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An example of palatal necrotizing sialometaplasia is presented, and the clinical and microscopic features suggestive of squamous-cell carcinoma and mucoepidermal carcinoma are noted. The patient's health status, as shown by a rather thorough work-up, was unremarkable during the period which would seem to preclude a systemic etiology of this disease. The resolution of the lesion with minimal therapy is documented.
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Focal oncocytosis in minor and major salivary glands is a relatively rare condition. We found it in 92 (8.7%) of 1056 biopsy and operation specimens of the salivary glands. There was a nearly balanced sex ratio. Oncocytosis was found mainly in patients between the 5th and 8th decades of life, with a progressive tendency. Oncocytic transformations of the ductal epithelium were always associated with additional lesions. These were chronic sialadenitis, hyperplasia and metaplasia of ductal epithelium and morphological signs of central or peripheral salivary obstruction. As etiologic factors or fundamental diseases, mainly neoplasms and chronic inflammations with hyperplasia of the oral mucosa and a primary chronic (obstructive) sialadenitis were found, but age-related mechanisms could not be excluded. We believe the oncocytic transformation to be a regressive alteration of previously hypertrophic or hyperplastic ductal epithelium with the appearance of a mitochondriopathy.
Sonography and computed tomography play complementary roles in imaging mass lesions in the salivary glands and their surroundings. Ninety per cent of parotid tumors originate from the superficial lobe, and we consider sonography to be the method of choice for imaging these lesions. The sensitivity of high-resolution sonography in detecting intraparotid tumors approaches 100 per cent, and ultrasound is therefore an excellent method to evaluate patients with parotid swelling. It may provide clinically useful information by precisely outlining the tumor borders or by detecting multiple or bilateral lesions. We restrict our use of CT to tumors that appear to extend beyond the borders of the parotid gland with possible invasion of surrounding soft tissues or bone. CT is also the method of choice for differentiating lesions of the deep lobe from parapharyngeal tumors and for staging carcinomas. Although ultrasound supplemented with computed tomography should replace conventional sialography in the work-up of parotid neoplasms, sialography remains the method of choice for evaluating patients with chronic sialadenitis, autoimmune diseases, and sialolithiasis. The role of sonography in these conditions is limited to ruling out a parotid neoplasm, assessing the extent of abscess formation, or assisting in localizing calculi in selected patients.
The value of needle aspiration biopsy in the evaluation and management of salivary gland pathology is controversial. The major reasons for this controversy are the difficulty in cytologic evaluation and the fact that the extent of surgery can be easily defined based on clinical judgement. However, a preoperative diagnosis is helpful in discussions with patients regarding the extent and type of surgery. Apart from the fact that needle biopsy can distinguish benign from malignant conditions, it is also very useful in distinguishing between salivary and other nonsalivary pathology. Over the past 7 1/2 years, we have performed 160 needle aspirations of parotid, submandibular, and submucosal lesions. Adequate specimens for cytologic evaluation were obtained in 155 patients (97%). A total of 84 parotid lesions, 70 submandibular lumps, and 6 submucosal abnormalities were detected. A cytologic diagnosis of benign pathology was made in 120 patients. Twelve patients had lymphoma and the diagnosis was suspected based on needle aspiration. There were 10 patients with tuberculosis and 30 patients with hyperplastic lymph nodes or benign lymphoepithelial disease of the parotid. There were three false-positive and two false-negative reports. No complications such as hematoma, nerve injury, or infection developed. The major difficulty was in distinguishing between malignancy and obstructive sialadenitis in the submandibular region. Needle aspiration was helpful in evaluating lesions in the tail of the parotid and submandibular area. The cytologic distinction between salivary and nonsalivary pathology was useful in planning the appropriate surgery and the extent of surgical resection. From a clinical standpoint, the distinction between benign and malignant salivary and nonsalivary pathology was very helpful. Preoperative diagnosis of Warthin's tumor, lymphoma, or benign lymphoepithelial disease was essential to the correct management of these patients.
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The greatest part of all diseases of salivary glands are caused by inflammations. The differential diagnosis to other diseases, e.g. tumors, if of great importance. The sialography has hereby developed to an important diagnostic measurement. There is a discussion about the technique of the sialography and its simple performance as well as the high effectiveness of this X-ray examination. The X-ray morphology of different kinds of inflammations is various. The acute inflammations are characterized by narrowing of ducts, the subacute inflammations by the pathological staining of the parenchyma, and the chronic by the increased changes of the Stenon's or Wharton's duct, respectively of ducts with superior range.
The potential usefulness of analysis of the salivary secretions in diagnosis and prognosis is beginning to be explored in depth. The preliminary work already undertaken indicates that modern methods applied to this secretion may provide information that is different from that obtained in other body fluids. Saliva is collected at the point of its manufacture and, therefore, is unaffected by collection or storage in the body. It is the product both of protein synthesis within the glands and of most of the known water and electrolyte exchange mechanisms. Salivary composition is affected by both autonomic and hormonal stimuli. As the specific influence of each of these factors is better understood, studies of this fluid will provide important clues to the understanding of disease and the evaluation of therapy. There are few places in the body where it is possible directly, utilizing a non-invasive technique, to examine the product of a large number of important biological processes. It is obvious that careful handling of collection and analytic techniques are essential if these secretions are to be utilized. Future investigations in clinical situations should take full advantage of the strong base of knowledge of the physiology of these glands. Development of this field depends on careful clinical investigations designed to make full use of our current knowledge.
