Swelling Of Major Salivary Glands Research Articles

Ultrasound Evaluations of Major Salivary Gland Pathology

No single sonographic feature is enough to distinguish gland disorders. Major salivary gland diseases are either localized or diffuse. Imaging must identify neoplastic from non-neoplastic diseases using Ultrasound, which is a non-invasive, low-cost, and accessible imaging method for the major salivary gland evaluation. Color Doppler in addition to B-mode ultrasound assesses gland enlargement and detects inflammatory, benign, and malignant gland enlargement. Moreover, this study aims to assess the diagnostic effectiveness of ultrasonography in diagnosis of major salivary gland pathology. Method: Ninety Major Salivary Gland swelling patients underwent preoperative ultra-sonography with a high-frequency linear probe. Echotexture, internal Calcification, focal lesion borders, lymphadenopathy, tumor shape, duct dilatation, and blood supply distribution were examined using color Doppler and B-mode Ultrasound. Result: A histological investigation of 62 tumors identified 18 malignant and 44 benign, with 68.2% of the benign group being pleomorphic adenoma and 61.1% of the malignant group being mucoepidermoid carcinoma. The rest of the cases, 28 cases were inflammatory, 50% of which were sialolithiasis. The sonographic features of malignant and benign differ significantly in echogenicity, posterior echo-enhancement, vascularity, morphology, and homogeneity and Calcification. All groups show considerable differences in duct dilatation, duct calcification, and homogeneity. Conclusion: Ultrasonography demonstrating excellent diagnostic efficacy in assessing salivary gland function, based on these results Ultrasonography may help reduce unnecessary biopsies especially in inflammatory cases.

SIALODOCHITIS FIBRINOSA OF KUSSMAUL: A CASE PRESENTATION

<h3>Objective</h3> Sialodochitis fibrinosa of Kussmaul is a rare phenomenon that was first reported in 1879. It is characterized by recurrent major salivary gland swelling in patients with atopic background. Treatment includes antihistamines, systemic glucocorticoids, massage, mucolytic agents, sialendoscopy, and surgery. To date, less than 70 cases have been reported in the literature. <h3>Case Summary</h3> A 42-year-old woman was referred from the emergency room to the Oral Medicine unit at Sheba Medical Center with the chief complaint of severe xerostomia and asphyxia due to submandibular swelling. Her medical history was significant only for asthma. The patient reported facial and submandibular swelling accompanied by severe pain, 3 weeks before her presentation. Two months earlier, she had developed urticaria, which was treated with antihistamines. The patient denied any symptoms associated with xerophthalmia. Complete blood count as well as lipase, IgG4, and angiotensin converting enzyme (ACE) levels were within normal limits. Blood levels of amylase and C-reactive protein were elevated. Virology (hepatitis B virus, cytomegalovirus, hepatitis C virus, human immunodeficiency virus [HIV], measles, mumps) and autoimmune panel were negative. Salivary glands ultrasound failed to demonstrate any pathologic findings. Clinical examination revealed enlarged cervical lymph nodes, bilateral mild swelling posterior to angle of mandible, perioral rash, dry tongue covered with white coating, erythema around the orifices of parotid ducts, and labial minor salivary glands enlargement. There was no secretion upon milking of major salivary glands. After stimulation with citric acid, foamy saliva secretion was noted, and on milking a mucous plug was released followed by clear saliva secretion. Sialography demonstrated dilated parotid gland ducts. No focal lymphocytic infiltration was noticed on minor salivary gland biopsy. Cytology of the mucous plugs demonstrated the presence of eosinophils. In the light of salivary glands swelling, dilated parotid ducts, the presence of eosinophils within the mucous plugs, and atopic background, the diagnosis of sialodochitis fibrinosa of Kussmaul was made. <h3>Conclusions</h3> Sialodochitis fibrinosa should be included in the differential diagnosis of patients presenting with sialadenitis, recurrent swelling of major salivary glands, and atopic background.

Genetic and clinical basis for two distinct subtypes of primary Sjögren's syndrome.

