Salivary gland scintigraphy with 99mTc-pertechnetate in Sjögren's syndrome: relationship to clinicopathologic features of salivary and lacrimal glands

Salivary gland scintigraphy was performed on 52 patients who were suspected of having Sjögren's syndrome (SS). and the results were compared with clinicopathologic features of the salivary and lacrimal glands. The time-activity curves which were obtained from computer-assisted analysis of ^99mTc-pertechnetate (^99mTc) scintigraphy were classified into four types (normal, median, flat and sloped types). The stimulated parotid flow rate decreased and the incidence of SS-related sialographic and histopathologic findings increased significantly as the scintigraphic abnormality advanced. In addition, the lacrimal gland function decreased and the proportion of patients diagnosed as having keratoconjunctivitis sicca (KCS) increased significantly as the scintigraphic abnormality advanced. These results indicate that the results of scintigraphy are related not only to the clinicopathologic features of the salivary glands but also to the lacrimal gland function in SS.     

Primary Sjögren's syndrome (pSS): subjective symptoms and salivary findings

We studied the relationship between dry mouth, general health and objective findings in 16 patients having primary Sjogren's syndrome (pSS) according to the 1993 European classification criteria as well as in healthy controls. Serum autoantibody to SSA/SSB (AB) was correlated to unstimulated whole saliva flow (UWS) and labial salivary gland focus score (FS). All patients had dry mouth symptoms and UWS ≦ 0.10 ml/min, but patients with UWS < 0.05 ml/min and AB had more complaints of oral and ocular dryness. These patients also tended to have more exocrine and non-exocrine manifestations, and oral dryness had a greater impact on their self-reported general health than in patients with UWS ≧ 0.05 ml/min. Accordingly, we consider rating of oral dryness by visual analogue scales or categorised questionnaires to be valuable for the evaluation of oral involvement in pSS.     

Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs

Background and OverviewXerostomia, also known as “dry mouth,” is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction, which is the objective measurement of reduced salivary flow. Patients with dry mouth exhibit symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, demineralization, tooth sensitivity, candidiasis and other oral diseases that may affect quality of life negatively. This article presents a multidisciplinary approach to the clinical management of xerostomia, consistent with the findings of published systematic reviews on this key clinical issue.Conclusions and Practice ImplicationsInitial evaluation of patients with dry mouth should include a detailed health history to facilitate early detection and identify underlying causes. Comprehensive evaluation, diagnostic testing and periodic assessment of salivary flow, followed by corrective actions, may help prevent significant oral disease. A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use. Comprehensive management of xerostomia and hyposalivation should emphasize patient education and lifestyle modifications. It also should focus on various palliative and preventive measures, including pharmacological treatment with salivary stimulants, topical fluoride interventions and the use of sugar-free chewing gum to relieve dry-mouth symptoms and improve the patient's quality of life.     

Effects on salivary flow rate and composition of withdrawal of and re-exposure to the β1 -selective antagonist metoprolol in a hypertensive patient population

Secretion rates and composition of unstimulated and chewing–stimulated whole saliva and 3% citric acid stimulated parotid and submandibular-sublingual secretions were studied in 12 hypertensive patients during withdrawal of and re-exposure to antihypertensive pharmacotherapy. All the patients' blood pressures were well controlled by monotherapy with metoprolol, a β₁-selective adrenoceptor antagonist. Blood pressure measurements and saliva sampling were performed at about 9.30 a.m., 2 h after intake of breakfast, on days 0 (medicated baseline), 7, 14, 28 (nonmedicated experimental values and nonmedicated baseline) and 35 (medicated experimental values). A significant increase in unstimulated whole saliva secretion rate was observed when metoprolol was withdrawn and a corresponding decrease when the drug was reintroduced. A positive correlation was found between diastolic blood pressure levels and chewing-stimulated whole saliva secretion rates. In unstimulated whole saliva and 3% citric acid stimulated submandibular-sublingual secretion, the output of total protein, amylase, potassium, calcium and phosphate was significantly increased during the withdrawal period and decreased when metoprolol was reintroduced. For chewing-stimulated whole saliva, the corresponding changes were restricted to output of total protein and amylase while for citric acid stimulated parotid secretion, no changes in salivary composition were observed. Finally, in all secretions one or both of the ratios hexosamine/total protein and sialic acid/total protein were affected, indicating a possible effect of (J-adrenoceptor antagonists on salivary protein synthesis.     

