title: Histopathological environment besides the focus score in Sjögren's syndrome.
abstract: OBJECTIVE
  To compare the prevalence of diverse histopathologic features among patients with Sjögren's syndrome (SS) and controls, and to evaluate their relationship with age, a focus score (FS) ≥ 1 and some clinical and serological SS features.
  
  
  METHODS
  A blinded pathologist examined 63 SS and 11 control minor salivary gland biopsies. Focal lymphocytic sialadenitis (FLS) was defined as a focus score (FS) ≥ 1. We also evaluated lymphoepithelial lesions, germinal centers (GCs), epithelial metaplasia, dilatation and hyperplasia in the main secretory duct, perivascular cell infiltrate, adipose infiltration, acinar atrophy, interstitial fibrosis and lymphocytes/plasma cells remote from the FLS. We registered demographics, anti-Ro/La status and clinical features. We used Kendall's tau coefficients and logistic regression analysis.
  
  
  RESULTS
  Sjögren's syndrome patients had a higher frequency of FS ≥ 1 (92% vs. 27%), acinar atrophy (78% vs. 18%), lymphocytes and plasma cells external to the FSL (92% vs. 64%) and stromal fibrosis (68% vs. 36%). A FS ≥ 1 correlated with the presence of GCs and acinar atrophy; whereas age correlated with duct dilation, duct epithelial hyperplasia, adipose infiltration and fibrosis. SS patients with hepatic involvement exhibited more frequent duct dilatation. After adjusting by age, anti-Ro/SSA (odds ratio [OR] 30.8, 95% CI 2.2-423.5, P = 0.01), a FS ≥ 1 (OR 54.3, 95% CI 4.8-612, P = 0.001) and fibrosis (OR 15.2, 95% CI 1.2-186.2, P = 0.03) were associated with SS.
  
  
  CONCLUSIONS
  Other histologic findings coexist with FLS, but only GC formation and acinar atrophy correlated with a FS ≥ 1. Age is mostly correlated with the remaining histological features. However, the clinical relevance of these findings is unknown.
authors.affiliation: Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Llamas-Gutierrez
authors.forename: Edgardo
authors.initials: E
authors.lastname: Reyes
authors.forename: Braulio
authors.initials: B
authors.lastname: Martínez
authors.forename: Gabriela
authors.initials: G
authors.lastname: Hernández-Molina
mesh_terms: D061354:Acinar Cells / Q000473:pathology; D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018987:Salivary Ducts / Q000473:pathology; D012793:Sialadenitis / Q000473:pathology*; D012859:Sjogren's Syndrome / Q000473:pathology*
keywords: Sjögren's syndrome; histopathology; lip biopsy