Salivary Gland Involvement Research Articles

Testicular Torsion Following MMR Vaccination in an 18-Month-old Infant: A Case Report

Introduction: The measles, mumps, and rubella (MMR) vaccine is associated with known complications, such as salivary gland involvement and aseptic meningitis. Isolated reports of epididymal orchitis following MMR vaccination have also been reported, but no reported case of testicular torsion in infancy has been explicitly attributed to the MMR vaccine. Objective: Here, we report an 18-month-old male infant presented with a history of gradually worsening painful left scrotal swelling following a booster dose of MMR that finally led to orchiectomy with the diagnosis of testicular torsion. Case Presentation: An 18-month-old male infant presented with a one-day history of gradually worsening painful left scrotal swelling following a booster dose of MMR. No evidence of blood flow was detected in the left testicle in color Doppler sonography, which was compatible with testicular torsion. In surgical exploration, the left testicle seemed firm and dark in color. The spermatic cord vessels were thrombotic in appearance, and the testicular appendix seemed completely necrotic. The nonviable left testicle was removed. Conclusions: Although testicular torsion after MMR vaccination is rare, in the case of any pain, swelling, and redness of the scrotum, the patient should seek an urgent medical consultation. Physicians should be aware that testicular swelling after the MMR vaccine might not be just epididymal-orchitis but really a medical emergency.

The clinical outcome, pathologic spectrum, and genomic landscape for 454 cases of salivary mucoepidermoid carcinoma

Mucoepidermoid carcinoma (MEC) is the most common malignant salivary tumor. A complete understanding of the high heterogeneity of MEC in histology and genetics would help in accurate diagnosis and treatment. Therefore, We evaluated the clinical features, treatment outcomes, and pathological parameters of 454 MECs and analyzed their genomic features using whole-exome sequencing and whole-transcriptome sequencing. We found that MECs predominantly occurred in females and those in their 4th–5th decades. The parotid gland was the most frequently affected site. All patients underwent complete mass resection with lobectomy; 414 patients were alive without relapse at follow-up, after an average period of 62 months (1–116 months). The disease progressed after initial treatment in 40 patients. The lungs were the most common site of distant metastasis. For classical MECs, histologic gradings of the AFIP, modified Healey, and MSK systems were significantly associated with recurrence and lymph nodal metastasis; these gradings were significantly related to lymph nodal metastasis for the subtypes. Older age, minor salivary gland involvement, clinical symptoms, high TNM stage, high-grade tumor, and improper surgical modality were the main prognostic factors. BAP1 was the most frequently mutated gene in MEC. Mutations in CDKN2A, MET, and TP53 were more frequently found in aggressive tumor phenotypes. MAML2 rearrangement was observed in 42% of patients, and EWSR1 rearrangement in 8%. Specific genetic events (in TP53 and FBXW7) with CRTC1::MAML2 fusion superimposed might be associated with unfavorable prognosis. This study provides new insights into precision therapeutic strategies for MEC.

Psychological resilience in patients with primary Sjögren's syndrome: effect of involvement of major salivary and lacrimal glands.

The aim of this study was to assess whether the involvement of major salivary and lacrimal glands in primary Sjögren's syndrome (pSS) affected the psychological resilience of patients. This cross-sectional study included 116 patients with pSS. Data were collected through clinical examinations, measurement of salivary flow rates (SFRs), and from Schirmer's test, as well as from patient-reported outcome measures (PROMs), such as the European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI), Brief Resilience Scale (BRS), Work Productivity and Activity Impairment (WPAI), Oral Health Impact Profile-14 (OHIP-14), and the Hospital Anxiety and Depression Scale (HADS). Hyposalivation was defined as an unstimulated SFR of≤0.1mL/min. The BRS score (mean±SD=2.60±0.69) was lower in patients with recurrent parotitis (2.11±0.37) than in those without recurrent parotitis (2.67±0.86), in the whole group. In patients with an unacceptable symptom state (ESSPRI score≥5 points), a lower BRS score was observed in patients with both hyposalivation and ocular dryness (2.59±0.69) than in patients with isolated hyposalivation (2.84±0.84). The BRS score was also negatively associated with the WPAI-Daily Impairment and OHIP-14 scores in patients with hyposalivation as well as with HADS-A (the seven items of HADS relating to the anxiety dimension) and HADS-D (the seven items of HADS relating to the depression dimension) in the whole group. The results suggest that psychological resilience in pSS may be affected by recurrent parotitis, the levels of anxiety and depression, as well as hyposalivation with ocular dryness.

