Estudo da glândula salivar menor de pacientes com Síndrome de Sjögren: análise histopatológica, caracterização do infiltrado inflamatório e associação com o vírus epstein-barr e citomegalovirus

Abstract

Sjögren’s Syndrome (SS) is an autoimune desease mostly common observed in women. The etiology of SS is not fully elucidated, but some environmental factors such viruses like EBV and CMV infection are known to influence such condition. In the present study we proposed to evaluate the histological features on 20 minor salivary glands biopsies with diagnosis suggestive of SS of patients evaluated regarding American-European Consensus Group in 2002, and the T lymphocyte expression was verified by immunohistochemistry (IH) and graded as 1 (up to 50%), 2 (50%-75%) and (over 75%). The presence of EBV was evaluated by IQ and PCR and the presence of CMV by PCR. Eight adjacent satellites glands to areas of mucocele were used as normal glandular control. Histological analysis revealed acinar alterations (95%), adipose infiltration (65%), fibrosis (90%) and ductal dilatation (100%). Regarding the grade of inflammatory activity, grade 3 was found in 50% (n=10) and grade 4 was found on the other half (n=10). Focus score (FS) analysis, 50% (n=10) of samples showed FS=1; 35% (n=7) showed FS =2; 10% (n=2) showed FS=3 and only 5% (n=1) showed FS=4. The lymphocytic foci in the periductal location was the most prevalent (90%; n=18), followed by perivascular region (85%, n=17) and periacinar region (35%, n=7). In general, there was no predominance of T cells in foci, since 60% of samples (n=12) were scored as 1, 25% (n=5) were scored as 2 and 15% (n=3) scored as 3. None of the samples showed immunoreactivity for EBV, but in control group (12,5%, n=1) showed immunoreactivity for EBV. About EBVs PCR, 5% (n=1) of samples showed positivity for EBNA1 region and none of the samples showed positivity for CMV. Histopathological changes of minor salivary gland are relatively frequent in patients with SS, and the presence of the lymphocytic foci is critical as diagnostic criteria for the disease. It is suggested that there is no significant relation between the presence of EBV and CMV virus in SS pathogenesis.