Clinical, histopathological, and immunohistochemical characteristics of patients with sicca syndrome with a focus score ≥ 1 in the minor salivary gland biopsy.

INTRODUCTION

Sjögren’s syndrome is a systemic autoimmune disease. The usefulness of immunohistochemistry in minor salivary gland biopsies has been described to be helpful in indirectly characterizing the lymphocyte phenotype in difficult diagnosis cases.

OBJECTIVE

To describe sociodemographic, clinical, serological, histopathological, and immunohistochemical variables in patients with sicca syndrome and a minor salivary gland biopsy focus score greater than or equal to one.

MATERIALS AND METHODS

We conducted an observational, retrospective study that included patients under study for potential sicca syndrome whose minor salivary gland biopsy was available and had obtained a focus score greater than or equal to one. Immunohistochemistry was performed on the minor salivary gland biopsy with chromogen red staining for CD8 T lymphocytes and brown staining for CD4 T lymphocytes. Expression ratio of CD20:CD3 and CD4:CD8 markers was determined with the MoticEasyScan Pro 6™ (MOTIC) device and the QuPath™ software. Qualitative variables were analyzed using the chi-square or Fisher’s exact test, and quantitative variables were analyzed according to their assumption of normality.

RESULTS

Twenty-eight patients were analyzed: 16 patients had Sjögren’s syndrome, and 8 of them had polyautoimmunity. An association was found between atrophy in the minor salivary gland biopsy and development of polyautoimmunity (OR = 11.1; 95% CI: 1.12-112; p value = 0.033). The CD20:CD3 and CD4:CD8 ratios were normal, with no statistically significant differences between patients with and without Sjögren’s syndrome. In the subgroup of patients with Sjögren’s syndrome, CD4 T lymphocytes were predominant, with 15 cases out of 16 with CD4:CD8 ratios equal to or greater than 2:1.

CONCLUSIONS

Glandular atrophy was associated with the development of polyautoimmunity and a predominance of CD4 T lymphocytes in patients with Sjögren’s syndrome. This finding highlights the potential value of immunohistochemistry of minor salivary gland biopsies in this group.