title: Clinicopathological characteristics of immunoglobulin G4-related sialadenitis.
abstract: BACKGROUND
  Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized fibro-inflammatory condition. Forty-two cases with immunoglobulin G4-related sialadenitis (IgG4-RS) confirmed by histopathological and immunohistochemical assessment were studied to clarify the clinicopathologic characteristics of the salivary glands involved in IgG4-RS, especially the relationship between the histopathologic features and function of salivary glands or serum levels of IgG4.
  
  
  METHODS
  Clinical, serologic, imaging and histopathological data of these cases were analyzed. CT volumes of submandibular, parotid, and lacrimal glands were calculated. The saliva flow rate was measured. Scintigraphy with 99mTc-pertechnetate was undertaken in 31 cases, and the concentration index (CI) and secretion index (SI) was calculated. Relationships between fibrosis severity and salivary gland function or serum IgG4 levels were analyzed.
  
  
  RESULTS
  The first symptom was swelling of bilateral submandibular or lacrimal glands. Physical examination showed multiple bilateral major salivary glands (including sublingual and accessory parotid glands) and lacrimal glands were enlarged in IgG4 RS. Multiple enlarged cervical lymph nodes were noted in 30 patients. Saliva flow at rest was lower than normal in 34 cases; stimulated saliva flow was lower than normal in 15 cases. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in 95.2% of cases and 78.6% patients had increased IgE levels. Serum IgG4 level was higher and saliva secretion lower as glandular fibrosis increased.
  
  
  CONCLUSIONS
  Prominent changes in the morphology, histology, immunohistochemistry and secretion of the major salivary glands of IgG4-RS patients were accompanied by involvement of the lacrimal glands and cervical lymph nodes. Elevated IgE, allergic history, eosinophil infiltration suggest allergic reactions as a potential pathogenesis of IgG4-RS. Severity of glandular fibrosis correlated with salivary function and serum levels of IgG4.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. liweibdkq@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, 100081, China. 1554326447@qq.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China. sunzhipeng@bjmu.edu.cn.
authors.forename: Zhi-Peng
authors.initials: ZP
authors.lastname: Sun
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. czg4209@126.com.
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: Cai
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. litongtong67@126.com.
authors.forename: Tong-Tong
authors.initials: TT
authors.lastname: Li
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. zhlie_doctor@sina.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. zk1938@aliyun.com.
authors.forename: Min-Xian
authors.initials: MX
authors.lastname: Huang
authors.affiliation: Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, 100081, China. honghua68@hotmail.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Hua
authors.affiliation: Department of Nuclear Medicine, Affiliated Beijing Tong Ren Hospital Capital University of Medical Science, Beijing, 100730, China. leemei@trhos.com.
authors.forename: Mei
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. dearhongxia@sina.com.
authors.forename: Xia
authors.initials: X
authors.lastname: Hong
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. jiazhengsu@163.com.
authors.forename: Jia-Zeng
authors.initials: JZ
authors.lastname: Su
authors.affiliation: Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China. zhangzy-bj@vip.sina.com.
authors.forename: Zhu-Yan
authors.initials: ZY
authors.lastname: Zhang
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China. 57495011@99.com.
authors.forename: Yan-Ying
authors.initials: YY
authors.lastname: Liu
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China. hejing1105@gmail.com.
authors.forename: Jing
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China. liqq@bjmu.edu.cn.
authors.forename: Zhan-Guo
authors.initials: ZG
authors.lastname: Li
authors.affiliation: Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, 100081, China. gaoyan0988@163.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China. gyyu@263.net.
authors.forename: Guang-Yan
authors.initials: GY
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007765:Lacrimal Apparatus / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012469:Salivary Glands / Q000473:pathology; D012793:Sialadenitis / Q000175:diagnosis* / Q000276:immunology*; D013363:Submandibular Gland / Q000473:pathology; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G