Non-Hodgkin's lymphoma of the major salivary gland: a morphologic and immunohistochemical study of 15 cases

A total of 15 cases of Japanese salivary gland lymphoma was analysed by conventional histology and also by immunoperoxidase staining of paraffin sections. The initial sites included: parotid gland (14 cases, 93%) and submandibular gland (1 case, 7%). The mean age was 59 yr, with a male to female ratio of 2.8:1. The only one patient (Case 9) with clinical evidence of Sjögren's syndrome showed the development of intrasalivary malignant lymphoma. Each lymphoma was classified according to the Working Formulation for Clinical Usage. The Working Formulation grades were 20% low, 67% intermediate, and 13% high. These neoplasms fell into six categories: follicular, small cleaved type (1 case); follicular, mixed small cleaved and large cell type (2 cases); follicular, large cell type (2 cases); diffuse, mixed small and large cell type (1 case); diffuse, large cell type (7 cases); and large cell, immunoblastic type (2 cases). Fifteen tumors were studied using a indirect immunoperoxidase method. A selected antibody panel was used, including B-cell markers (immunoglobulins, Ki-B3, L26), T-cell markers (UCHL-1 and MT1) and histiocytic markers (lysozyme, α₁-antitrypsin and cathepsin D). Eleven cases reacted with pan-B-marker (Ki-B3 and L26) and eight of them showed the presence of monoclonal cytoplasmic immunoglobulin (C-Ig). Following rigid criteria, monoclonal C-Ig of MK was demonstrated in one case of follicular, small cleaved cell type, one follicular, large cell type and two diffuse, large cell type; Mλ was demonstrated in one diffuse, large cell type; and Gλ was demonstrated in one follicular, mixed small cleaved and large cell type, and two diffuse, large cell type. Two T-cell lymphomas which reacted with UCHL-1 and MT1 were demonstrated in two cases of large cell, immunoblastic type. In both cases, Ber-H2 was positive in neoplastic large cells. Two true histiocytic lymphomas that were positive for α-antitrypsin and cathepsin D were demonstrated in two diffuse, large cell type.     

Apoptosis-induced and -suppressed cells in salivary gland adenoid cystic carcinoma: correlation with histological growth patterns

OBJECTIVE: It is well known that adenoid cystic carcinoma (ACC) arising from salivary glands shows a correlation between prognosis and histological growth patterns. The aim of the study was to evaluate whether three growth patterns of ACC are related to the distributions of apoptosis-induced and -suppressed tumor cells. MATERIALS AND METHODS: We examined 77 cases of ACC including tubular (18 cases), glandular (50) and solid (9) patterns. In order to visualize the apoptotic cells, terminal deoxynucleotidyl transferase (TdT)- mediated dUTP-biotin nick end labeling (TUNEL) and avidin-biotin complex staining using Lewis Y (LeY) antibody were applied to paraffin sections. For detection of the apoptosis-suppressed cells, immunohistochemistry employing bcl-2 antibody was utilized. RESULTS: Apoptosis index (AI) based on the TUNEL-stained specimens were tubular, 7.0; glandular 2.4; solid, 5.1. In tubular type, apoptotic cells were frequently located in the inner tubular layer rather than the outer layer. Solid type had scattered apoptotic cells in the nests. Bcl-2 expression was found in 61% of tubular, 20% of glandular and 22% of solid cases. The localization of bcl-2 protein was noticed in outer tubular cells, and peripheral cells or undifferentiated cells in solid pattern. CONCLUSIONS: The peculiar distribution of apoptotic cells may result from the various proportions and distinctive arrangement of neoplastic ductal cells and neoplastic myoepithelial cells in ACC. Apoptotic cells and bcl-2 positive apoptosis-suppressed cells may participate in the construction of characteristic histological appearances of ACC.     

Bilateral submandibular gland oncocytoma in a patient with multiple endocrine neoplasia 2B syndrome and neurofibromatosis type 1: an unusual case

Oncocytomas are unusual neoplasms of the head and neck that occur mainly in the parotid gland. The authors report a case of bilateral submandibular gland oncocytoma in a patient with multiple endocrine neoplasia 2B syndrome and neurofibromatosis type 1. Histopathology of the resection specimens demonstrated lymphovascular invasion but no other aggressive features. This was a highly unusual feature in an otherwise rare benign tumour.