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Review article: Biomedical intelligence

Vol. 145 No. 3738 (2015)

The value of histopathological examination of salivary gland biopsies in diagnosis, prognosis and treatment of Sjögren’s Syndrome

  • Francesca Barone
  • Joana Campos
  • Simon Bowman
  • Benjamin A Fisher
DOI
https://doi.org/10.4414/smw.2015.14168
Cite this as:
Swiss Med Wkly. 2015;145:w14168
Published
06.09.2015

Summary

Primary Sjögren’s syndrome (pSS) is a complex autoimmune disease characterised by local exocrine glandular involvement and systemic multiorgan manifestations. In this review we will discuss the value of the histological examination of the salivary glands in the classification criteria, and more recently as prognostic tool for patient stratification and monitoring. The limitations of the current tools used to assess salivary gland pathology in pSS will also be reviewed in relation to using salivary gland biopsy analysis as an outcome measure in clinical trials.

References

  1. Chisholm DM, Mason DK. Labial salivary gland biopsy in Sjogren’s disease. J Clin Pathol. 1968;21(5):656–60.
  2. Moutsopoulos HM. Sjogren’s syndrome: autoimmune epithelitis. Clin Immunol Immunopathol. 1994;72(2):162–5.
  3. Bowman SJ, Ibrahim GH, Holmes G, Hamburger J, Ainsworth JR. Estimating the prevalence among Caucasian women of primary Sjogren's syndrome in two general practices in Birmingham, UK. Scand J Rheumatol. 2004;33(1):39–43.
  4. Fox RI, Tornwall J, Michelson P. Current issues in the diagnosis and treatment of Sjogren’s syndrome. Curr Opinion Rheumatol. 1999;11(5):364–71.
  5. Pillemer SR, Matteson EL, Jacobsson LT, Martens PB, Melton LJ, 3rd, W.M. O’Fallon, et al. Incidence of physician-diagnosed primary Sjogren syndrome in residents of Olmsted County, Minnesota. Mayo Clin Proc. 2001;76(6):593–9.
  6. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, Lanfranchi H, et al. American College of Rheumatology classification criteria for Sjogren’s syndrome: a data-driven, expert consensus approach in the Sjogren’s International Collaborative Clinical Alliance cohort. Arthritis Care Res. 2012;64(4):475–87.
  7. Anaya JM, Delgado-Vega AM, Castiblanco J. Genetic basis of Sjogren’s syndrome. How strong is the evidence? Clinical & developmental immunology. 2006;13(2-4):209–22.
  8. Ramos-Casals M, Solans R, Rosas J, Camps MT, Gil A, Del Pino-Montes J, et al. Primary Sjogren syndrome in Spain: clinical and immunologic expression in 1010 patients. Medicine. 2008;87(4):210–9.
  9. Malladi AS, Sack KE, Shiboski SC, Shiboski CH, Baer AN, Banushree R, et al. Primary Sjogren’s syndrome as a systemic disease: a study of participants enrolled in an international Sjogren’s syndrome registry. Arthritis Care Res. 2012;64(6):911–8.
  10. Moutsopoulos HM, Manoussakis MN. Lumping or splitting autoimmune rheumatic disorders? Lessons from Sjogren’s syndrome. Br J Rheumatol. 1998;37(12):1263–4.
  11. Theander E, Henriksson G, Ljungberg O, Mandl T, Manthorpe R, Jacobsson LT. Lymphoma and other malignancies in primary Sjogren’s syndrome: a cohort study on cancer incidence and lymphoma predictors. Ann Rheum Dis. 2006;65(6):796–803.
  12. Voulgarelis M, Dafni UG, Isenberg DA, Moutsopoulos HM. Malignant lymphoma in primary Sjogren’s syndrome: a multicenter, retrospective, clinical study by the European Concerted Action on Sjogren’s Syndrome. Arthritis Rheum. 1999;42(8):1765–72.
  13. Greenspan JS, Daniels TE, Talal N, Sylvester RA. The histopathology of Sjogren’s syndrome in labial salivary gland biopsies. Oral Surg Oral Med Oral Pathol. 1974;37(2):217–29.
  14. Daniels TE, Cox D, Shiboski CH, Schiodt M, Wu A, Lanfranchi H, et al. Associations between salivary gland histopathologic diagnoses and phenotypic features of Sjogren’s syndrome among 1,726 registry participants. Arthritis Rheum. 2011;63(7):2021–30.
  15. Pijpe J, Kalk WW, van der Wal JE, Vissink A, Kluin PM, Roodenburg JL, et al. Parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjogren’s syndrome. Rheumatology. 2007;46(2):335–41.