ObjectivesClinical presentation of primary Sjögren’s syndrome (pSS) varies considerably. A shortage of evidence-based objective markers hinders efficient drug development and most clinical trials have failed to reach primary endpoints.MethodsWe performed a multicentre study to identify patient subgroups based on clinical, immunological and genetic features. Targeted DNA sequencing of 1853 autoimmune-related loci was performed. After quality control, 918 patients with pSS, 1264 controls and 107 045 single nucleotide variants remained for analysis. Replication was performed in 177 patients with pSS and 7672 controls.ResultsWe found strong signals of association with pSS in the HLA region. Principal component analysis of clinical data distinguished two patient subgroups defined by the presence of SSA/SSB antibodies. We observed an unprecedented high risk of pSS for an association in the HLA-DQA1 locus of odds ratio 6.10 (95% CI: 4.93, 7.54, P=2.2×10−62) in the SSA/SSB-positive subgroup, while absent in the antibody negative group. Three independent signals within the MHC were observed. The two most significant variants in MHC class I and II respectively, identified patients with a higher risk of hypergammaglobulinaemia, leukopenia, anaemia, purpura, major salivary gland swelling and lymphadenopathy. Replication confirmed the association with both MHC class I and II signals confined to SSA/SSB antibody positive pSS.ConclusionTwo subgroups of patients with pSS with distinct clinical manifestations can be defined by the presence or absence of SSA/SSB antibodies and genetic markers in the HLA locus. These subgroups should be considered in clinical follow-up, drug development and trial outcomes, for the benefit of both subgroups.

Oral mucosal lesions in Anorexia Nervosa, Bulimia Nervosa and EDNOS

ObjectivesThe aim of this study is to describe oral lesions in patients with eating disorders (ED), including Anorexia Nervosa (AN), Bulimia Nervosa (BN) and eating disorders not otherwise specified (EDNOS). Material and methodsA prospective case-control study was carried out from April 2003 to May 2004. Inclusion criteria for the study group were individuals with a diagnosis of ED; age and sex-matched individuals without ED were included as controls. Clinical data regarding ED, medical complications and oral examination were performed by previously calibrated professionals. ResultsStudy group (n = 65) presented 46 cases of BN (71%), 13 of EDNOS (20%) and 6 of AN (9%); also, 94% (n = 61) showed oral lesions. The most common were: labial erythema, exfoliative cheilitis, orange-yellow palate, hemorrhagic lesions, lip-cheek biting and non-specific oral atrophies. Only two patients of the study group had dental erosions, and no case of major salivary gland swelling was found. ConclusionsED display a wide array of oral mucosal lesions that can be regarded as their early manifestations. The dentist could be the first professional to detect symptoms of eating disorders, potentially improving early detection and treatment of ED.

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

SUMMARYInflammatory and obstructive disorders of the salivary glands are caused by very different pathological conditions affecting the gland tissue and/or the excretory system. The clinical setting is essential to address the appropriate diagnostic imaging work-up. According to history and physical examination, four main clinical scenarios can be recognised: (1) acute generalised swelling of major salivary glands; (2) acute swelling of a single major salivary gland; (3) chronic generalised swelling of major salivary glands, associated or not with "dry mouth"; (4) chronic or prolonged swelling of a single major salivary gland. The algorithm for imaging salivary glands depends on the scenario with which the patient presents to the clinician. Imaging is essential to confirm clinical diagnosis, define the extent of the disease and identify complications. Imaging techniques include ultrasound (US), computed tomography (CT) and magnetic resonance (MR) with MR sialography.

THU0188 Lymphoproliferative complications in the course of primary sjægren’s syndrome: Prevalence and common features in a large cohort of patients

BackgroundPrimary Sjögren’s syndrome (pSS) is the autoimmune disease most often associated with lymphoma. Mixed cryoglobulinemia as well as persistent parotid swelling are the well known pre-lymphomatous clinical conditions.ObjectivesTo describe the...

FRI0282 Serological biomarkers of b-cell lymphoproliferative disorders in patients with primary sjögren’s syndrome: retrospective study in a large italian cohort

Backgroundprimary Sjögren’s syndrome (pSS) is the autoimmune disease with the highest risk of lymphoma. Lymphoma and mixed cryoglobulinemic vasculitis (CV) occur in a minority of cases, but they are the...