Local lymphoplasmacytoid infiltration of the diseased exocrine glands is a cardinal sign of Sjögren's syndrome (SS). The state of T lymphocyte activation present in these local infiltrations was studied by three different techniques: determination of interleukin 2 (IL2) receptor (Tac) on cell surface membrane; autoradiography combined with immunoperoxidase staining of T cell epitopes; and electron microscopic analysis of the lymphoblast subclasses. Although 64 (SEM 4)% of the local inflammatory cells expressed Ia antigen, only 4 (SEM 1)% of them displayed the T cell activation antigen Tac. Autoradiography-immunoperoxidase double labelling showed that less than 1% of all T cells in situ were [3H]thymidine incorporating blasts. This finding suggests that although T lymphocyte is the dominant cell in situ, only a few of these cells have passed the G0/G1 interphase, and even fewer have been pushed to the S phase of the cell cycle by IL2. Transmission electron microscopy showed that few T blasts were present, even though there were many plasma cells. This result further confirms the impression that only a minor T cell subpopulation in situ is blast transformed despite the fact that many of the local T lymphocytes in the diseased salivary glands in SS are Ia positive.
In the present study 162 patients with clinically suspected diseases of the major salivary glands were examined via sonography (n = 162), sialography (n = 111) and CT-sialography (n = 49). The reliability of the three radiological procedures was assessed in diagnosing sialoadenitis, sialolithiasis and glandular and extraglandular tumors. Forty-seven patients were examined with all three methods, 64 patients with sonography and sialography, 2 patients with sonography and CT-sialography and 49 patients with only sonography. The results were compared retrospectively with histologically (70%), cytologically (26%) and clinically proven diagnoses. A sialoadenitis was diagnosed via sonography at a sensitivity of 58%. Sialography frequently produced a false diagnosis of "glandular tumor", which resulted in a comparatively lower sensitivity of 54%. This finding contrasted with the experiences of other authors. A glandular tumor was correctly diagnosed by all three methods and had approximately the same sensitivity (sonography 89%, sialograph 91% and CT-sialography 92%). The correct diagnosis of salivary gland tumors was found by sonography and CT-sialography in 76% of cases and by sialography in 83% of cases. CT-sialography was clearly the superior diagnostic method for detecting extraglandular tumors. Sonography proved its worth as the fundamental procedure for special diagnostic testings of the salivary glands. Sialography is necessary for obtaining important additional information, especially in cases with suspect glandular tumors. CT-sialography is indispensable in the diagnosis of tumors, especially if a malignant, extraglandular or medially localized process is suspected.
Scintigraphy with 99mTc pertechnetate has proved as an enlargement of diagnostic possibilities of salivary gland diseases. 58 patients with tumors, posttherapeutical findings, acute an chronic inflammations and sialosis were examined with the Anger-camera. In our opinion scanning is not suitable for demonstrating tumors, but shows better results in estimating the function of glandular parenchyma after operation or radiation. A high significance of the method is given, when there is suspicion or presentation of acute and chronic inflammations, sialoses or Xerostomia with indefinite glandular swelling.
The histopathological diagnosis 'benign lympho-epithelial lesion' characterizes the major salivary gland disease in Sjögren's syndrome. It is not known if all cases with microscopically diagnosed benign lympho-epithelial lesion are variants of Sjögren's syndrome. The present clinical investigation showed that in 19 patients with the microscopical diagnosis of lympho-epithelial lesion, 84% fulfilled all criteria of Sjögren's syndrome. The rheumatoid factor and/or antinuclear factor was found in 84% and M-component was present in 16%. Sialography revealed sialectasis in all parotid glands. Salivary gland enlargement was found in 79%, and keratoconjunctivitis sicca in 89% of the patients. Systemic disease was found in 32%. The disease in the 2 patients with M-component took a malignant course, culminating in immunoblastic sarcoma and myelomatosis. The clinical diagnosis 'autoimmune sialadenitis' is proposed for the oral and salivary gland component is Sjögren's syndrome.
PURPOSE: To document the clinical features, management, and outcome of ranulas in Zimbabwe. METHODS: A retrospective review of clinical and pathologic records of 83 patients with ranulas who presented during the period of January 1981 to September 2003 was undertaken. RESULTS: Thirty-six (43.4%) of the ranulas were in males and 47 (56.6%) in females. Sixty-one (73.5%) were in the 0 to 10-year-old age group. Oral ranulas (92.8%) were equally distributed on the right and left sublingual region. Six (7.2%) were plunging ranulas. In a study group of 38 patients, 88.5% of ranula patients were HIV-positive with 95% of them in the 0 to 10-year-old age groups. Excision of ranula with sublingual gland removal was done in 80.7% of the cases with 0% recurrence; marsupialization (cavity left open and cavity packed) was done in 12% (n = 10) of the patients with 20% (n = 2) recurrence. CONCLUSIONS: Female predominance with no right or left sublingual region predilection was noted. Ranula was most common in the 0 to 10-year-old age group; 95% of this group were HIV positive. HIV salivary gland disease could be an etiologic factor. No recurrence was observed when the ranula was excised along with removal of the sublingual gland. Plunging ranula is uncommon.