  16. Carbone A, Gloghini A, Ferlito A. Pathological features of lymphoid proliferations of the salivary glands: lymphoepithelial sialadenitis versus low-grade B-cell lymphoma of the malt type. Ann Otol Rhinol Laryngol. 2000;109(12 Pt 1):1170–5.
  17. Barone F, Bombardieri M, Manzo A, Blades MC, Morgan PR, Challacombe SJ, et al. Association of CXCL13 and CCL21 expression with the progressive organization of lymphoid-like structures in Sjogren’s syndrome. Arthritis Rheum. 2005;52(6):1773–84.
  18. Bombardieri M, Barone F, Humby F, Kelly S, McGurk M, Morgan P, et al. Activation-induced cytidine deaminase expression in follicular dendritic cell networks and interfollicular large B cells supports functionality of ectopic lymphoid neogenesis in autoimmune sialoadenitis and MALT lymphoma in Sjogren’s syndrome. J Immunol. 2007;179(7):4929–38.
  19. Gonzalez S, Aguilera S, Alliende C, Urzua U, Quest AF, Herrera L, et al. Alterations in type I hemidesmosome components suggestive of epigenetic control in the salivary glands of patients with Sjogren’s syndrome. Arthritis Rheum. 2011;63(4):1106–15.
  20. Christodoulou MI, Kapsogeorgou EK, Moutsopoulos HM. Characteristics of the minor salivary gland infiltrates in Sjogren’s syndrome. J Autoimm. 2010;34(4):400–7.
  21. Christodoulou MI, Kapsogeorgou EK, Moutsopoulos NM, Moutsopoulos HM. Foxp3+ T-regulatory cells in Sjogren’s syndrome: correlation with the grade of the autoimmune lesion and certain adverse prognostic factors. Am J Pathol. 2008;173(5):1389–96.
  22. Salomonsson S, Jonsson MV, Skarstein K, Brokstad KA, Hjelmstrom P, Wahren-Herlenius M, et al. Cellular basis of ectopic germinal center formation and autoantibody production in the target organ of patients with Sjogren’s syndrome. Arthritis Rheum. 2003;48(11):3187–201.
  23. Ansel KM, Ngo VN, Hyman PL, Luther SA, Forster R, Sedgwick JD, et al. A chemokine-driven positive feedback loop organizes lymphoid follicles. Nature. 2000;406(6793):309–14.
  24. Luther SA, Tang HL, Hyman PL, Farr AG, Cyster JG. Coexpression of the chemokines ELC and SLC by T zone stromal cells and deletion of the ELC gene in the plt/plt mouse. Proc Natl Acad Sci U S A. 2000;97(23):12694–9.
  25. Luther SA, Bidgol A, Hargreaves DC, Schmidt A, Xu Y, Paniyadi J, et al. Differing activities of homeostatic chemokines CCL19, CCL21, and CXCL12 in lymphocyte and dendritic cell recruitment and lymphoid neogenesis. J Immunol. 2002;169(1):424–33.
  26. Mebius RE. Organogenesis of lymphoid tissues. Nature reviews. Immunology. 2003;3(4):292–303.
  27. Barone F, Bombardieri M, Rosado MM, Morgan PR, Challacombe SJ, De Vita S, et al. CXCL13, CCL21, and CXCL12 expression in salivary glands of patients with Sjogren’s syndrome and MALT lymphoma: association with reactive and malignant areas of lymphoid organization. J Immunol. 2008;180(7):5130–40.
  28. Vitali C, Bombardieri S, Moutsopoulos HM, Coll J, Gerli R, Hatron PY, et al. Assessment of the European classification criteria for Sjogren’s syndrome in a series of clinically defined cases: results of a prospective multicentre study. The European Study Group on Diagnostic Criteria for Sjogren’s Syndrome. Ann Rheum Dis. 1996;55(2):116–21.
  29. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554–8.
  30. Rasmussen A, Ice JA, Li H, Grundahl K, Kelly JA, Radfar L, et al. Comparison of the American-European Consensus Group Sjogren’s syndrome classification criteria to newly proposed American College of Rheumatology criteria in a large, carefully characterised sicca cohort. Ann Rheum Dis. 2014;73(1):31–8.
  31. Giovelli RA, Santos MC, Serrano EV, Valim V. Clinical characteristics and biopsy accuracy in suspected cases of Sjogren’s syndrome referred to labial salivary gland biopsy. BMC Musculoskelet Disord. 2015;16:30.
  32. Colella G, Cannavale R, Vicidomini A, Itro A. Salivary gland biopsy: a comprehensive review of techniques and related complications. Rheumatol. 2010;49(11):2117–21.
