title: Serological implications of germinal center-like structures in primary Sjögren's syndrome.
abstract: OBJECTIVE
  To determine serological implications of germinal center (GC)-like structures in primary Sjögren's syndrome (pSS).
  
  
  METHODS
  Retrospectively, minor salivary gland biopsies (n = 269) with focal lymphoid aggregates corresponding to focus score > 1 were evaluated for the presence of GC-like morphology. Relevant clinical information was obtained from medical records.
  
  
  RESULTS
  Of 269 patients, 169 fulfilled the American-European criteria for pSS. GC-like features were observed in 47/169 (28%) biopsies. In the majority of cases, GC-like lesions were confirmed by CD21-positive follicular dendritic cell networks. Mean inflammatory focus score was significantly higher in GC-positive compared to GC-negative samples (p < 0.001). GC-positive patients had lower mean salivary secretion (p < 0.001) and a higher frequency of patients with unstimulated salivary secretion < or = 1.5 ml/15 min (p < 0.01). In addition, elevated titers of rheumatoid factor, serum anti-Ro/SSA and anti-La/SSB (p < 0.05), and IgG levels > or = 15.3 g/l (p < 0.05) were more common in GC-positive compared to GC-negative. Enlarged salivary glands were observed in 46/163 (28%) patients, but could not be linked to either presence or absence of GC-like features.
  
  
  CONCLUSIONS
  Inflammatory infiltrates with GC-like morphology were observed in 28% of the investigated patients with pSS, and was particularly noted in patients with higher focus score. The observed serological aberrations in patients with ectopic GC-like structures in the minor salivary glands warrant further prospective studies.
authors.affiliation: Department of Oral Sciences - Oral Pathology and Forensic Odontology, Haukeland University Hospital, Bergen, Norway. malin.jonsson@odont.uib.no
authors.forename: Malin V
authors.initials: MV
authors.lastname: Jonsson
authors.forename: Kathrine
authors.initials: K
authors.lastname: Skarstein
authors.forename: Roland
authors.initials: R
authors.lastname: Jonsson
authors.forename: Johan G
authors.initials: JG
authors.lastname: Brun
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D018858:Germinal Center / Q000166:cytology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012469:Salivary Glands / Q000166:cytology / Q000473:pathology; D012859:Sjogren's Syndrome / Q000097:blood / Q000473:pathology