Multisystem ALK-Positive Histiocytosis With DCTN1::ALKFusion in an Adult, Responsive to Alectinib: Case Report and Literature Review.

Anaplastic lymphoma kinase (ALK)-positive histiocytosis has emerged as a clinically relevant diagnosis featuring a wide span of clinical presentations, which are unified by the presence of ALK-positive histiocytes on histopathology and molecular drivers involving the ALK kinase gene. This report presents an adult case of multisystem ALK-positive histiocytosis with xanthogranuloma-like features on histopathology that was responsive to ALK inhibition, and includes a review of ALK-positive histiocytoses with cutaneous involvement reported in the literature. A 56-year-old male developed a widespread eruption of red-brown papules on the face, trunk, and upper extremities. Histopathological evaluation revealed a well-circumscribed, nodular dermal infiltrate of epithelioid histiocytes with Touton giant cells, rare bizarre multinucleated cells, and focal emperipolesis. The lesional cells were positive for CD68 and ALK1 immunohistochemical stains, and negative for CD1a. Next-generation sequencing identified a DCTN1::ALK fusion. On imaging, he was found to have bone, lung, soft tissue, and salivary gland involvement. ALK inhibition was initiated with alectinib, resulting in rapid improvement of cutaneous lesions and eventual complete resolution of abnormal imaging findings, which was sustained at 24 months of follow-up. This case adds to the spectrum of ALK-positive histiocytoses and further demonstrates the positive response with targeted therapy.

Characteristics of 18F-FDG PET/CT in patients with Kimura's disease from China.

'Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown etiology and is difficult to diagnose due to poor clinical presentation and imaging features. Few studies on characteristics of 18F-FDG PET/CT of KD have been reported. This study aimed to observe the reliable characteristics and usefulness of 18F-FDG PET/CT for the evaluation of consecutive patients with KD. The clinical data and 18F-FDG PET/CT imaging findings of 8 patients with pathologically confirmed KD were reviewed retrospectively.18F-FDG PET/CT images were evaluated visually and semiquantitatively by measuring the maximum standardized uptake value (SUVmax). The correlations between clinical data and 18F-FDG PET/CT features were analyzed by simple linear regression. This study included 7 males and one female ranging in age from 17 to 79years. The longest diameter of lesions ranged from 0.8cm to 4.8cm, and regional or generalized lymphadenopathy was found in all 8 patients with eosinophilia, while subcutaneous masses and salivary gland involvement concurrently were found in 4 patients. 18F-FDG PET/CT revealed that these involved lesions had high 18F-FDG uptake with SUVmax > 2.5 (2.6 to 6.3). Moreover, the margin of the lesions was well defined in 6 cases and ill defined in 2 cases, and homogeneous density and 18F-FDG uptake were both found in all these lesions. There was negative correlation between eosinophils and SUVmax (R2 = 0.538). Kimura's disease should be considered when 18F-FDG PET/CT is characterized by homogeneous lesions of regional or generalized lymphadenopathy, accompanied with subcutaneous masses and salivary gland involvement concurrently, especially in patients with eosinophilia.

The Impact of IgG Fc-Glycosylation on Disease Dynamics in Primary Sjögren's Disease- Insights from the Belgian Sjögren's Syndrome Transition Trial.

