title: Clinical features and treatment outcomes of immunoglobulin g4-related sclerosing sialadenitis.
abstract: Idiopathic enlargement of salivary glands used to be confusing in diagnosis until immunoglobulin G4 (IgG4)-related sclerosing sialadenitis was proposed as a possible answer. In this case series, we reported the clinical features and management outcomes in 16 patients with IgG4-related sclerosing sialadenitis. We retrospectively studied 16 patients in clinical examination, serology, pathology, and sonography features. All patients were treated by corticosteroids and followed up for at least 3 months. The results of clinical features showed that all of the patients presented persistent, symmetric bilateral swelling of the salivary glands, elevated levels of serum IgG4, and/or IgG4-positive plasmacytes infiltration and tissue fibrosis. The results of all autoantibody tests were negative. The typical sonographic manifestation revealed multiple hypoechoic foci with an irregular netlike diffuse lesion in salivary glands. Most patients showed excellent response to steroids treatment. We conclude that, for patients who present (1) symmetric swelling of bilateral salivary glands for more than 3 months, (2) elevated serum IgG4 level (>135 mg/dL), and (3) enlargement in bilateral salivary glands with multiple hypoechoic areas (irregular netlike appearance) in the sonography, the diagnosis of IgG4-related sclerosing sialadenitis should be considered. A comprehensive understanding of the medical condition and appropriate pathology examination are the key to diagnose. Steroids treatment is effective, and a treatment plan should be set up and followed in the long-term.
authors.affiliation: From the *Department of Oral Surgery, Ninth People's Hospital, School of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; and †Department of Ultrasonography, Ninth People's Hospital, School of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhi-jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Ling-yan
authors.initials: LY
authors.lastname: Zheng
authors.forename: Yi-ping
authors.initials: YP
authors.lastname: Pu
authors.forename: Hui-hong
authors.initials: HH
authors.lastname: Zhou
authors.forename: Li-song
authors.initials: LS
authors.lastname: Xie
authors.forename: Huan
authors.initials: H
authors.lastname: Shi
authors.forename: Chuang-qi
authors.initials: CQ
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology*; D007765:Lacrimal Apparatus / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010305:Parotid Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D010950:Plasma Cells / Q000276:immunology; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012598:Sclerosis; D012793:Sialadenitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology*; D013364:Submandibular Gland Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007074:Immunoglobulin G; D011239:Prednisolone