Predictors for the development of non-Hodgkin lymphoma in primary Sjögren's syndrome

Sjögren's syndrome (SS) is a complex autoimmune disease with multi-organ involvement. Its most serious complication is the development of non-Hodgkin lymphoma (NHL). In cohorts of unselected patients with long observation, this lifetime risk is estimated to be 5 to 15%, or approximately 20 times increased risk compared to the general population. Being able to identify patients prone to malignancy would significantly aid in the process of customised treatment and strategy for follow-up. Among the established predictors for lymphoma development in SS, we recognize recurrent or permanent swelling of major salivary glands (SG), lymphadenopathy, cryoglobulinemia, splenomegaly, low complement levels of C4 and C3, lymphopenia, skin vasculitis or palpable purpura, M-component in serum or urine, peripheral neuropathy, glomerulonephritis and elevated beta2-microglobulin. More recent suggestions include some genetic factors, CD4 lymphocytopenia, and ectopic germinal center-like structures in minor SG biopsies. Despite these predictors, there remains a need for defining algorithms for NHL screening and patient follow-up in SS.

Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue-type in the lower labial minor salivary gland of a patient with Sjögren's syndrome

Patients with autoimmune and chronic inflammatory conditions are at increased risk of developing lymphoma. We report a case of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) in a 60-year-old woman who has been treated for Sjogren's syndrome for the last 8 years. She was referred to our hospital because of a painless swelling in her left lower lip. There were no clinical signs of major salivary gland swelling or systemic lymphadenopathy. The tumor was removed surgically, and microscopic examination showed it to be characterized by lymphoepithelial lesions, proliferation of centrocyte-like cells, and follicular colonization, leading to the diagnosis of MALT lymphoma. The patient has undergone periodic systemic examination without evidence of tumor recurrence for 18 months since the surgical treatment. The present report supports the postulation that the labial salivary gland biopsy can offer early diagnostic clues to lymphoma development in patients with underlying Sjogren's syndrome.

Cystic lymphoid hyperplasia in the parotid gland in HIV infection: Report of 2 cases

Unilateral or bilateral swelling of major salivary glands is a condition occasionally associated with human immunodeficiency virus (HIV) infection.1,2 Since 1985,2-6 several cases of parotid gland enlargement, sometimes associated with xerostomia, have been reported in the early stages of HIV infection. Cystic lymphoid hyperplasia of the parotid nodes (CLHP), first described by Ryan et al,3 is one such clinicopathologic entity. CLHP clinically presents as a unilateral or bilateral swelling of the parotid gland in young HIV-infected patients, often, but not exclusively in association with generalized lymphadenopathy. In rare instances, the submandibular salivary gland is affected.4 Epithelial lined cystic cavities within hyperplastic lymph nodes are characteristic features of this condition. We report two additional cases of CLHP and the clinicopathologic features and likely histogenesis of the lesions are discussed.

Less common oral lesions associated with HIV infection: prevalence and classification.

This paper deals with a number of group II and III lesions, ie lesions definitely but less commonly, and lesions possibly associated with HIV infection, respectively. Salivary gland disease includes dry mouth and/or swelling of major salivary glands, often as a part of CD8-lymphocytosis syndrome. Xerostomia occurs commonly (2-10%) in HIV-infected individuals. Enlargement of the major salivary glands occurs frequently (19%) among HIV-infected children, but rarely among adults (0.8%). The major salivary glands show lymphoepithelial lesions or cysts histopathologically. Hyperpigmentation of the oral mucosa was found in 2.2% of 1710 HIV+ individuals in seven studies. The hyperpigmentation has been ascribed to a number of medicaments, and possibly to HIV. The prevalence of pigmentation is not significantly higher among HIV+ than HIV- individuals. Thrombocytopenia frequently occurs in HIV infection. Oral petechiae were reported in 2% of 1121 HIV+ in five studies. Human papilloma virus (HPV) infection occurred in 1.1% of 989 HIV+ in seven studies. Drug reactions (white lichenoid lesions, ulceration, toxic epidermal necrolysis) have been reported in a number of cases, not allowing prevalence figures. However certain drugs, notably Foscarnet, Interferon and 2,3-dideoxycytidine, may frequently cause oral ulcerations. Oral neurologic manifestations such as peripheral facial paralysis and sensory neuropathy have been reported in a few cases or series only.