Estudo histopatologico, imunoistoquimico e de hibridização ?in situ? das glandulas submandibular e sublingual em pacientes autopsiados com aids em fase avançada / Histopathological, immunohistochemical, and in situ hybridization study of the submandibular and sublingual glands of autopsied patients with advanced AIDS

Jorge Esquiche Leon

This study describes the histopathological, immunohistochemical (lHC), and in situ hybridization (ISH) features found in the submandibular (n=103) and sublingual (n=92) glands of autopsied patients who died with AIDS between 1996 and 1999 in the SVOC FMUSP (Medical School of São Paulo University). Sex, age, CD4 cell count, and clinical history were obtained from the clinical records of 105 patients, of them 103 cases corresponded to the submandibular glands and 92 cases to the sublingual glands. All glands were examined for macroscopical alterations and stained using H&E, Gomori-Grocott, Ziehl-Neelsen, and Mucicarmine. IHC analysis to detect infectious agents (CMV, LMP-EBV, HSV-l, HSV-2, HIV-p24, and BCG) and to characterize the sialadenitis (CD3, CD4, CD8, CD20, and CD68) was performed, while the ISH assessed the presence of EBV (EBERl/2). The mean age of the patients and CD4 cell count of the cases of the submandibular and sublingual glands were 36,62 + or - 11,18 years and 74,37 + or - 112,82 cells mu L POT .-1 , and 35,93 + or - 10,2 years and 78,75 + or - 118,98 cells mu L POT .-1 , respectively. There were no histological alterations in 51 (49,5%) and 54 (58,7%) cases of the submandibular and sublingual glands, respectively. The infection conditions were the most common in the submandibular gland (n=35), followed by chronic non-specific sialadenitis in both glands (n=25). Mycobacteriosis (11 and 07 cases of the submandibular and sublingual glands, respectively), cytomegalovirosis (14 and 02 cases of the submandibular and sublingual glands, respectively), and cryptococcosis (03 and 04 cases of the submandibular and sublingual glands, respectively) were found frequently. The IHC analysis did not show immunoreactivity for LMP-EBV, HSV-l, and HSV-2; while BCG displayed strong immunopositivity only in cases of chronic diffuse macrophagic infiltrate associated to mycobacteriosis (n=2). Six out of 16 cases of cytomegalovirosis (05 and 01 case of the submandibular and sublingual glands, respectively) were detected for IHC analysis only. The p24-HIV protein (02 and 01 case of the submandibular and sublingual glands, respectively) and EBERl/2 (09 and 04 cases of the submandibular and sublingual glands, respectively), this latter evaluated only in the sialadenitis cases, were expressed only in macrophages and lymphocytes, respectively, indicating that the participation of these viruses in the etiopathogenesis of the sialadenitis is still unc1ear. Chronic non-specific sialadenitis revealed CD8+ T-lymphocytes predominance (p=0,323), hile the granulomatous, diffuse macrophagic associated to mycobacteriosis, and chronic non-specific diffuse macrophagic sialadenitis showed great amount of CD68+ macrophages (p=0,99) surrounded by numerous CD8+ T-lymphocytes, in both glands. Moreover, one case of diffuse large B-celllymphoma affected both glands. These results indicate that both submandibular and sublingual glands were affected mainly by infectious diseases and chronic non-specific sialadenitis. Similarly, the parotid glands in a study previously published by our team, were mainly affected for systemic infectious diseases. Therefore, c1inicians should consider more carefully the occurrence of these lesions in major salivary glands of patients with advanced AIDS

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