The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.for more details please visit  www.indiandentalacademy.com

1. Non neoplastic lesions of the salivary
gland
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

2. Objectives
- Describe the etiology, clinical features,
histopathological features of benign lymphoepithelial
lesion
– Describe the etiology, clinical features,
histopathological features of sjogren’s syndrome
At the end of the lecture , the student should be
able to
www.indiandentalacademy.com

3. Benign lymphoepithelial lesion
• Also called as Mikulicz disease
• Usually develop as component of Sjogren’s syndrome
• Usually unilateral
• Most common in parotid glands
• Seen as firm, diffuse swelling, usually asymptomatic
www.indiandentalacademy.com

4. • Heavy lymphocytic infiltration associated with
destruction of salivary acini
• The ductal epithelium, however persists
• Ductal and surrounding myoepithelial cells are
hyperplastic and form large groups,called as
epimepimyoepithelial islands.
Epimepimyoepithelial
islands.
www.indiandentalacademy.com

5. • Most common immunologic disorder associated with
salivary gland disease.
• Characterized by a lymphocyte-mediated destruction of
the exocrine glands leading to xerostomia and
keratoconjunctivitis sicca
www.indiandentalacademy.com

6. • 90% cases occur in women
• Average age of onset is 50yrs
• Classic monograph on the disease published in 1933 by
Sjogren, a Swedish ophthalmologist
www.indiandentalacademy.com

7. Two forms:
• Primary: involves the exocrine glands only
• Secondary: associated with a definable autoimmune
disease, usually rheumatoid arthritis.
– 80% of primary and 30-40% of secondary involves
unilateral or bilateral salivary glands swelling
– Unilateral or bilateral salivary gland swelling occurs,
may be permanent or intermittent
www.indiandentalacademy.com

8. Xerostomia: most bothersome; difficulty
swallowing dry food, difficulty speaking
continuously, burning sensation, increased
caries, problems wearing dentures;
erythematous/sticky oral mucosa, atrophy of
filiform papillae.
www.indiandentalacademy.com

9. – Keratoconjunctivitis Sicca: gritty feeling under
eyelids, blurred vision, burning sensation, thick
strands at inner canthi, decreased tearing,
redness/itching, photosensitivity; results from
destruction of conjunctival epithelium
– Diminished tear production caused by
lymphocytic cell replacement of the lacrimal
gland parenchyma.
www.indiandentalacademy.com

10. – Other exocrine gland involvement: dry nose, dry throat,
xerotrachea, esophageal mucosal atrophy, atrophic
gastritis, subclinical pancreatitis, vaginal dryness
– 1/3rd shows fatigue, low grade fever, myalgias
/arthralgias
– Extraglandular involvement in ¼: Lungs, kidneys,
vasculitis, nervous system
www.indiandentalacademy.com

11. • S
Sjogren syndrom
www.indiandentalacademy.com

12. • Sialographic examination often reveals punctate
sialectasia and lack of normal arborization of ductal
system
• This gives a typical ‘fruit-laden, branchless tree’
appearance.
www.indiandentalacademy.com

13. ‘fruit-laden, branchless tree’ appearance
www.indiandentalacademy.com

14. – Lymphocytic infiltration, with destruction of acinar units
– Severe lymphoid (T-cell) infiltrate can mimic
lymphoma; heterogenous, lobular architecture
preserved
– Enlarged lymph nodes with pleomorphic infiltrates and
frequent mitotic figures = “pseudolymphoma”
www.indiandentalacademy.com

15. Lymphocytic
infiltration
www.indiandentalacademy.com

16. • Lymphoma
www.indiandentalacademy.com

17. • Avoid xerostomic meds if possible
• Avoid alcohol, tobacco (accentuates xerostomia)
• Sialogogue (eg: pilocarpine) use is limited by other
cholinergic effects like bradycardia & lacrimation.
• Sugar free gum or diabetic confectionary
• Salivary substitutes/sprays
www.indiandentalacademy.com

18. Summary
– etiology, clinical features, histopathological features of
benign lymphoepithelial lesion
– etiology, clinical features, histopathological features
of sjogren’s syndrome
www.indiandentalacademy.com

19. BIBLIOGRAPHY
• Text book of oral pathology Shafer's, 5 & 6th edition
• Surgical Pathology of Salivary Glands Ellis 1st Edition
• Color Atlas of Oral Diseases Cawson, R. 2nd edition
• Oral and Maxillofacial Pathology Neville, Brad W. 2nd
• Lucas’s Pathology Of Tumor’s of the Oral Tissues
• Cawson, R. A., Bennie, W. H 5th edition
www.indiandentalacademy.com

20. THANK YOU
www.indiandentalacademy.com