A 52-year-old woman presents with severe dry eyes, dry mouth, and bilateral parotid enlargement for 8 months. Schirmer test is 3 mm bilaterally. Lab work shows positive ANA, anti-Ro positive, anti-La positive, RF positive, and polyclonal hypergammaglobulinemia. Lip biopsy is performed. Which histopathological finding is diagnostic?
- A Non-caseating granulomas within glandular parenchyma
- B Lymphocytic infiltration with focal lymphoepithelial lesions (focus score ≥1 per 4 mm²) ✓
- C Diffuse infiltration by CD20-positive B-cell lymphoma cells
- D Extensive periductal fibrosis with acinar atrophy and no inflammation
Correct answer: B. Lymphocytic infiltration with focal lymphoepithelial lesions (focus score ≥1 per 4 mm²)
Explanation
The patient meets criteria for primary Sjogren syndrome. Definitive diagnosis requires focal lymphocytic sialadenitis with a focus score of ≥1 lymphocytic focus per 4 mm² on minor salivary gland biopsy. Non-caseating granulomas suggest sarcoidosis. Diffuse large B-cell lymphoma is a complication but not the diagnostic finding. Periductal fibrosis without inflammation is seen in late-stage disease or IgG4-related disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.