A new and highly sensitive immunohistologic diagnostic criterion for Sjögren's syndrome

Abstract

Immunohistologic investigation of the sublabial salivary glands of 65 surgical patients who were free of systemic disease (control) and 19 patients with Sjogren's syndrome resulted in a new diagnostic criterion for SS that was more disease-specific than the widely used lymphocytic focus wore criterion. Our bivariate classification criterion, which is based on the percentages of IgA-and IgG-containing plasma cells, has a specificity of 95.4% and a sensitivity of loo%, while its overall percentage of misclassification is 3.6%. This immunohistologic diagnostic criterion results in a reduction of the percentage of false-positive diagnoses from 9% to 4.6%.Sjogren's syndrome (SS) is a chronic autoimmune disease characterized by the clinical manifestations of xerostomia and keratoconjunctivitis sicca (KCS) related to lymphocytic infiltration and dysfunction of the salivary and lacrimal glands (1-7). SS has

Chronic lymphocytic sialoadenitis in HCV‐related chronic liver disease: comparison with Sjögren's syndrome

“…The number of IgA, IgG and IgM positive plasma cells was counted using an eyepiece graticule according to standard point counting techniques 23 . All plasma cells within salivary gland tissue were counted; in order to avoid overestimation 11,19 , the plasma cells which fell on the right and lower edges of the eyepiece graticule were not considered. The total number of plasma cells was obtained and the percentage of each plasma cell type calculated.…”

“…The volume percentages of the diffuse lymphoplasmacytic infiltrate, of intralobular ducts and of acini were measured using a point counting technique described by de Wilde et al 23 . The immunohistological discriminant function 1 (DF1) was calculated according to the formula DF1 = (0.062 2 % IgA) -(0.088 2 %IgG) -4.387 11,19 . The immunohistological and histomorphometric discriminant function 2 (DF2) was calculated according to the formula DF2 = 0.043 Values lower than -1.19 for discriminating function 1 11,19 and lower than -1.79 for discriminating function 2 12 were taken as the cut-off for distinguishing primary Sjögren's syndrome patients.…”

“…However, Manthorpe et al 9 and Vitali et al 7 set a value of 1/4 mm 2 of salivary tissue in keeping with other reports 8,10-14 , while Fox et al 6 set a value of 2/4 mm 2 . Many other features have been described as being characteristic of primary Sjögren's syndrome: intralobular salivary duct alterations 15 , presence of lymphoid aggregates with less than 50 lymphocytes 16 , evidence of lymphoid infiltration within intralobular salivary duct epithelium 17 , a high percentage of IgM positive plasma cells 18 and a low percentage of IgA reactive plasma cells 19 , scoring by means of quantitative morphometrical formulae which take into account percentage of plasma cell types either alone (discriminant function 1, DF1) or in combination with volume percentages of salivary gland tissue compartments (discriminant function 2, DF2) 11,12,19 , and T-cell immunophenotype of lymphoid foci and of lymphocytes within intralobular salivary duct epithelium 20,21 . Even though these features have been reported as being able to discriminate primary Sjögren's syndrome salivary gland biopsies from those of controls, they are not usually taken into account in the routine morphological evaluation of a patient suspected of having primary Sjögren's syndrome.…”

“…The aim of this study was to examine in labial salivary gland biopsies from 22 consecutive chronic HCV liver disease and 10 consecutive primary Sjögren's syndrome patients those morphological, immunocytochemical and quantitative characteristics which have been reported as being typical of primary Sjögren's syndrome 11,12,[15][16][17][18][19][20][21] in order to characterize HCVrelated chronic sialoadenitis.…”

Detection of anti-Ro/SSA and anti-La/SSB autoantibody-producing cells in salivary glands from patients with Sj�gren's syndrome

“…The percentage of IgA-producing cells is often reduced. The B cells are most often found at the margins of the focal infiltrates, but are also present as small conglomerates throughout the parenchyma (25)(26)(27). It has been demonstrated that an increase in small aggregates of plasma cells can precede the focal lymphocytic infiltrates (28).…”