Glycans attached to the fragment crystallizable region (Fc) of IgG antibodies influence their pro- or anti-inflammatory effector function. We aimed to explore the interrelation between the Fc-glycosylation profile and disease transition, disease activity and outcome in patients with suspected and confirmed primary Sjögren's Disease (SjD). IgG Fc-sialylation and IgG Fc-galactosylation serum levels were determined in 300 patients from the Belgian Sjögren's Syndrome Transition Trial (BeSSTT). This cohort includes both suspected and confirmed SjD patients meeting the 2016 ACR/EULAR criteria. Salivary gland involvement was evaluated through ultrasonography (Hocevar score 0-48) and histopathology (focus score). The relative amount of sialylated and galactosylated IgG was determined by capillary electrophoresis after using the endoS endoglycosidase based assay. SjD patients exhibited significantly lower sialylation and galactosylation levels versus asymptomatic anti-SSA carriers and sicca patients. Lower sialylation and galactosylation levels were significantly associated with an increase in B-cell activation markers and distinct autoantibody profiles, particularly with multiple autoantibody reactivities. They were also linked to histopathological salivary gland alterations, higher Hocevar scores and importantly with risk factors for non Hodgkin lymphoma (NHL) development. In contrast, mono-anti-Ro60 positive and anti-SSA negative SjD patients had normal IgG Fc-glycosylation. This study points to a novel role of IgG Fc-glycosylation in SjD in predicting disease transition, monitoring disease activity, and risk stratification for NHL development.

Accuracy of two-dimensional transverse wave elastography of salivary glands in diagnosis of Sjögren’s disease: a systematic review and meta-analysis

ObjectivesTwo-dimensional shear wave elastography (2D-SWE) is a non-invasive technique for the evaluation of Sjögren’s disease (SjD). This study investigated the diagnostic accuracy of 2D-SWE in assessing major salivary gland involvement...

Clinical and laboratory characteristics of salivary gland ultrasonography-positive patients with primary Sjögren's syndrome.

This study aimed to investigate the clinical and laboratory characteristics of salivary gland ultrasonography (SGUS)-positive patients with primary Sjögren's syndrome (pSS) compared to SGUS-negative patients and to analyse the diagnostic value of SGUS and labial salivary gland biopsy (LSGB) grading in pSS. A retrospective analysis of patients admitted to the Affiliated Hospital of Yangzhou University between May 2019 and November 2023 was conducted. According to the OMERACT scoring system, patients with pSS were divided into an SGUS-negative group (score <2) and an SGUS-positive group (score ≥2). The patient's age, gender, clinical symptoms, laboratory parameters and diagnostic examinations were compared and analysed, and Spearman correlation analysis was used to analyse the correlation between SGUS, LSGB and influencing factors. There was no significant difference in dry mouth, dry eyes, tooth loss, fever, joint pain, fatigue, interstitial lung disease or renal tubular acidosis between the two groups, although there were more patients with salivary gland enlargement in the SGUS-positive group (p < 0.05). In terms of high levels of immunoglobulin G (IgG), high levels of rheumatoid factor (RF), anti-nuclear antibody ≥1:320, anti-Sjögren's syndrome A-52KD and anti-Sjögren's syndrome B, the number of cases in the SGUS-positive group was greater than that in the SGUS-negative group (p < 0.05). LSGB samples were graded per the Chisholm-Mason system with significant differences between multiple groups. SGUS score negatively correlated with age and positively correlated with LSGB grade. This study showed that the SGUS score positively correlated with LSGB grade in pSS patients and negatively correlated with patient age. Thus, SGUS and LSGB are consistent in the diagnosis of pSS to reflect the degree of salivary gland involvement, and patients who are SGUS positive have high RF and IgG levels, a variety of autoantibodies positive and a tendency toward salivary gland enlargement.

