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Standardisation of the detection of germinal centres in salivary gland biopsies of patients with primary Sjögren’s syndrome is needed to assess their clinical relevance
  1. Erlin A Haacke1,2,
  2. Bert van der Vegt2,
  3. Arjan Vissink3,
  4. Frederik K L Spijkervet3,
  5. Hendrika Bootsma1,
  6. Frans G M Kroese1
  1. 1Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  2. 2Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  3. 3Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  1. Correspondence to Dr Erlin A Haacke, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands; e.a.haacke{at}umcg.nl

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We thank Alunno et al1 for their comments, as a response to our recent publication2 in which we describe that, in contrast to the prevailing view, germinal centres in diagnostic labial gland biopsies are not predictive for the development of mucosa-associated lymphoid tissue (MALT) lymphoma in parotid salivary glands in patients with (primary) Sjögren’s syndrome (pSS). As we2 and others also noted before,3–6 Alunno et al1 underpin in their comments the need for standardisation of the detection method of germinal centres in salivary gland biopsies in patients with pSS. Germinal centres are structures that arise in B-cell follicles of secondary lymphoid organs as a response to antigenic stimulation. In these structures, high-affinity memory B-cells are generated, as a consequence of an intimate interplay between B-cells, follicular helper T cells (TFH) and immune-complex presenting follicular dendritic cells (FDCs). Germinal centres can also be found within B-cell areas of ectopic (tertiary) lymphoid tissue that develops in target tissues of various rheumatic autoimmune diseases, including pSS.7 While detection in secondary lymphoid tissue is …

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