[Biopsy of the accessory salivary glands in Sjögren's disease. Value in the diagnosis and estimation of the developmental stage of the disease. Analysis of 148 cases].

Biopsies of the labial accessory (144 cases) or principal (4 cases) salivary glands were performed in 139 patients with clinically and biologically confirmed Sjögren's syndrome, and 9 patients with rheumatoid arthritis alone to act as control. Confirmation of diagnosis was obtained in both isolated cases (31 p. cent) and those with associated collagen disease (69 p. cent). Histological lesions were classified in 3 stages of increasing severity. Stage I cases had ectasia of several distal canals which, in the absence of significant lymphocytic reactions, permitted early diagnosis. In stage II, a typical appearance was noted: abundant nodular or diffuse lymphocytic infiltration with an increase in numbers of ectasias. In stage III of acini destruction, the dominant feature was diffuse peri- and intralobular sclerosis and only rare lymphocytes. Is, therefore, distal canal dilation the most reliable diagnostic sign of the syndrome, which has been shown by ultrastructural studies to arise from massive destruction, followed by anarchic regeneration, of myoepithelial cells that ensure canal contractility. These 3 histologically-defined stages generally correlate well with those normally employed to grade sialographic images (stage I, initial, showing miliary filling defects; stage II with larger rounded areas and penetration of the contrast medium into tissues around the canal; stage III demonstrating the "dead tree" appearance together with lack of contrast medium extension beyond Stenon's duct and its main branches). However, certain discordances were noted, histological signs sometimes preceding sialographic modifications. Biopsy of accessory salivary glands could be the most simple, reliable method for confirming diagnosis of Sjögren's syndrome in its early stages.