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Histologic Grading of a Labial Salivary Gland Biopsy in Patients with Sjogren's Syndrome

Purpose: To grade a salivary or lacrimal gland for the degree of lymphocytic infiltration in a patient with Sjogren's disease.

Description

Patients with Sjogren's syndrome typically have a chronic inflammatory cell infiltrate of salivary and lacrimal glands. Biopsy of a minor labial salivary gland may be done as part of the diagnostic workup of a patient suspected of having Sjogren's disease. The presence and extent of a lymphocytic infiltrate can be graded by the histopathologist.


 

Focus Score of Waterhouse

 

A focus is an aggregate of >= 50 lymphocytes and histiocytes.

 

focus score in 4 square mm =

= number of foci in 4 square mm of histologic section of salivary gland tissue

 

If the biopsy shows confluence of foci filling the counting area, then the focus score is arbitrarily set to 12.

 

The focus score is the most useful histologic index of severity in Sjogren's disease (Greenspan, page 217).

 

Histologic Grading of Chisholm and Mason (referred to by Greenspan et al)

 

Histologic Features

Grade

no lymphocytes in 4 square mm of salivary gland tissue

0

slight lymphocytic infiltrate

1

moderate, OR, less than 1 focus

2

1 focus in 4 square mm

3

more than 1 focus (2 or more) in 4 square mm

4

 

where:

• A 4 mm square area is based on a square with sides 2 mm long or a circle with a diameter of 1.77 mm.

• To convert the focus score in an area to the equivalent area in 4 square mm =

= (focus score) / ((area in square mm) / 4) = (focus score) * 4 / (area in sq mm)


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Specialty

Objective

ICD-10