Monday 5 November 2007
Myoepithelial sialadenitis of the salivary gland is associated with an increased risk of lymphoma, but criteria that predict its development have not been clearly defined.
LESA is found in virtually all patients with Sjögren’s syndrome but may occur without Sjogren’s syndrome. It is associated with lymphoid infiltration of salivary gland tissue, producing atrophy and destruction of the acini.
Lymphoepithelial lesions form as the result of atrophy of the columnar ductal epithelium and proliferation of basal epithelial cells, associated with intraepithelial infiltration of marginal zone B cells. These are analogous to the lymphoepithelial lesions seen in gastrointestinal cases of extranodal marginal zone lymphoma.
Reactive lymphoid follicles typically surround the altered ducts, and aggregates of marginal zone B cells may be present around affected ducts as well as around reactive follicles.
Acute sialodochitis and fibrosis are not typical features of LESA. The development of frank lymphoma is characterized by broad sheets of marginal zone cells outside of follicles and lymphoepithelial lesions.
Ihrler S, Blasenbreu-Vogt S, Sendelhofert A, Rossle M, Harrison JD, Lohrs U. Regeneration in chronic sialadenitis: an analysis of proliferation and apoptosis based on double immunohistochemical labelling. Virchows Arch. 2004 Apr;444(4):356-61. PMID: 14762713
Metwaly H, Cheng J, Ida-Yonemochi H, Ohshiro K, Jen KY, Liu AR, Saku T. Vascular endothelial cell participation in formation of lymphoepithelial lesions (epi-myoepithelial islands) in lymphoepithelial sialadenitis (benign lymphoepithelial lesion). Virchows Arch. 2003 Jul;443(1):17-27. PMID: 12761623
Harris NL. Lymphoid proliferations of the salivary glands. Am J Clin Pathol. 1999 Jan;111(1 Suppl 1):S94-103. PMID: 9894474
Bahler DW, Swerdlow SH. Clonal salivary gland infiltrates associated with myoepithelial sialadenitis (Sjogren’s syndrome) begin as nonmalignant antigen-selected expansions. Blood. 1998 Mar 15;91(6):1864-72. PMID: 9490668
DiGiuseppe JA, Corio RL, Westra WH. Lymphoid infiltrates of the salivary glands: pathology, biology and clinical significance. Curr Opin Oncol. 1996 May;8(3):232-7. PMID: 8804813
Hsi ED, Zukerberg LR, Schnitzer B, Harris NL. Development of extrasalivary gland lymphoma in myoepithelial sialadenitis. Mod Pathol. 1995 Oct;8(8):817-24. PMID: 8552569
Diss TC, Wotherspoon AC, Speight P, Pan L, Isaacson PG. B-cell monoclonality, Epstein Barr virus, and t(14;18) in myoepithelial sialadenitis and low-grade B-cell MALT lymphoma of the parotid gland. Am J Surg Pathol. 1995 May;19(5):531-6. PMID: 7726362
De Vita S, Ferraccioli G, De Re V, Dolcetti R, Carbone A, Bartoli E, Boiocchi M. The polymerase chain reaction detects B cell clonalities in patients with Sjogren’s syndrome and suspected malignant lymphoma. J Rheumatol. 1994 Aug;21(8):1497-501. PMID: 7983653
Seifert G. Tumour-like lesions of the salivary glands. The new WHO classification. Pathol Res Pract. 1992 Oct;188(7):836-46. PMID: 1448373