroids are effective for the treatment of chronic sclerosing sialadenitis, but the natural clinical course of this disease is not fully understood. We report a 67-year-old man with chronic sclerosing sialadenitis who showed lung lesions, which spontaneously regressed without steroid therapy after excision of the submandibular gland. He presented with several weeks' history of continuous swelling in the right submandibular region. Physical examination showed a hard swelling of the right submandibular gland; the cytological finding was Papanicolaou class III. A chest X-ray demonstrated bilateral infiltration of the right middle and left lower lobes. The right submandibular gland was excised under general anesthesia for definite diagnosis, and histopathological examination revealed an IgG4-positive plasmacytic infiltration accompanied by periductal fibrosis and interlobular sclerosis, consistent with chronic sclerosing sialadenitis. Five months after operation, the lung lesions regressed spontaneously.
慢性硬化性涎腺炎在临床上类似于涎腺肿瘤，被认为是IgG4相关炎性疾病的涎腺病变。皮质类固醇对慢性硬化性涎腺炎的治疗有效，但该疾病的自然临床病程尚未完全明了。我们报告一名67岁患有慢性硬化性涎腺炎的男性，其出现肺部病变，在切除下颌下腺后未经类固醇治疗而自发消退。他有右侧下颌下区持续肿胀数周的病史。体格检查显示右侧下颌下腺坚硬肿胀；细胞学检查结果为巴氏三级。胸部X线显示右中肺和左下肺双侧浸润。在全身麻醉下切除右侧下颌下腺以明确诊断，组织病理学检查显示IgG4阳性浆细胞浸润，并伴有导管周围纤维化和小叶间硬化，符合慢性硬化性涎腺炎。术后五个月，肺部病变自发消退。
