Biopsy of parotid gland in Sjogren's shows:
Ref: Robbins Pathologic Basis of Disease, 8th edition,Pg: 221-3Explanation:"The earliest histologic finding in both the major and the minor salivary glands is periductal and perivascular lymphocytic infiltration." (Ref: Robbins)Sjogren SyndromeIt is a immune-mediated destruction of the lacrimal and salivary glands characterized by dry eyes {keratoconjunctivitis sicca) and dry mouth (xerostomia)It occurs as an isolated disorder (primary form), also known as the sicca syndrome, or more often in association with another autoimmune disease (secondary form).Associated diseasesRheumatoid Arthritis (Me)SLEPolymyositisSystemic sclerosisVasculitisThyroiditisThe ductal epithelial cells of the exocrine glands are the primary target for autoantibodies.There is also systemic B-eell hyperactivity, as evidenced by the presence of ANAs and RF.Autoantibodies to the RNP antigens SS-A (Ro) and SS-B (La) (also present in SLE)Other secretory glands like nasopharynx, upper airway, and vagina, may also be involvedInvolved tissues show an intense lymphocyte (primarily activated CD4+ T ceils) and plasmacell infiltrate.Lacrimal gland destruction results in a lack of tears, leading to drying of the corneal epithelium, with subsequent inflammation, erosion, and ulceration (keratoconjunctivitis).Similar changes may occur in the oral mucosa as a result of loss of salivary gland output, giving rise to mucosal atrophy, with inflammatory Assuring and ulceration (xerostomia).Dryness and crusting of the nose may lead to ulcerations and even perforation of the nasal septum.When the respiratory passages are involved, secondary laryngitis, bronchitis, and pneumonitis may appear.Approximately 25% of the patients (especially those with anti-SS-A antibodies) develop extraglandular disease affecting the CNS, skin, kidneys, and muscles.Renal lesions take the form of mild interstitial nephritis associated with tubular transport defects: Unlike in SLE. glomerulonephritis is rare.90%% cases occur in women between 35 and 45 yearsExtraglandular manifestations include synovitis, pulmonary fibrosis, and peripheral neuropathy.There is a 40-fold increased risk of developing non-Hodgkin B-cell lymphoma.
Lymphocytes
Neutrophils
Eosinophils
Basophils
Autoimmune Diseases