Oral and maxillofacial radiology
Sonographic diagnosis for Mikulicz disease

https://doi.org/10.1016/j.tripleo.2009.02.032Get rights and content

Objective

The aim was to investigate the diagnostic imaging characteristics of Mikulicz disease (MD), especially sonographic ones, and to clarify the differences between them and those in Sjögren syndrome (SS), based on new criteria of MD.

Study design

The sonographic and sialographic images, as well as clinical, histopathologic, and serologic findings of 9 patients satisfying the new criteria of MD were analyzed and compared with those in SS.

Results

All swollen submandibular glands showed bilateral nodal hypoechoic areas with high vascularization on sonograms and a parenchymal defect on sialograms, whereas parotid glands showed normal or slight change on both images. Nodal areas in submandibular gland sonograms were unclear on computerized tomography and on magnetic resonance imaging, but showed accumulation on gallium scintigraphy.

Conclusion

Mikulicz disease showed a high rate of bilateral nodal change in submandibular glands, which was completely different from SS. For detection and follow-up of these changes, sonography may be the best imaging modality.

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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