Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation

Perspectives on oral chronic graft-versus-host disease from immunobiology to morbid diagnoses

“…Acute and chronic salivary gland GVHD can affect the saliva production in both minor and major glandular structures, but the immunopathology has been principally assessed in the minor glands ( 46 , 66 , 67 , 70 – 73 ) Clinical signs of mucoceles and glandular enlargement, as well as xerostomia are described for both salivary gland cGVHD and Sjogren’s Syndrome, but links between salivary gland cGVHD and overall cGVHD severity remains controversial ( 16 , 35 , 66 , 71 , 74 ). Patients experiencing salivary gland dysfunction commonly report additional signs associated with a dry mouth, including mucoid viscous saliva, reduced or absent mucosal biofilm, the accumulation of soft debris and erythematous mucosa ( 75 ).…”

“…A labial minor salivary gland biopsy should be used to verify the histopathological criteria of salivary gland cGVHD ( 14 ). Histological diagnosis (“possible or likely”) of salivary gland cGVHD has also been based on the NIH cGVHD histopathological consultation form, and the Chisholm-Mason composite score for Sjogren’s Syndrome ( 14 , 17 , 46 , 47 ). Periductal and acinar lymphocytic inflammation are considered specific for cGVHD ( 14 ).…”

“…Periductal and acinar lymphocytic inflammation are considered specific for cGVHD ( 14 ). Typically, a mixed infiltrate involving both plasma cells and lymphocytes have been described ( 14 , 46 , 47 , 56 , 58 ). The presence of Sjogren’s Syndrome-like focused lymphocytic clusters is a contentious issue but salivary gland cGVHD could be related to diffuse peri-ductal and acinar inflammation rather than typical foci, which might depend on disease specificity, severity, and duration post-HCT ( 46 , 47 , 56 , 65 ).…”

“…Typically, a mixed infiltrate involving both plasma cells and lymphocytes have been described ( 14 , 46 , 47 , 56 , 58 ). The presence of Sjogren’s Syndrome-like focused lymphocytic clusters is a contentious issue but salivary gland cGVHD could be related to diffuse peri-ductal and acinar inflammation rather than typical foci, which might depend on disease specificity, severity, and duration post-HCT ( 46 , 47 , 56 , 65 ). The NIH cGVHD histopathological consultation form specifically includes exocytosis with periductal and acinar inflammation, in contrast to the Chisholm-Mason composite score ( 14 , 46 , 47 ).…”

“…The presence of Sjogren’s Syndrome-like focused lymphocytic clusters is a contentious issue but salivary gland cGVHD could be related to diffuse peri-ductal and acinar inflammation rather than typical foci, which might depend on disease specificity, severity, and duration post-HCT ( 46 , 47 , 56 , 65 ). The NIH cGVHD histopathological consultation form specifically includes exocytosis with periductal and acinar inflammation, in contrast to the Chisholm-Mason composite score ( 14 , 46 , 47 ). Identification of lymphocytic acinar migration with exocytosis is hard to assess and could be attributed to heavy inflammation leading to acinar destruction and difficulties in assessing acinar exocytosis ( 46 ).…”