Erkılınç Gamze, Doğru Atalay, Arslan Yaşar, Burak Öz Rıza, Karahan Nermin, Şahin Mehmet, Çiriş İbrahim Metin
Department of Pathology, Süleyman Demirel University School of Medicine, Isparta, Turkey.
Department of Internal Medicine, Division of Rheumatology, Süleyman Demirel University School of Medicine, Isparta, Turkey.
Arch Rheumatol. 2021 Oct 18;37(1):49-58. doi: 10.46497/ArchRheumatol.2022.8607. eCollection 2022 Mar.
This study aims to evaluate which of the histomorphological criteria defined in labial salivary gland biopsy are more valuable in diagnosing Sjögren's syndrome (SS) and to examine its correlation with clinical and laboratory findings.
Between January 2005 and January 2019, a total of 927 patients (104 males, 823 females; mean age: 51 years; range, 19 to 85 years) who underwent minor salivary gland biopsies with the suspicion of SS were retrospectively analyzed. The American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2016 classification criteria were used for the classification of SS. We evaluated salivary gland biopsies histomorphologically for the presence and number of lymphocytic focus, as well as chronicity findings (acinar atrophy, ductal dilatation, fibrosis), the presence of lymphocytic infiltration, distribution, localization, ectopic germinal center, and mast cell count. The presence of accompanying diseases, clinical and laboratory findings including age, sex, the presence of dry eye and mouth, and autoantibodies for discriminating SS were noted. Histomorphologically, salivary gland biopsy which fulfilled the adequacy criteria for glandular tissue were compared with the other criteria used to diagnose SS.
Strong chronicity and diffuse lymphocytic infiltration were significantly higher in the SS group compared to the non-SS group (p<0.001). Lymphocytic focus score >1 was significantly higher in the SS group compared to the non-SS group (p<0.001). Strong chronicity, acinar atrophy, andductal dilatation were significantly higher in the SS group compared to the non-SS group (p<0.001).
More than one lymphocytic focus is the most valuable finding in diagnosing SS. However, it should be kept in mind that, in cases of SS, ductal dilatation, acinar atrophy, and chronicity may be present without lymphocytic infiltration.
本研究旨在评估唇腺活检中定义的组织形态学标准中哪些在诊断干燥综合征（SS）方面更具价值，并探讨其与临床及实验室检查结果的相关性。
回顾性分析2005年1月至2019年1月期间共927例疑似SS而接受小唾液腺活检的患者（104例男性，823例女性；平均年龄：51岁；范围19至85岁）。采用美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）2016分类标准对SS进行分类。我们对唾液腺活检组织进行组织形态学评估，观察淋巴细胞灶的存在及数量，以及慢性改变（腺泡萎缩、导管扩张、纤维化）、淋巴细胞浸润的存在、分布、定位、异位生发中心及肥大细胞计数。记录伴随疾病的存在情况、包括年龄、性别、干眼和口干的存在情况以及用于鉴别SS的自身抗体等临床和实验室检查结果。在组织形态学上，将符合腺体组织充足标准的唾液腺活检结果与用于诊断SS的其他标准进行比较。
与非SS组相比，SS组的重度慢性改变和弥漫性淋巴细胞浸润明显更高（p<0.001）。与非SS组相比，SS组淋巴细胞灶评分>1明显更高（p<0.001）。与非SS组相比，SS组的重度慢性改变、腺泡萎缩和导管扩张明显更高（p<0.001）。
多个淋巴细胞灶是诊断SS最有价值的发现。然而，应记住，在SS病例中，可能存在导管扩张、腺泡萎缩和慢性改变而无淋巴细胞浸润。
