J. Ussmuller et K. Donath, Histopathogenesis of chronic sialectatic parotitis as precursor of benign lymphoepithelial lesion (Sjogren's syndrome), LARY RH OTO, 77(12), 1998, pp. 723-727
Background: Chronic sialectatic parotitis (CSP) is classified as a characte
ristic form of chronic recurrent parotitis the etiology and pathogenesis of
which still remains unclear. The multiplicity of different therapeutic adv
ices, especially the permanent failure of antibiotic treatment, underlines
the lack of an appropriate causal therapy. Case report: Detailed histopatho
logical investigations of an 41-year old woman were possible over a seven-y
ear period. These follow-up observations enabled clarification of the histo
pathogenesis of CSP by means of immunohistochemistry. Results: During the c
ourse and development of CSP different stages can be observed: The initial
phase is characterised by mild infiltration of B-lymphocytes (CD20, CD45 R)
and plasma cells in the environment of ectatic ducts. Progredient stages s
how neogenetic lymph follicles periductular as well as metaplasia of the du
ctal epithelium. Terminal phases of CSP are characterised by near-total lym
phatic transformation of parenchyma, follicular lymphatic hyperplasia (KiM4
) and myoepithelial proliferation. In this phase myoepithelial sialadenitis
(MESA, i.e. benign lymphoepithelial lesion, possibly part of Sjogren's syn
drome) develops. Beyond it low grade non-Hodgkin's lymphoma of the MALT-Typ
e of the submandibular gland occurred finally. Conclusions: CSP presents as
a precursor of MESA. Immunohistological detection of follicular dentritic
network (KiM4) within extensive lymphatic hyperplasia periductular demonstr
ates overshooting humoral immune reaction of B-lymphocytes. Hence, CSP shou
ld be classified with regard to pathogenesis as an immunopathological disor
der of the MALT system.