Pathology · single question
SJOGREN'S SYNDROME CASE: A patient presents with dry mouth and dry eyes. A lip biopsy is performed. What would you find on histology?
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Correct answer: D. Lymphocytic infiltration of salivary gland tissue
The hallmark finding in a lip (minor salivary gland) biopsy in Sjogren's syndrome is focal lymphocytic sialadenitis — clusters of 50 or more lymphocytes (predominantly CD4+ T cells) around salivary ducts and acini. A focus score ≥1 (per 4mm² of tissue) is diagnostic. The lymphocytes infiltrate and destroy secretory cells, causing xerostomia.
- A. Incorrect. Fat cells may appear incidentally with fatty replacement in aging glands, but this is NOT diagnostic of Sjogren's and is not the characteristic finding.
- B. CORRECT. Focal lymphocytic infiltration (periductal lymphocytic sialadenitis) with a focus score ≥1 is the diagnostic histologic hallmark of Sjogren's syndrome on lip biopsy.
- C. Incorrect. Granulomas with giant cells suggest sarcoidosis or granulomatous disease, not Sjogren's syndrome.
- D. Incorrect. Tzanck cells (acantholytic keratinocytes) are found in pemphigus vulgaris and herpetic infections, not Sjogren's syndrome.