Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
Oral and maxillofacial radiologySonographic diagnosis for Mikulicz disease
Section snippets
Criteria of MD
Although unanimous criteria for MD have not been defined so far, they are being discussed in the working group for MD of the Japanese Medical Society for SS. Our institution's criteria are listed in Table I. There are 2 conditions that are essential for an ailment to be considered as MD. The first is persistent bilateral swelling in ≥1 of the lacrimal, parotid, and submandibular glands for >3 months. SS shows repeated swelling or swelling that disappears in due course. The second condition is
Clinical findings
Table II shows the clinical findings of 9 cases. All cases showed bilateral swelling over the course of >3 months in ≥1 of the lacrimal, parotid, or submandibular glands (essential requirement 1). One case showed the swelling of lacrimal glands only, and 2 cases showed solely submandibular gland swelling. Five of the 9 cases showed swelling in lacrimal glands. Only 2 cases showed swelling in parotid glands, whereas in almost all (8 cases), submandibular glands showed swelling.
Six cases suffered
Discussion
Unanimous criteria of MD have not been defined so far, although a new concept of MD has been recently discussed. In the present criteria, we emphasized a histopathologic pattern of lymphocytes different from SS. Lymphocytes infiltrate mainly around acinar cells in MD, whereas SS shows mainly periductal infiltration. Yamamoto et al.14 showed figures in which the difference in the amount of plasmacytes with IgG4 between MD and SS could be seen. These figures also showed the difference of
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Cited by (33)
Imaging of IgG4-Related Disease in the Head and Neck: A Systematic Review, Case Series, and Pathophysiology Update
2021, Journal of NeuroradiologyCitation Excerpt :To this end, a recent study of 35 Chinese patients with confirmed IgG4-RD found that in 71.4% of patients, PET imaging identified additional sites of involvement, not obvious on the other methods of imaging utilized such as CT, MRI, or ultrasound.30 There are few reports describing the utility of ultrasound in the diagnosis of IgG4-RD31–34 and given the frequent multifocality of the disease, other imaging modalities are generally more useful in the workup and follow-up once IgG4-RD has been histologically confirmed. Quantitative imaging may also have a role in evaluating treatment response but requires further investigation.
Imaging of IgG4-related disease in the extracranial head and neck
2021, European Journal of RadiologyCitation Excerpt :On imaging, the affected glands in MD are enlarged, with associated lymphadenopathy, and often with sparing of the parotid glands(Fig. 5). US has been shown to have the highest sensitivity and specificity for IgG4-RD in the salivary glands, typically demonstrating bilateral hypoechoic nodules which bulge the contour of the gland, with increased colour Doppler flow within the nodules, preserved glandular parenchyma around the lesions and no duct dilatation [35,36]. US is also a helpful differentiator of MD from SS, which is associated with gland atrophy, a heterogeneous predominantly hypoechoic parenchyma and sialectasis [16,35].
Major salivary gland ultrasound in patients with dry syndrome: Description of a Colombian cohort, and a preliminary report
2020, Revista Colombiana de ReumatologiaImaging of IgG4-related disease of the head and neck
2018, Clinical RadiologyCitation Excerpt :The classic imaging features of long-standing Sjögren's syndrome include microcystic and subsequent macrocystic changes due to sialectasis, duct dilatation, nodules, microcalcification, and glandular atrophy; the submandibular glands, in particular, are grossly atrophic or absent (Fig 2). Ultrasound findings of IgG4-RS involved glands include multiple, relatively uniform sized hypoechoic nodules, interspersed within hyperechoic reticulated septa, particularly evident within the SMG.43,44 Shimizu and co-authors found CT and MRI of lower diagnostic accuracy compared to ultrasound and combined FDG-PET/CT.43 Parotid sialography and potentially MR sialography, may help to differentiate IgG4-RS from Sjögren's syndrome43; Moriyama reported 95% of patients with IgG4-RS to have normal sialography, one patient exhibiting ductal dilatation only.
A case of IgG4-related disease with initial symptoms in the labial salivary gland
2016, Journal of Oral and Maxillofacial Surgery, Medicine, and PathologyUltrasonographic Features of Immunoglobulin G4-Related Sialadenitis
2016, Ultrasound in Medicine and BiologyCitation Excerpt :This indicates that ultrasonography can provide valuable information for the follow-up evaluation of the results of immunomodulatory therapy for IgG4-RS. Ultrasonography could be used as an essential imaging modality for follow-up evaluation as proposed previously (Shimizu et al. 2009; Wang et al. 2014). The submandibular and parotid glands involved in IgG4-RS have ultrasonographic characteristics that are useful for the diagnosis of IgG4-RS.