Primary hematologic malignancies with the onset of involvement of the major salivary glands in rheumatologic practice

Objective: to identify the main types of lymphoma with the onset of involvement of the major salivary glands (MSGs), which are encountered in rheumatologic practice, and to evaluate the efficiency of minimally invasive incisional biopsies of the MSGs/lacrimal glands in the diagnosis of different diseases affecting the parotid, submandibular, sublingual, and lacrimal glands.

Patients and methods. A total of339patients (291 women and 48 men) aged 18 to 78 years (median age, 55 years) with MSG involvement were examined at the V.A. Nasonova Research Institute of Rheumatology in 2004 to 2017. Minimally invasive incisional biopsies of the parotid, submandibular salivary (SMSG), and lacrimal glands were carried out to verify the diagnosis.

Results and discussion. Different variants of hematological malignancies with MSG involvement were diagnosed in 187 (55%) patients; nonneoplastic diseases were in 152 (45%) patients. Primary tumors with the onset of MSG involvement were detected in 52 (15.3%) patients. Hematologic malignancies were diagnosed in 32 (61.5%) cases and 20 (38.5%) patients had various benign neoplastic or infectious diseases with MSG involvement. The prevailing hematologic malignances with MSG involvement were non-Hodgkin lymphomas (NHL), indolent MALT-lymphomas in 12 (23%) patients, follicular lymphomas in 6 (11.5%), and AL-amyloidosis affecting the SMSG in 9 (17.3%). The diagnosis was morphologically verified using minimally invasive incisional biopsy of the salivary/lacrimal glands; in all cases, the biopsy was informative for full morphopathological examination and diagnosis verification.

Conclusion. Minimally invasive incisional biopsy of the MSG/lacrimal glands should be actively used in dentistry, rheumatology and blood oncology hospitals for verification of nosological diagnoses when the MSG and lacrimal glands are involved. A sufficient number of tissues obtained using these techniques allows one to abandon severe surgical interventions (partial and complete parotidectomy, SMSG removal, and orbitotomy) currently used for diagnostic purposes in various types of hospitals.

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