case_images: PMC7864275_01
case_images: ultrasound of the lacrimal glands before treatment: the left (A) and right (B) lacrimal glands were enlarged (left: 30 x 14 mm and right: 26 x 14 mm) before treatment, with multiple hypoechoic areas; C, D) both glands displayed hypervascularity
case_images: PAMJ-37-252-g001.jpg
case_images: PMC7864275_01_PAMJ-37-252-g001.jpg
case_images: F1
case_images: ultrasound of the lacrimal glands after treatment: left (A) and right (B) lacrimal glands decreased in size (left: 9 x 4 mm and right: 8 x 5 mm), and the vascularity and hypoechoic areas disappeared in response to corticosteroid therapy
case_images: PAMJ-37-252-g002.jpg
case_images: PMC7864275_01_PAMJ-37-252-g002.jpg
case_images: F2
case_images: Figure 2, Figure 3). Facial magnetic resonance imaging (MRI) demonstrated the diffuse enlargement of the lacrimal and submandibular glands, without evidence of focal lesion or nodularity.
case_images: ultrasound of the submandibular glands: A, B) the submandibular glands before treatment showed bilateral enlargement with multiple hypoechoic, hypervascular areas; C) the submandibular glands after treatment showed a decrease in the size and vascularity of the glands, in addition to the disappearance of hypoechoic areas
case_images: PAMJ-37-252-g003.jpg
case_images: PMC7864275_01_PAMJ-37-252-g003.jpg
case_images: F3
case_images: Figure 2, Figure 3). Facial magnetic resonance imaging (MRI) demonstrated the diffuse enlargement of the lacrimal and submandibular glands, without evidence of focal lesion or nodularity.
case_images: MRI showed enlarged lacrimal glands before treatment: A, B) fat-suppressed T2-weighted images demonstrated the hypointense bilateral swelling of the lacrimal glands; C) the lacrimal glands were isointense to skeletal muscle on T1-weighted images; D) T1-weighted images post-contrast showed that the lacrimal glands are remarkably and homogeneously enhanced
case_images: PAMJ-37-252-g004.jpg
case_images: PMC7864275_01_PAMJ-37-252-g004.jpg
case_images: F4
case_images: No evidence of sialolithiasis or dilatation of the parotid duct was detected (Figure 4, Figure 5).
case_images: facial MRI before treatment: A) fat-suppressed T2-weighted images showed that the submandibular glands were diffusely enlarged and hypointense; B) T1-weighted images demonstrated the low signal intensity of submandibular glands; C) T1-weighted images with contrast showed the remarkably homogeneous enhancement of these glands
case_images: PAMJ-37-252-g005.jpg
case_images: PMC7864275_01_PAMJ-37-252-g005.jpg
case_images: F5
case_images: No evidence of sialolithiasis or dilatation of the parotid duct was detected (Figure 4, Figure 5).
case_images: microscopic images of the lacrimal gland visualized with hematoxylin and eosin stain (A-C) and CD138 antibody stain (D); A) lymphoplasmacytic infiltration and fibrosis; B) fibrosclerosis was found in the gland interstitium; C) lacrimal ducts were observed with collagenous sheaths; D) CD38 immunoreactivity was observed, confirming plasma cell infiltration
case_images: PAMJ-37-252-g006.jpg
case_images: PMC7864275_01_PAMJ-37-252-g006.jpg
case_images: F6
case_images: The immunohistochemical findings revealed CD138-positive cells (Figure 6) and the absence of malignant cells.
case_images: microscopic images of lacrimal gland with anti-IgG antibody stain x100 (A); anti-IgG4 antibody stain x100 (B) and anti-IgG4 antibody stain x400 (C); A, B) representative section of the lacrimal gland showed infiltration of IgG and IgG4 cells; C) markedly increased IgG4-positive plasma cells (the number of IgG4+ cells >50/ high-power field)
case_images: PAMJ-37-252-g007.jpg
case_images: PMC7864275_01_PAMJ-37-252-g007.jpg
case_images: F7
case_images: Immunostaining results demonstrated that there were remarkably increases of IgG and IgG4 positive plasma cells with the IgG4 positive plasma cells > 50/ high-power field (Figure 7).