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  • Need for consensus guidelines to standardise the assessment of germinal centres and other histopathological parameters in salivary gland tissue of patients with primary Sjögren's syndrome

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Need for consensus guidelines to standardise the assessment of germinal centres and other histopathological parameters in salivary gland tissue of patients with primary Sjögren's syndrome
  1. Konstantina Delli1,
  2. Erlin A Haacke2,3,
  3. Stephan Ihrler4,
  4. Bert van der Vegt3,
  5. Arjan Vissink1,
  6. Hendrika Bootsma2,
  7. Frederik K L Spijkervet1,
  8. Frans G M Kroese2
  1. 1Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  4. 4Laboratory for Dermatohistology and Oral Pathology, Munich, Germany
  1. Correspondence to Dr Konstantina Delli, Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands; k.delli{at}umcg.nl
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http://dx.doi.org/10.1136/annrheumdis-2016-209480

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    We have read with great interest the letter to the editor by van Roon et al1 commenting on our paper ‘Towards personalised treatment in primary Sjögren's syndrome: baseline parotid histopathology predicts responsiveness to rituximab treatment’.2 The authors argue that there is a need for standardisation of the histopathological characteristics of salivary gland tissue of patients with primary Sjögren's syndrome (pSS), in general, and of the presence of germinal centres (GCs), in particular.

    We fully agree with van Roon et al1 and other authors about the need for consensus guidelines to standardise the histopathological evaluation of salivary gland biopsies in patients with pSS.3 A standardised scoring system may facilitate prognostication and stratification of patients with pSS and is needed for a valid evaluation of various clinical trials.3 In particular, histological definition of GCs in salivary gland tissue is warranted, since these structures can be difficult to detect in diagnostic H&E-stained tissue sections. Detection of GCs in the periductal lymphoid infiltrates of the salivary glands is clinically relevant, because the presence of these structures is associated with more severe disease.4 Importantly, the presence of GCs in minor salivary gland biopsies has been postulated to be a predictor of patients who are at risk of lymphoma development.5 …

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