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Difference between revisions of "Sjögren syndrome"
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==Microscopic== | ==Microscopic== | ||
Features ([[salivary gland]]):<ref name=pmid19323360/> | Features ([[salivary gland]]):<ref name=pmid19323360/> | ||
* | *Viable [[salivary gland]] (or [[lacrimal gland]]) acini with significant lymphocytic infiltration - '''key feature'''. | ||
** | **Plasma cells should not exceed 10% of the inflammatory infiltrate.<ref name=pmid12022353/> | ||
* | **"Significant" infiltrate = cluster of >= 50 lymphocytes - '''important'''. | ||
* | ***Lymphocytes that are perivascular count.<ref name=pmid12022353/> | ||
***May have "benign lymphoepithelial lesion"<ref name=pmid15956090/> - intraepithelial lymphocytes. | |||
*+/-Fibrosis. | *+/-Fibrosis. | ||
DDx: | DDx: | ||
*[[MALT lymphoma]]. | *[[MALT lymphoma]]. | ||
*[[Chronic sialadenitis]]. | |||
Note: | Note: | ||
*Diagnosis is based on clinicopathologic correlation; the histology alone is insufficient. | *Diagnosis is based on clinicopathologic correlation; the histology alone is insufficient. | ||
Images: | Images: | ||
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*[http://commons.wikimedia.org/wiki/File:Sjogren_syndrome_%282%29.jpg SS - high mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Sjogren_syndrome_%282%29.jpg SS - high mag. (WC)]. | ||
===Grading=== | ===Focus score=== | ||
*This is a count of significant lymphocytic foci. | |||
====Grading - historical==== | |||
In the past lesions were graded with the ''Chisholm-Mason classification''.<ref name=pmid15956090>{{Cite journal | last1 = Ramos-Casals | first1 = M. | last2 = Font | first2 = J. | title = Primary Sjögren's syndrome: current and emergent aetiopathogenic concepts. | journal = Rheumatology (Oxford) | volume = 44 | issue = 11 | pages = 1354-67 | month = Nov | year = 2005 | doi = 10.1093/rheumatology/keh714 | PMID = 15956090 | url = http://rheumatology.oxfordjournals.org/content/44/11/1354.long }}</ref> | |||
It is based on assessing 4 mm<sup>2</sup> area of salivary gland tissue and depends on the abundance and aggregation of lymphocytes as follows:<ref>{{Cite journal | last1 = Chisholm | first1 = DM. | last2 = Mason | first2 = DK. | title = Labial salivary gland biopsy in Sjögren's disease. | journal = J Clin Pathol | volume = 21 | issue = 5 | pages = 656-60 | month = Sep | year = 1968 | doi = | PMID = 5697370 | PMC = 473887 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC473887/?tool=pubmed }}</ref> | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
!Grade | !Grade | ||