Whole phenotype of patients with systemic sclerosis and sicca manifestations: Comparison with sicca manifestations from other causes

Introduction & objectivesThis study aimed to characterize the whole phenotype of Systemic sclerosis (SSc) patients with sicca symptoms, using major salivary glands Ultrasound (SGUS) parameters, minor salivary glands biopsies (mSGB) and clinical findings, and to compare these characteristics with those from patients with Sjogren's Disease (SjD), and patients with sicca manifestations from other causes. MethodsSixty SSc patients fulfilling the 2013 ACR/EULAR classification criteria and with subjective self-declared sicca symptoms were consecutively recruited and had SGUS and mSGB. Fifteen SSc patients without subjective sicca symptoms and 65 patients with sicca symptoms from other causes (including 37 SjD with no SSc). ResultsSSc patients with subjective sicca symptoms had frequent objective clinical (up to 83 %), histological (44 % of Focus score≥1/ mm2) and US anomalies (63 % of OMERACT ≥2). 53 % patients without subjective clinical complaint also had abnormal objective tests, suggesting the existence of a sub clinical involvement of salivary glands in SSc. SjD-SSc patients had more severe glandular involvement as compared to patients with isolated SjD and isolated Sicca-SSc patients (70%, 48,6 % and 38% of patients with OMERACT ≥2 respectively) suggesting additive impact of both diseases on glandular physiology and structure. ConclusionSjD-SSc overlap have more severe sicca features as compared to isolated sicca-SSc and isolated SjD, suggesting a specific impact of SSc on salivary gland physiology. Further translational studies are needed to identify the underlying pathways that could serve as therapeutic targets.

Co-Existence of Dry Mouth, Xerostomia, and Focal Lymphocytic Sialadenitis in Patients with Sjögren’s Syndrome

Background: Some patients with Sjögren’s syndrome (SS) do not develop xerostomia despite advanced involvement of the salivary glands and the presence of focal lymphocytic sialadenitis (FLS). The aim of the study is to determine possible correlations between xerostomia, symptoms of sicca syndrome, FLS, and other features in SS patients. Methods: The study group comprised 50 patients with SS. The comprehensive assessment of patients included clinical, laboratory, and serological examinations. All patients underwent labial salivary gland biopsies. Dry mouth and dry eyes were assessed by unstimulated whole salivary flow rate (USWSF) and Schirmer’s test, respectively. Results: Xerostomia and xerophthalmia are closely related components of sicca syndrome. Xerostomia did not correlate with any serological or laboratory values, including ANA titers, SSA, SSB, Ro52 antibodies, rheumatoid factor, C-reactive protein, and Erythrocyte Sedimentation Rate. There were no correlations between xerostomia and FLS or Focus score. USWSF results correlated with xerostomia reported by patients, contrary to Schirmer’s test, which did not correlate with xerophthalmia. Conclusions: Dry mouth in SS is independent of any serological or inflammatory parameters. The occurrence of FLS does not determine xerostomia and its severity. Dry mouth in SS is influenced by other undetermined factors and mechanisms independent of salivary gland involvement.

Fatty Acid Desaturase Bmdesat5, Suppressed in the Salivary Glands by Domestication, is Involved in Regulation of Food Intake in Silkworms.

Understanding the evolutionary genetics of food intake regulation in domesticated animals has relevance to evolutionary biology, animal improvement, and obesity treatment. Here, we observed that the fatty acid desaturase gene (Bmdesat5), which regulates food intake, is suppressed in domesticated silkworms, but expressed in the salivary glands of the wild silkworm Bombyx mandarina. The content of its catalytic product, cis-vaccenic acid, was related to the expression levels of Bmdesat5 in the salivary glands of domesticated and wild silkworm strains. These two strains also showed significant differences in food intake. Using orally administering cis-vaccenic acid and transgenic-mediated overexpression, we verified that cis-vaccenic acid functions as a satiation signal, regulating food intake and growth in silkworms. Selection analysis showed that Bmdesat5 experienced selection, especially in the potential promoter, 5'-untranslated, and intron regions. This study highlights the importance of the decrement of satiety in silkworm domestication and provides new insights into the potential involvement of salivary glands in the regulation of satiety in animals, by acting as a supplement to gut-brain nutrient signaling.

