GOGETA
Trying to get in PGY1
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What is the mos specific test to Dx Sjorgen?
and what is the most common send?
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| donjuan
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usmle world say lip biposy
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| elitoki
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Agree. Lip biopsy.
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| sprint123
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Yes...Most specific test is LOWER lip biopsy.although, antibodies like anti-SSA,SSB and speckled pattern of ANA supports the diagnosis.
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| GOGETA
Trying to get in PGY1
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I never heard that lipbiopsy is more specific to DX Sjorgen till I saw that in UW
Always in my head anti ss-a= Specific Sjorgen- Antibody
and they say is not
also 70% of patientes have rheumatic factor positive
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| doc_clotaire
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Lip biopsy( Yes it is )
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| GOGETA
Trying to get in PGY1
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I just read that in the medstudy, kaplan did not had it, neither crush, only UW and medstudy
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| Miradautas Vras
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If Specific in question and biopsy in options , go for it! There are some isolated exceptions but mostly biopsies are the most specific investigations.
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| kpmle2
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what do you see on lip biopsy?
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| DrVirgo
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GOGETA wrote:
I never heard that lipbiopsy is more specific to DX Sjorgen till I saw that in UW
Always in my head anti ss-a= Specific Sjorgen- Antibody
and they say is not
also 70% of patientes have rheumatic factor positive
Yes, Lip biopsy is the most specific.
Anti-Rho or SSA can also be positive in Neonatal Lupus (complete heart block) or in SLE too.
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| peraspera
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Procedures:
Minor salivary gland biopsy
In this procedure, an incision is made on the inner lip, and some minor salivary glands are removed for examination.
Obtaining the biopsy sample from below normal-appearing mucosa is important in order to avoid false-positive results.
At least 4 salivary gland lobules should be obtained for analysis.
Currently, this is the best single test to establish a diagnosis of SS.
Histologic Findings: Although pathologists use different classification systems, the characteristic findings after minor salivary gland biopsy in a person with SS include the following:
Focal aggregates of at least 50 lymphocytes are seen and, to a lesser extent, plasma cells and macrophages.
More than 1 focal aggregate is seen per 4 mm2.
T cells are present that are predominantly CD4+ cells, unlike the predominately CD8+ T cells seen in the salivary gland biopsy samples from patients with DILS associated with HIV disease.
Lymphocytic replacement of the normal acini occurs.
Focal aggregates are seen in almost all glands.
Ten percent of the lymphocytes are CD5+ B cells that produce immunoglobulin M and immunoglobulin G antibodies, often with a monoclonal or oligoclonal pattern.
Large foci are present, possibly showing germinal centers.
Epimyoepithelial islands are uncommon in the minor salivary gland but can be seen in the major salivary glands.
Lymphocytic infiltrates are also seen in other organs. Findings from a gastric mucosal biopsy may show lymphocytic infiltrates with atrophic gastritis. The results of a kidney biopsy may show interstitial lymphocytic infiltration. Lung biopsy can reveal infiltrating CD4+ T cells of a lymphocytic interstitial pneumonitis. Salivary gland biopsy can help detect pseudolymphoma or lymphoma and the noncaseating granulomas of sarcoidosis
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