A síndrome de Sjögren (SS) é uma doença autoimune crônica sistêmica que afeta as glândulas lacrimal e salivar. A SS pode se manifestar como SS primária (SSp) ou SS secundária (SSs), a última ocorrendo em conjunto com outra desordem autoimune. Em ambos os casos, os olhos secos e a boca seca afetam a qualidade de vida do paciente. As complicações tardias podem incluir cegueira, destruição dos tecidos dentários, candidíase oral e linfoma. Este artigo relata dois casos de SS, cada um apresentando lesão nodular oral incomum diagnosticada como linfoma MALT reincidente e mucocele. A importância do diagnóstico, tratamento e manejo das lesões orais por um cirurgião-dentista durante o atendimento de pacientes com SS é enfatizada, pois as manifestações orais da SS podem comprometer a qualidade de vida do paciente.

Autoria

Juliana Barchelli Pinheiro

Department of Dental Material and Prosthesis, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, BrazilUniversidade de São PauloBrazilRibeirão Preto, SP, BrazilDepartment of Dental Material and Prosthesis, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil

Camila Tirapelli

Claudia Helena Lovato da Silva

Marilena Chinali Komesu

Department of Morphology, Physiology and Pathology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, BrazilUniversidade de São PauloBrazilRibeirão Preto, SP, BrazilDepartment of Morphology, Physiology and Pathology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil

Flávio Calil Petean

Department of Internal Medicine, Medical School of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, BrazilUniversidade de São PauloBrazilRibeirão Preto, SP, BrazilDepartment of Internal Medicine, Medical School of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil

Paulo Louzada Junior

Jorge Esquiche León

Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil- Universidade de São PauloBrazilRibeirão Preto, SP, BrazilDepartment of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil

Ana Carolina Fragoso Motta

Correspondence: Ana Carolina Fragoso Motta, Avenida do Café s/n, Monte Alegre, 14090-904 Ribeirão Preto, SP, Brasil. Tel: +55-16-3315-4067. e-mail: anacfm@usp.br

SCIMAGO INSTITUTIONS RANKINGS

Figuras

Figuras (8)

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Figure 1
A,B: Generalized caries cavities, cracked restorations, fistula from dental abscess and (C,D) inflammation of the submandibular gland duct secondary to obstruction by calculus formation.

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Figure 2
A: Surgical excision of the nodular lesion on the upper lip. B: Microscopic analysis showing a nodular proliferation of lymphoid cells involving the glandular parenchyma. C: Observe the interface with the residual minor salivary glands, highlighting the prominent infiltration of the glandular parenchyma. Notice the atypical lymphoid infiltrate surrounding the ductal epithelium (lymphoepithelial lesion) (inset). D: In high-power view, infiltration of the glandular parenchyma (bottom right area), intravascular location of lymphoid cells (bottom left area), and focal lymphocytic sialadenitis adjacent to normal-appearing mucous acini (upper area). Hematoxylin and eosin staining; original magnification: ×4 (B), ×10 (C), and ×20 (D).

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Figure 3
Immunohistochemical characterization of MALT lymphoma. A: There were numerous CD20 positive tumor cells, while CD3 positive cells were scarce (not shown). (b: The cell proliferation assessed by the Ki-67 index was <15%. C: The B-cell population did show kappa light chain restriction, confirming the diagnosis (D). Original magnification: ×40 (A-D).

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Figure 4
A: Enlargement of the parotid glands, which was more evident on the left side. B and C: Minor salivary gland biopsy.

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Figure 5
A and B: Chronic multifocal lymphocytic sialadenitis in the minor salivary glands. The focus score was >1. Hematoxylin and eosin staining; original magnification: ×4 and ×20.

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Figure 6
A-D: Surgical excision of the nodular lesion on the floor of the mouth.

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Figure 7
A: Pseudocystic cavity exhibiting sparse to absent mucoid material diagnosed as mucocele. B: Lymphocytic infiltration in the minor salivary glands surrounding the lesion, typically observed in Sjogren’s syndrome. C,D: Wall of granulation tissue containing foamy macrophages. Hematoxylin and eosin staining; original magnification: ×4 (A), ×10 (B), ×40 (C) and ×100 (D).

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Figure 8
Immunohistochemical characterization of the multifocal lymphocytic sialadenitis. A: CD20 and CD3 (not shown) exhibiting similar immunoexpression. (B: The cell proliferation assessed by the Ki-67 index was <5%. A,D: The B-cell population did not show light chain restriction. Original magnification: ×20 (A,B): and ×40 (C,D).

Figure 1 A,B: Generalized caries cavities, cracked restorations, fistula from dental abscess and (C,D) inflammation of the submandibular gland duct secondary to obstruction by calculus formation.

Figure 2 A: Surgical excision of the nodular lesion on the upper lip. B: Microscopic analysis showing a nodular proliferation of lymphoid cells involving the glandular parenchyma. C: Observe the interface with the residual minor salivary glands, highlighting the prominent infiltration of the glandular parenchyma. Notice the atypical lymphoid infiltrate surrounding the ductal epithelium (lymphoepithelial lesion) (inset). D: In high-power view, infiltration of the glandular parenchyma (bottom right area), intravascular location of lymphoid cells (bottom left area), and focal lymphocytic sialadenitis adjacent to normal-appearing mucous acini (upper area). Hematoxylin and eosin staining; original magnification: ×4 (B), ×10 (C), and ×20 (D).

Figure 3 Immunohistochemical characterization of MALT lymphoma. A: There were numerous CD20 positive tumor cells, while CD3 positive cells were scarce (not shown). (b: The cell proliferation assessed by the Ki-67 index was <15%. C: The B-cell population did show kappa light chain restriction, confirming the diagnosis (D). Original magnification: ×40 (A-D).

Figure 4 A: Enlargement of the parotid glands, which was more evident on the left side. B and C: Minor salivary gland biopsy.

Figure 5 A and B: Chronic multifocal lymphocytic sialadenitis in the minor salivary glands. The focus score was >1. Hematoxylin and eosin staining; original magnification: ×4 and ×20.

Figure 6 A-D: Surgical excision of the nodular lesion on the floor of the mouth.

Figure 7 A: Pseudocystic cavity exhibiting sparse to absent mucoid material diagnosed as mucocele. B: Lymphocytic infiltration in the minor salivary glands surrounding the lesion, typically observed in Sjogren’s syndrome. C,D: Wall of granulation tissue containing foamy macrophages. Hematoxylin and eosin staining; original magnification: ×4 (A), ×10 (B), ×40 (C) and ×100 (D).

Figure 8 Immunohistochemical characterization of the multifocal lymphocytic sialadenitis. A: CD20 and CD3 (not shown) exhibiting similar immunoexpression. (B: The cell proliferation assessed by the Ki-67 index was <5%. A,D: The B-cell population did not show light chain restriction. Original magnification: ×20 (A,B): and ×40 (C,D).

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Fundação Odontológica de Ribeirão Preto Av. do Café, S/N, 14040-904 Ribeirão Preto SP Brasil, Tel.: (55 16) 3602-3982, Fax: (55 16) 3633-0999 - Ribeirão Preto - SP - Brazil
E-mail: bdj@forp.usp.br

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[1] Correspondence: Ana Carolina Fragoso Motta, Avenida do Café s/n, Monte Alegre, 14090-904 Ribeirão Preto, SP, Brasil. Tel: +55-16-3315-4067. e-mail: anacfm@usp.br