Risk stratification of submandibular salivary gland involvement in oral squamous cell carcinoma based on histopathological parameters: A 15-year retrospective study.

Squamous cell carcinoma (SCC) represents about 90% of all oral malignancies. The study aimed to assess the involvement of the submandibular salivary gland (SMG) in oral SCC (OSCC) patients and the need for SMG excision. Demographics, clinical information and staging of the 210 patients undergoing surgery for OSCC were obtained from the department records. The histopathological slides were retrospectively reviewed. The nodal status was also verified with the histopathology reports. Frequency distribution, Chi-square association, ordinal logistic regression analysis and Kaplan-Meier analysis were performed. SMG was excised in 171 patients. Five patients had SMG involvement. Buccal mucosa (BM) and gingivobuccal sulcus had a greater risk of level IB metastases (P < 0.01). Pattern 3 and pattern 4 of invasion had a higher risk of level IB metastases (P = 0.04). Depth of invasion (DOI) >4 mm was associated with level IB lymph node (LN) involvement (P = 0.0001). DOI >4 mm to 8 mm had 3.7 times the risk and a DOI >8 mm to 12 mm had 5 times the risk of level IB metastases. Pattern of invasion (POI), tumour budding and DOI >4 mm were significant prognosticators for patient survival. Histologically, patients may be categorised as 'high risk': those with an increased risk of level IB LN involvement and 'low risk': those at low risk for level IB involvement with the help of POI, tumour budding and DOI as risk factors. In low-risk patients, SMG may be spared and the level IB LNs are dissected. High-risk patients may be chosen as candidates for SMG transfer or excision based on the extent of LN involvement.

Diffuse Lymphocytic Infiltration Syndrome (DILS) as a Mode of Revelation of HIV: On a Case

Diffuse Lymphocyte Infiltration Syndrome (DILS) is a rare condition observed in HIV patients, characterized by infiltration of CD8+ T lymphocytes in several organs. In this article, a case of revelation of HIV infection is presented, diagnosed following bilateral parotidomegaly associated with DILS. The patient, aged 60, presented a progressive deterioration in general condition, significant asthenia, weight loss, and local symptoms including bilateral parotid swelling, cervical lymphadenopathy, and intermittent fever. Investigations revealed HIV-1 seropositivity, lymphocytosis with high T-CD8+ levels, salivary gland enlargement on imaging, and benign lymphoepithelial lesions on parotid biopsy. The diagnostic criteria for DILS were met, highlighting the importance of salivary gland involvement in this syndrome. Treatment with HAART resulted in significant regression of symptoms. In summary, DILS represents a multisystem complication of HIV, requiring appropriate management including antiretroviral treatment to improve patient prognosis.

Juvenile Primary Sjögren Syndrome in a 15-Year-Old Boy with Renal Involvement: A Case Report and Review of the Literature

Juvenile primary Sjögren syndrome (pSS) with renal involvement is extremely rare, reported approximately in 50 children, predominantly girls. Here, we present the first reported case of a male child with juvenile pSS with ocular surface disease (previously keratoconjunctivitis sicca), submandibular salivary gland involvement, and tubulointerstitial nephritis. First, two symptoms were clinically apparent at presentation. We illustrate here that kidney involvement in pSS should be actively looked for, as juvenile pSS may be associated with asymptomatic renal involvement. Immunophenotyping of peripheral blood cells using multicolor flow cytometry revealed at the time of diagnosis changes in both adaptive (T memory cells and B memory cells), and innate immunity (an increased activation of natural killer cells, as well as monocytes and neutrophils, and an increased representation of intermediate monocytes). Our case report points to the importance of kidney examination, early diagnosis and therapy in juvenile pSS, as well as highlights international collaboration to obtain more data for this rare disease.

Performance of the 2019 ACR/EULAR Classification Criteria for IgG4-Related Disease in a Large Chinese Cohort.

