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Eosinophilic Sialodochitis: Histopathological Characteristics and Treatment Outcomes
Xiao-Tong Ling1, Dan-Ni Zheng1, Liu-Yang Qu1
1Center for Sialoendoscopy, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, China.
Objectives:
To evaluate the traditional histopathology, expression of allergy-related cytokines, and treatment results of eosinophilic sialodochitis (ES).
Methods:
Fifty-four patients with suspected ES and six patients with chronic obstructive sialadenitis (COS) were prospectively enrolled. Terminal duct biopsy of the affected glands was performed concomitantly with endoscopy-assisted duct dilatation. For these samples, the hematoxylin-eosin stained sections were reviewed and graded according to the density of eosinophil infiltration. Moreover, immunohistochemical expressions of six types of Th2-type cytokines were semi-quantitatively analyzed. All these patients and 20 additional COS patients underwent routine endoscopic therapy and regular follow-up.
Results:
The enrolled 60 specimens were classified as: positive subgroup (24/54), suspected subgroup (18/54), negative subgroup (12/54), and control group (six cases). There were significant differences in chemokine receptor-3 and mast cell tryptase in the grade proportions among different groups, and the expressions of interleukin 13, chemokine receptor-3, and mast cell tryptase were found to be associated with mucus plug secretion. During an average 11 months' follow-up, 10 patients (10/80) received systemic and/or local anti-allergy medication. The rate of good efficacy was 45.8% (11/24) in the positive subgroup, 77.8% (14/18) in the suspected subgroup, 75.0% (9/12) in the negative subgroup, and 84.6% (22/26) in the COS group (p = 0.019). Patients with mucus plug secretion (p = 0.019) and elevated immunoglobulin E/peripheral blood eosinophil (p = 0.027) exhibited lower efficacies.
Conclusion:
Allergic inflammation plays an important role in the pathogenesis of ES, and eosinophil infiltration can be asynchronous with the process of immune reactions. Management of ES necessitates the integration of local and systemic anti-allergy strategies.
Level Of Evidence:
Level: 3.
