Pathology · patient case question
A labial minor salivary gland biopsy is performed. What is the expected histological finding?
Patient case: The mouth that will not stay wet
demo: 54-year-old female
chief: Burning, sticky mouth for the past eight months; food gets caught and she wakes at night to sip water.
history: Hashimoto thyroiditis. Her rheumatologist ordered an autoantibody panel after she reported gritty, burning eyes.
meds: Levothyroxine 75 mcg daily. Amitriptyline 25 mcg at night for chronic tension headache.
findings: Anti-SSA (Ro) strongly positive. Salivary pooling is absent; the mucosa is dry and the tongue is fissured with papillary atrophy. Cracking and erythema at both commissures. Two new cervical lesions since her last visit a year ago.
Show answer and explanation
Correct answer: D. Focal aggregates of lymphocytes around ducts and acini
- A. Fatty replacement of acini is a feature of ageing and chronic sialadenitis. It may be present incidentally but it is not diagnostic and its presence alone does not support Sjogren.
- B. A dense plasma cell infiltrate with Russell bodies suggests a plasma cell disorder or chronic sclerosing sialadenitis, not the T-cell driven focal lesion of Sjogren.
- C. Non-caseating granulomas point to sarcoidosis, which is an important mimic of Sjogren because it also causes salivary swelling and dry mouth. The histology separates them cleanly.
- D. Correct. The diagnostic finding is focal lymphocytic sialadenitis: periductal collections of at least 50 lymphocytes, mostly CD4-positive T cells. A focus score of 1 or more per 4 square millimetres of glandular tissue supports the diagnosis.
Note: The recall option was written loosely as 'immunity cells' against a distractor of 'fat cells.' The examinable point is that the infiltrate is lymphocytic and focal, and that a focus score of 1 or more is the threshold.