Clinical, histopathological and immunohistological study of lymphoid disorders in the parotid gland of patients with Sjögren's syndrome

Trenkić-Božinović, Marija; Katić, Vuka; Krasić, Dragan; Veselinović, Dragan; Jovanović, Predrag; Krstić, Miljan

doi:10.2298/VSP0912955T

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Vojnosanitetski pregled

2009, vol. 66, br. 12, str. 955-960

Klinička, morfološka i imunohistohemijska analiza limfoidnog poremećaja u parotidnoj žlezdi kod bolesnika sa Sjegrenovim sindromom

Trenkić-Božinović Marija^a

, Katić Vuka^b, Krasić Dragan^c

, Veselinović Dragan^a, Jovanović Predrag^a, Krstić Miljan^b

^aKlinički centar Niš, Klinika za očne bolesti
^bUniverzitet u Nišu, Medicinski fakultet, Katedra Patologija
^cUniverzitet u Nišu, Medicinski fakultet, Katedra Maksiofacijalna hirurgija i oralna hirurgija

e-adresa: marija.trenkic@gmail.com

Ključne reči: Sjegrenov sindrom; limfom, malt; dijagnoza, diferencijalna; histologija; imunohistohemija

Sažetak

Uvod/Cilj. Sjegrenov sindrom je hronična autoimuna sistemska bolest okarakterisana poliglandularnom tkivnom destrukcijom, suvim keratitisom i suvim ustima. Ovi bolesnici imaju 44 puta veći rizik od razvoja limfoma, pri čemu je kod 80% njih prisutan MALT tip. Zbog nejasnih kriterijuma za razlikovanje benignih limfoepitelnih lezija pljuvačnih žlezda od MALT limfoma, cilj ove analize bio je obezbeđivanje praktičnih, kliničkih, histopatoloških i imunohistohemijskih informacija o njima. Metode. Od 32 parotidektomije, kod 27 nađen je Sjegrenov sijaloadenitis, a kod 5 MALT limfom. Laboratorijski preseci debljine 4 μm bojeni su hematoksilin/eozin (HE), Van Gieson, AB-PAS i LSAB2 metodama, uz korišćenje antitela na: CD3, CD20, kappa i lambda lake lance i panCytokeratin antigene. Rezultati. Analizom je bilo obuhvaćeno 27 bolesnika (22 žene i 5 muškaraca) sa Sjegrenovim sijalodenitisom i pet bolesnika (samo žene) sa MALT limfomom. U skladu sa Ann Harbor klasifikacijom svi bolesnici sa MALT limfomom bili su u stadijumu IE. Obe grupe bolesnika imale su blagi klinički tok, sem bržeg povećanja jedne parotidne žlezde kod onih sa limfomom. Za razliku od benignih limfoepitelnih lezija, MALT limfom odlikovao se difuznim i gustim monoklonskim B-ćelijskim infiltratom, uz brisanje normalne građe pljuvačne žlezde i malignim limfoepitelnim lezijama infiltrovanim monoklonskim tipom B limfocita potpuno ili delimično. Maligne limfoepitelne lezije, prikazane kao infiltracije duktusnih i epitelnih struktura monoklonskim neoplastičnim B-ćelijama pozitivnim na CD 20, prikazale su se pomoću antitela na citokeratin. Zaključak. Za optimalnu dijagnozu MALT limfoma pljuvačne žlezde neophodni su klinički, morfološki i imunohistohemijski nalazi.

Abstract

Bacground/Aim. Sjögren's syndrome is a chronic autoimmune systemic disease characterized by polyglandular tissue destruction, leading to keratoconjunctivitis sicca and xerostomia. These patients have 44-fold increased risk of developing salivary gland lymphoma, of which 80% are marginal zone (MALT) type. Having in mind that criteria for distinguishing benign lymphoepithelial lesions from MALT lymphoma are obscure, the aim of this study was to provide practical information that could be integrated into diagnostic practice. Methods. Among 32 parotidectomies, 27 cases were identified as having benign lymphoepithelial disorders and 5 cases low grade MALT lymphoma. Histological sections were stained routinely with hematoxylin and eosin (H&E and special stains. Immunohistochemical study was performed by LSAB2 method, by using primary antibodies for CD20, CD3, Kappa and Lambda light chains and Cytokeratin (Dako Denmark). Results. The 27 patients with Sjögren's sialoadenitis (22 women and 5 men), and 5 patients with MALT lymphoma (only women) were included in this analysis. According to the Ann Harbor Classification, all patients with MALT lymphoma had stage IE. Both groups of patients had an indolent clinical course, except permanent, rapid parotid enlargement in the patients with MALT lymphoma. Histologically, the periductal lymphoid infiltrate, gradually extended to the acini, completely replacing them by a sea of polyclonal lymphocytes, immunoblasts, germinal centers and plasma cells (confirmed immunohistochemically), but sparing the ducts and preserving lobular appearance. The histological feature of salivary gland MALT lymphoma included heterogeneous B-cell infiltrate that totally or subtotally had effaced the normal glandular structure. Malign lymphoepithelial lesions, representing infiltration of the ductal and epithelial structures by monoclonal neoplastic Bcells, positive for CD20, were highlighted by antibody to cytokeratin. Conclusion. The optimal diagnosis of salivary gland MALT lymphoma requires careful integration of clinical, morphological and immunohistochemical results.

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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP0912955T
objavljen u SCIndeksu: 12.01.2010.

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