title: Submandibular and sublingual glands involvement in advanced acquired immunodeficiency syndrome (AIDS): an autopsy-based study.
abstract: OBJECTIVE
  To assess the histopathological, immunohistochemical (IHC), and in situ hybridization (ISH) features found in the submandibular (SM) and sublingual (SL) glands of 105 acquired immunodeficiency syndrome (AIDS) patients at autopsy.
  
  
  METHODS
  Gender, age, CD4 cell level, and clinical histories were obtained from clinical charts (SM: n = 103; SL: n = 92). Histologic analysis of hematoxylin and eosin, Gomori-Grocott, and Ziehl-Neelsen stained tissues, IHC to detect infectious agents and characterize inflammatory cells in sialadenitis, and ISH for EBER-1/2 were performed.
  
  
  RESULTS
  The mean age of the patients and CD4 cell count were 36 years and 76 cells/microL, respectively. Fifty-eight cases (SM: n = 51 [49%]; SL: n = 54 [59%]) were considered to be microscopically normal. The most common infectious conditions were mycobacteriosis (SM: n = 11 [10%]; SL: n = 7 [7%]), followed by cytomegalovirus (CMV) (SM: n = 14 [13%]; SL: n = 2 [2%]), and cryptococcosis (SM: n = 3 [3%]; SL: n = 4 [4%]). Human immunodeficiency virus (HIV) p24 (SM: n = 2 [2%]; SL: n = 1 [1%]) and EBER-1/2 (SM: n = 9 [39%]; SL: n = 4 [20%]) were seen only in macrophages and lymphocytes, respectively. The most prevalent cells seen in chronic nonspecific sialadenitis (SM: n = 25; SL: n = 25) were CD8+ T lymphocytes, whereas CD68+ macrophages were predominant in the mycobacteriosis-associated granulomatous and nonspecific diffuse macrophagic sialadenitis. Concomitant infections occurred in 5 cases (SM: n = 4; SL: n = 1) and non-Hodgkin lymphoma in 1 case.
  
  
  CONCLUSIONS
  Infectious diseases and chronic nonspecific sialadenitis were the main alterations found in the SM and SL glands. These alterations were greater in the SM than in the SL glands. CD8+ T lymphocytes and CD68+ macrophages might be relevant to the pathogenesis of the sialadenitis. Clinicians should consider these diseases when assessing the major salivary glands in advanced AIDS patients and follow biosafety procedures to avoid contamination by HIV, CMV, mycobacteriosis, and cryptococcosis.
authors.affiliation: Oral Pathology Section, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: León
authors.forename: Thais
authors.initials: T
authors.lastname: Mauad
authors.forename: Paulo H N
authors.initials: PH
authors.lastname: Saldiva
authors.forename: Oslei P
authors.initials: OP
authors.lastname: Almeida
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Vargas
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000473:pathology / Q000821:virology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003453:Cryptococcosis / Q000150:complications / Q000473:pathology; D003586:Cytomegalovirus Infections / Q000150:complications / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000150:complications / Q000473:pathology; D012466:Salivary Gland Diseases / Q000145:classification / Q000150:complications / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D012720:Severity of Illness Index; D013361:Sublingual Gland / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D013363:Submandibular Gland / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D055815:Young Adult