title: Localized or diffuse lesions of the submandibular glands in immunoglobulin g4-related disease in association with differential organ involvement.
abstract: OBJECTIVE
  The purpose of this study was to assess the relationship between the sonographic characteristics of the submandibular glands and organ involvement at the initial presentation in patients with immunoglobulin G4 (IgG4)-related disease.
  
  
  METHODS
  We conducted a retrospective study that included 15 patients who had bilateral swollen submandibular glands and elevated serum IgG4 levels between January 2005 and December 2010.
  
  
  RESULTS
  In all 15 patients, sonography revealed the involvement of both sides of the submandibular glands. The sonographic appearance of each gland was classified into two types: localized tumor-forming and diffuse focal types. On the basis of this typing, all 15 patients were classified into two groups: a group with the localized tumor-forming type observed on one or both sides of the glands (n = 10) and a group with the diffuse focal type present on both sides (n = 5). All 10 patients in the former group had lesions in local exocrine organs, such as the lacrimal and parotid glands, with regional lymphadenopathy. In contrast, all 5 patients in the latter group had lesions in abdominal organs, such as autoimmune pancreatitis and sclerosing cholangitis.
  
  
  CONCLUSIONS
  The sonographic patterns of the submandibular glands in patients with IgG4-related disease can be divided into two types: localized tumor-forming and diffuse focal. The distinctive patient groups defined by the sonographic patterns in both glands were associated with differential organ involvement and thus could be used as indicators of the disease extension and specific organ involvement.
authors.affiliation: Department of Laboratory Medicine, Tokai University School of Medicine, Isehara, Japan. sa@is.icc.u-tokai.ac.jp
authors.forename: Satomi
authors.initials: S
authors.lastname: Asai
authors.forename: Kenji
authors.initials: K
authors.lastname: Okami
authors.forename: Naoya
authors.initials: N
authors.lastname: Nakamura
authors.forename: Shuichi
authors.initials: S
authors.lastname: Shiraishi
authors.forename: Ryousuke
authors.initials: R
authors.lastname: Sugimoto
authors.forename: Damdinsuren
authors.initials: D
authors.lastname: Anar
authors.forename: Shinji
authors.initials: S
authors.lastname: Sato
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Matsushita
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Hayato
authors.initials: H
authors.lastname: Miyachi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000000981:diagnostic imaging*; D009928:Organ Specificity; D010265:Paraproteinemias / Q000000981:diagnostic imaging* / Q000276:immunology*; D012466:Salivary Gland Diseases / Q000000981:diagnostic imaging* / Q000276:immunology*; D013363:Submandibular Gland / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods
chemical_list: D007074:Immunoglobulin G