Chronic GVHD in minor salivary glands and oral mucosa: histopathological and immunohistochemical evaluation of 25 patients

Abstract

Histological features were useful in the diagnosis of oral cGVHD. It is suggested that CD8-T cells and macrophages play important role in the pathogenesis of the disease.

The impact of morphological and immunohistological changes in minor salivary glands on the health of the oral cavity in HSCT patients

“…Severe involvement of the MSG in cGVHD results in marked destruction of the secretory units and, thus, in permanent and profound oral dryness. 27,28 Unlike our results, Soares et al 14 found increased CD68 þ cell number in cGVHD patients, compared with non-cGVHD HSCT patients. This discrepancy might be explained by the previous development of acute GVHD.…”

“…[7][8][9] The typical histological findings of cGVHD in salivary glands are periductal and diffuse lobular lymphocyte infiltrate (CD8 þ over CD4 þ ), atrophy or destruction of acini, and fibrosis. 5,[10][11][12][13][14][15] Despite the advent of new therapies and management of cGVHD, minimal changes in this scenario have been observed, mainly due to an incomplete understanding of the pathogenesis of this disorder. 1,16 Knowing the most important histological findings for the diagnosis of minor salivary gland (MSG) cGVHD and its possible influence on overall patient health and understanding the mononuclear subset participation in salivary glands after HSCT can contribute to better management of those patients.…”

Effect of pilocarpine hydrochloride on unstimulated whole saliva flow rate and composition in patients with chronic graft-versus-host disease (cGVHD)

“…8,[12][13][14][15][16][17] Xerostomia is a major feature of cGVHD. 6,[18][19][20] Temporary symptomatic relief can be offered by moistening agents and saliva substitutes, and is the only option for patients without residual salivary function. The carboxymethylcellulose-based artificial saliva does not replace the many salivary macromolecules critical to protective and other functions of saliva.…”

“…1 Unfortunately, a number of patients who receive allogeneic BMT suffer from chronic graft-versus-host disease (cGVHD) following the procedure. [2][3][4][5][6] Oral symptoms in extensive form are present in approximately 80% of patients. 5 Usually, atrophy of mucous membranes promotes the development of severe periodontitis and caries.…”

<b>Pivotal role of duct epithelia in salivary gland </b><b>GVHD </b>

“…In reports of human cases, to avoid invasive clinical examination, assessment of salivary gland lesions had been substituted with oral minor salivary glands (Alborghetti et al, 2005;Prochorec-Sobieszek et al, 2012;Soares et al, 2013). Using biopsies of minor salivary glands of oral mucosa, expression of chemokines and cytokines (Hayashida et al, 2013), infiltration of CD4-positive and CD8-positive T cells (Hiroki et al, 1996;Soares et al, 2005), and expression of HLA-DR, human class II major histocompatibility complex (MHCII) molecule on ductal epithelial cells (Hiroki et al, 1996;Lindahl et al, 1988) were assessed to date, from an immunological point of view. However, because the major salivary glands are composed of a varied mixture of serosal and mucous glands, minor glands might not always reflect pathology of three different major glands, submandibular gland (SMG), parotid gland (PG), and sublingual gland (SLG).…”