The purpose of this research was to ascertain the effectiveness of the newly established criteria for classifying IgG4-related disease (IgG4-RD), as applied to a large Chinese cohort in real-world clinical settings. Patient data were procured from the digital health records of 4 prominent academic hospitals. The criterion standard for identifying IgG4-RD patients was from a seasoned rheumatologist. The control group consisted of individuals with other ailments such as cancer, other forms of pancreatitis, infectious diseases, and illnesses that mimic IgG4-RD. A total of 605 IgG4-RD patients and 760 mimickers were available for analysis. The 2019 EULAR/ACR criteria have a sensitivity of 69.1% and a specificity of 90.9% in this large Chinese cohort. IgG4-RD had a greater proportion of males (55.89% vs 36.25%, p < 0.001), an older average age at diagnosis (54.91 ± 13.44 vs 48.91 ± 15.71, p < 0.001), more pancreatic (29.59% vs 6.12%, p < 0.001) and salivary gland (63.30% vs 27.50%, p < 0.001) involvement, and a larger number of organ involvement (3.431 ± 2.054 vs 2.062 ± 1.748, p < 0.001) compared with mimickers. The 2019 EULAR/ACR criteria are effective in classifying IgG4-RD in Chinese patients, demonstrating high specificity and moderate sensitivity.

Langerhans cell histiocytosis of the thyroid mimicking thyroiditis in a boy: a case report and literature review

BackgroundLangerhans cell histiocytosis affecting the thyroid commonly presents with nonspecific clinical and radiological manifestations. Thyroid Langerhans cell histiocytosis is typically characterized by non-enhancing hypodense lesions with an enlarged thyroid on computed tomography medical images. Thyroid involvement in LCH is uncommon and typically encountered in adults, as is salivary gland involvement. Therefore, we present a unique pediatric case featuring simultaneous salivary and thyroid involvement in LCH.Case presentationA 3-year-old boy with complaints of an anterior neck mass persisting for 1 to 2 months, accompanied by mild pain, dysphagia, and hoarseness. A physical examination revealed a 2.5 cm firm and tender mass in the left anterior neck. Laboratory examinations revealed normal thyroid function test levels. Ultrasonography revealed multiple heterogeneous hypoechoic nodules with unclear and irregular margins in both lobes of the thyroid. Contrast-enhanced neck computed tomography revealed an enlarged thyroid gland and bilateral submandibular glands with non-enhancing hypointense nodular lesions, and multiple confluent thin-walled small (< 1.5 cm) cysts scattered bilaterally in the lungs. Subsequently, a left thyroid excisional biopsy was performed, leading to a histopathological diagnosis of LCH. Immunohistochemical analysis of the specimen demonstrated diffuse positivity for S-100, CD1a, and Langerin and focal positivity for CD68. The patient received standard therapy with vinblastine and steroid, and showed disease regression during regular follow-up of neck ultrasonography.ConclusionsInvolvement of the thyroid and submandibular gland as initial diagnosis of Langerhans cell histiocytosis is extremely rare. It is important to investigate the involvement of affected systems. A comprehensive survey and biopsy are required to establish a definitive diagnosis.

A case report of KIMURA’S DISEASE with nasal septum presentation

Abstract Kimura disease is a rare chronic inflammatory disorder of unknown aetiology, primarily seen in young Asians. The disease is characterised by painless subcutaneous swelling, blood and tissue eosinophilia and raised IgE levels. Kimura’s Disease has three components; cellular component showing lymphoid follicles with germinal centre hyperplasia with inflammatory infiltrate including increased eosinophils, plasma cells, and lymphocytes, surrounded by fibro collagenous and vascular stroma. Kimura disease is a disorder that involves the subcutaneous tissue of the head and neck regions. It is usually associated with regional lymphadenopathy and/or salivary gland involvement.