  33. Gerli R, Muscat C, Giansanti M, Danieli MG, Sciuto M, Gabrielli A, et al. Quantitative assessment of salivary gland inflammatory infiltration in primary Sjogren’s syndrome: its relationship to different demographic, clinical and serological features of the disorder. Br J Rheumatolo. 1997;36(9):969–75.
  34. Haldorsen K, Moen K, Jacobsen H, Jonsson R, Brun JG. Exocrine function in primary Sjogren syndrome: natural course and prognostic factors. Ann Rheum Dis. 2008;67(7):949–54.
  35. Risselada AP, Kruize AA, Bijlsma JW. Clinical features distinguishing lymphoma development in primary Sjogren’s Syndrome – a retrospective cohort study. Sem Arthritis Rheum. 2013;43(2):171–7.
  36. Costa S, Quintin-Roue I, Lesourd A, Jousse-Joulin S, Berthelot JM, Hachulla E, et al. Reliability of histopathological salivary gland biopsy assessment in Sjogren’s syndrome: a multicentre cohort study. Rheumatology. 2015;54(6):1056–64.
  37. Morbini P, Manzo A, Caporali R, Epis O, Villa C, Tinelli C, et al. Multilevel examination of minor salivary gland biopsy for Sjogren’s syndrome significantly improves diagnostic performance of AECG classification criteria. Arthritis Res Ther. 2005;7(2):R343–8.
  38. Risselada AP, Looije MF, Kruize AA, Bijlsma JW, van Roon JA. The role of ectopic germinal centers in the immunopathology of primary Sjogren’s syndrome: a systematic review. Semin Arthritis Rheum. 2013;42(4):368–76.
  39. Theander E, Vasaitis L, Baecklund E, Nordmark G, Warfvinge G, Liedholm R, et al. Lymphoid organisation in labial salivary gland biopsies is a possible predictor for the development of malignant lymphoma in primary Sjogren’s syndrome. Ann Rheum Dis. 2011;70(8):1363–8.
  40. Fox RI. The importance of minor salivary gland biopsy in prediction of lymphoma in Sjogren’s syndrome: should we be obtaining more information about prognosis from minor salivary gland samples? Ann Rheum Dis. 2011;70(8):1351–3.
  41. Pijpe J, Meijer JM, Bootsma H, van der Wal JE, Spijkervet FK, Kallenberg CG, et al. Clinical and histologic evidence of salivary gland restoration supports the efficacy of rituximab treatment in Sjogren’s syndrome. Arthritis Rheum. 2009;60(11):3251–6.
  42. Pijpe J, van Imhoff GW, Vissink A, van der Wal JE, Kluin PM, Spijkervet FK, et al. Changes in salivary gland immunohistology and function after rituximab monotherapy in a patient with Sjogren’s syndrome and associated MALT lymphoma. Ann Rheum Dis. 2005;64(6):958–60.
  43. Carubbi F, Cipriani P, Marrelli A, Benedetto P, Ruscitti P, Berardicurti O, et al. Efficacy and safety of rituximab treatment in early primary Sjogren’s syndrome: a prospective, multi-center, follow-up study. Arthritis Res Ther. 2013;15(5):R172.
  44. Adler S, Korner M, Forgerv, Huscher D, Caversaccio MD, Villiger PM. Evaluation of histologic, serologic, and clinical changes in response to abatacept treatment of primary Sjogren’s syndrome: a pilot study. Arthritis Care Res. 2013;65(11):1862–8.
  45. Delaleu N, Mydel P, Kwee I, Brun JG, Jonsson MV, Jonsson R. High fidelity between saliva proteomics and the biologic state of salivary glands defines biomarker signatures for primary Sjogren’s syndrome. Arthritis Rheum. 2015;67(4):1084–95.
  46. Carotti M, Ciapetti A, Jousse-Joulin S, Salaffi F. Ultrasonography of the salivary glands: the role of grey-scale and colour/power Doppler. Clin Exp Rheumatol. 2014;32(1 Suppl 80):S61–70.
  47. Kramer JM, Klimatcheva E, Rothstein TL. CXCL13 is elevated in Sjogren's syndrome in mice and humans and is implicated in disease pathogenesis. J Leukocyte Biol. 2013;94(5):1079–89.
  48. Bowman SJ, Fox RI. Classification criteria for Sjogren's syndrome: nothing ever stands still! Ann Rheum Dis. 2014;73(1):1–2.
  49. Fisher BA, Brown RM, Bowman SJ, Barone F. A review of salivary gland histopathology in primary Sjogren's syndrome with a focus on its potential as a clinical trials biomarker. Ann Rheum Dis. 2015;74(9):1645–50.
  50. Waterhouse JP, Doniach I. Post-mortem prevalence of focal lymphocytic adenitis of the submandibular salivary gland. J Pathol Bacteriol. 1966;91(1):53–64.

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