case_images: PMC11146451_01
case_images: Gross examination of the specimens
case_images: RJME-65-1-113-fig1.jpg
case_images: PMC11146451_01_RJME-65-1-113-fig1.jpg
case_images: F1
case_images: Bilateral submandibular excision was performed under general anesthesia and specimens were sent to HP examination (Figure 1).
case_images: Morphological appearance of the submandibular gland. Severe fibrosis with hyalinization of the interlobular septum; perivenular lymphocytic inflammatory infiltrate with few plasma cells is present; however, no fully developed phlebitis is noted. Hematoxylin-Eosin (HE) staining, x400
case_images: RJME-65-1-113-fig2.jpg
case_images: PMC11146451_01_RJME-65-1-113-fig2.jpg
case_images: F2
case_images: The residual salivary gland tissue presented acinar atrophy, with dense mature lymphoplasmacytic cell infiltrate between residual identifiable acini (Figure 2).
case_images: Relatively frequent plasma cells [cluster of differentiation 138 (CD138)-positive cells] are present within the inflammatory infiltrate. CD138 immunostaining, x400
case_images: RJME-65-1-113-fig3.jpg
case_images: PMC11146451_01_RJME-65-1-113-fig3.jpg
case_images: F3
case_images: Relatively frequent plasma cells positive for CD138 mainly as isolated cells and occasional distribution in groups with polytypical expression of kappa and lambda light chains were present (Figure 3).
case_images: Numerous immunoglobulin G4 (IgG4)-positive cells are present (more numerous than the cut-off level of 10 IgG4-positive cells per high-power field). IgG4 immunostaining, x400
case_images: RJME-65-1-113-fig4.jpg
case_images: PMC11146451_01_RJME-65-1-113-fig4.jpg
case_images: F4
case_images: IgG4 highlighted numerous positive cells (77-90 cells per 0.55 diameter high-power field); IgG4(+) plasma cells represented 42.77% of the IgG(+) cells (Figure 4).