Clinical patterns and risk factors for multiorgan involvement in IgG4-Related disease patients

BackgroundIgG4-related disease with multiorgan involvement predicts higher disease activity, thus, it is necessary to identify whether IgG4-related disease involves multiple organs at the early stage. To further clarify the clinical characteristics and risk factors for IgG4-related disease with multiorgan involvement, we conducted an observational study. MethodsWe retrospectively analysed the clinical data of 160 patients who were primarily diagnosed with IgG4-related disease at the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2021. According to the number of involved organs, patients were divided into two groups: multiorgan involvement and nonmultiorgan involvement. Patients were divided into a multiorgan group and a nonmultiorgan group according to multiple organ involvement. ResultsThere were 82 cases identified with multiorgan involvement and 78 cases diagnosed with no multiorgan involvement in this series. Most cases were elderly and male (p > 0.05). The most frequently affected organs in IgG4-RD were the lymph nodes (50.6 %), pancreas (38.7 %) and salivary glands (35.6 %). Multivariate analysis showed that eosinophilia, IgG4>2*ULN, lymph node involvement, salivary gland involvement and lung involvement were independent risk factors for multiorgan involvement (p < 0.05). ConclusionsThe main issues in clinical practice are how to accurately diagnose the disease and screen the more vulnerable organs.

Facial Tumors Revealing Systemic Sarcoidosis: About a Case Report

Cutaneous involvement in sarcoidosis is highly variable, occurring in 9 to 37% of cases, and can be classified into specific and non-specific lesions. The specific lesions are essentially sarcoids with small and large nodules, plaques and annular lesions. However, the tumoral form is still very rare, and has only been reported in a handful of cases in the literature. We report the case of a 33-year-old female patient diagnosed with systemic sarcoidosis, revealed by a 5-year history of atypical skin lesions on the face, the largest of which measured 7 cm long. Skin biopsy was consistent with sarcoidosic granuloma, and workup for other localizations revealed ocular, respiratory, salivary gland and joint involvement. The originality of our observation lies in the extreme rarity of the tumoral form in cutaneous sarcoidosis.

Combination of ultra-micro angiography and sound touch elastography for diagnosis of primary Sjögren's syndrome: a diagnostic test.

Primary Sjogren's syndrome (PSS) is a prevalent systemic autoimmune disease. However, the current gold standard diagnostic method is invasive, increasing the difficulty of patient acceptance and then delaying treatment. Therefore, a non-invasive, convenient, and effective diagnostic method is required. Although salivary gland ultrasonography (SGUS) is a good choice, previous studies have not found suitable parameters to diagnose PSS. Salivary gland involvement in patients with PSS leads to changes in gland stiffness and vascularization, so we combined sound touch elastography (STE) and ultra-microangiography (UMA) to demonstrate the diagnostic effectiveness of ultrasonography in PSS. This prospective study included 27 patients with PSS and 20 healthy controls, with all participants forming a random series. Major salivary glands were examined with UMA and STE. Color pixel percentage (CPP), shear wave velocity (SWV), and Young's modulus values were investigated, and the combination of these parameters was evaluated by logistic regression analysis. For Young's modulus and SWV in the elasticity index, combined evaluation of both parotid glands and submandibular glands yielded an area under the receiver operating characteristic (ROC) curve (AUC) and confidence interval (CI) of 0.819, 0.699-0.938 and 0.801, 0.677-0.925, respectively. The levels of CPP in the parotid glands were significantly elevated (P<0.003) among patients compared to those in the control group, whereas the CPP values in the submandibular glands were not statistically different (P>0.086). We evaluated the elasticity values of the total 4 glands and the CPP of parotid glands together by logistic regression modeling. The ROC curve yielded an AUC of 0.954 (95% CI: specificity 0.849-0.994) which showed the best accuracy, with 92.6% sensitivity and 85.0% specificity. The use of STE and UMA to examine the salivary glands may aid in the diagnosis of PSS, and their combination may be a promising method. This is good news for patients with PSS who are not suitable or unwilling to undergo labial gland biopsy.