To assess the accuracy with which quantitative scintigraphy reflects the true extent of parenchymal losses in diseased salivary glands, the parotid glands of vervet monkeys were unilaterally subjected to experimental injury and studied by scintigraphy and histomorphometry. The glandular 99Tcm pertechnetate uptake, relative to a standard dose, was expressed as the ratio of operated to unoperated sides. This was compared with the equivalent ratios of the weights of various salivary component tissues, morphometrically determined at necropsy. Our results suggest that uptake levels of 99Tcm pertechnetate are influenced predominantly by the mass of acinar rather than ductal tissue present. Furthermore, in comparisons between scans, because of the inherent variability in the results, quantitative scintigraphy is sensitive only to differences exceeding 25% of the gland mass.
Although a number of autoimmune diseases are known to develop in postmenopausal women, the mechanisms by which estrogen deficiency influences autoimmune lesions remain unclear. We speculate that antiestrogenic actions might be a potent factor in the formation of pathogenic autoantigens. Previously, we have identified 120-kd alpha-fodrin as an important autoantigen in Sjögren's syndrome (SS). When healthy C57BL/6 (B6) mice were treated with an ovariectomy (Ovx), we found a significant increase in TUNEL(+)-apoptotic epithelial cells in the salivary gland cells associated with alpha-fodrin cleavage during 2 and 3 weeks after Ovx. By contrast, no apoptotic cells were found in estrogen receptor-alpha knockout mice. In in vitro studies using primary cultured mouse salivary gland cells and human salivary gland cells, we found a cleavage product of 120-kd alpha-fodrin in cells that had undergone tamoxifen (Tam)-induced apoptosis through caspase activation, especially caspase-1. Adoptive transfer of alpha-fodrin-reactive T cells into Ovx-B6 and -SCID mice resulted in the development of autoimmune exocrinopathy quite similar to SS. These results suggest that estrogen deficiency exerts a crucial influence on autoantigen cleavage, and may cause, in part, autoimmune exocrinopathy in postmenopausal women.
Necrotizing sialometaplasia cannot be diagnosed clinically and has frequently been misdiagnosed microscopically. The fact that the disease can be misinterpreted as cancer is sufficient cause for the clinician to question a malignant diagnosis of an ulcerated or nodular lesion, especially one of the hard palate, that developed rather rapidly. When performing a biopsy of these lesions, care should be taken to ensure adequate size and depth of the specimen, as small biopsy tissue samples might include only the necrotic and actively regenerating portions of the lesion, thus causing diagnostic problems. Necrotizing sialometaplasia certainly should be considered in a differential diagnosis of soft tissue lesions arising in the vicinity of intraoral minor salivary glands, especially on the hard palate.
Lymphocytic infiltration of the salivary glands in autoimmune diseases results in the human condition known as xerostomia. To date, an animal model for the autoimmune development of salivary gland dysfunction has yet to be described. With the autoimmune diabetes-prone nonobese diabetic (NOD) mouse strain, salivary flow rates and total saliva protein concentration in both male and female mice showed a progressive decline in the nondiabetic and diabetic states. Submandibular gland weight decreased from control mice with the progression to onset of diabetes in both sexes, whereas the weight of the parotid gland remained unchanged. The level of saliva amylase activity, when measured relative to unit volume, decreased in nondiabetic males but increased upon onset of diabetes to control values. When expressed relative to protein concentration in saliva, amylase activity was depressed for both sets of NOD mice but was higher upon diabetes onset than in the nondiabetic animals. In females a similar pattern was observed except that amylase activity expressed relative to unit volume was not significantly depressed in either set of NOD mice. The same observations were made for glandular amylase activity. The level of epidermal growth factor (a product of the ductal cells of the submandibular gland) was reduced over 500- and 18-fold for male and female diabetic mice, respectively. Sodium dodecyl sulfate polyacrylamide gels of total saliva showed changes in mobility as well as concentration of several proteins in the NOD mice.(ABSTRACT TRUNCATED AT 250 WORDS)
The clinical course of 48 patients with primary Sjögren's syndrome (primary SS) was reviewed. Forty-three north European patients were typed for HLA class I and class II alloantigens. In this population with primary SS HLA B8, DR3 and DRw52 all occurred more frequently than in the control population (P < 0.009, P < 0.0035, P < 0.02 respectively). The subgroup of primary SS patients with antibodies to Ro and/or La antigen had the greatest prevalence of DR3 (relative risk 33.4). The primary SS patients fall into two distinct groups: those with extraglandular disease in whom lymphopaenia, hypergammaglobulinaemia, antibodies to Ro and/or La and HLA DR3 were all more frequent and those patients with either glandular disease alone or only one extraglandular feature. There was no difference in disease duration between the two groups, although on average the latter group were 10 years older.