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I mentioned that one of the systemic diseases that can

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cause cysts, nodules, and calcifications within

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the parotid gland is Sjögren's syndrome.

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Sjögren's syndrome is a chronic autoimmune sialadenitis.

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As you know, it may even affect the lacrimal

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glands and lead to the Sicca syndrome.

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By that, we're saying dryness both of the eyes as well,

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as well as the mouth.

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This is obviously a disease that

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is much more common in women.

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The point about Sjögren's syndrome is that it has a high

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risk rate for the development of primary parotid lymphoma.

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So any dominant nodule that you see within the parotid

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gland should be treated sort of like a thyroid nodule,

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in that it should be aspirated to make sure it's not

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representing a tumor but instead is just sort of these

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lymphoid aggregates of what we refer to

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as benign lymphoepithelial lesions.

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Here on the CT scan to the right here,

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you see the fine calcifications that can occur

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within the parotid gland.

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They may have stones in the duct as well,

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and you may see cysts and nodules

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within the parotid gland.

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This is probably better demonstrated on the MRI scan,

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in that you have these lymphoid aggregates within the

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parotid tissue and it just looks kind of heterogeneous,

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these little microcystic areas within the glands.

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Now initially, the glands may be enlarged,

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but over the course of time,

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they do get chronic sialadenitis,

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which results in smaller glands than usual.

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This is, again, a slide loaned to me by Ruth Eliahou,

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and on the MR scan,

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you see these little areas of cyst formation

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within the glandular tissue, bilaterally.

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If you do MR sialography,

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you see this is the sialodochoectasia,

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the dilated ductal system,

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and this is evidence of chronic sialadenitis.

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Here is a conventional sialogram in a 3D reconstruction,

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where you see what looks like discontinuous areas of...

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of pooling of the contrast, which don't appear to

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communicate any longer with the ductal system.

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And this is one of the patterns of chronic sialadenitis

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that you see with Sjögren's syndrome.

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The glands may ultimately show atrophy.

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As I said,

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the glands may initially be inflamed and enlarged,

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but over the course of time, they do atrophy.

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And in this example, you see that the patient has those

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focal calcifications that we see in Sjögren's syndrome,

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has some asinine nodularity to the gland

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but also has a dominant nodule.

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This dominant nodule either can follow it with

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ultrasound to see whether it enlarges,

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or do the aspiration cytology with flow cytometry

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in order to exclude lymphoma.

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The parotid gland fine calcifications

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are most commonly seen with Sjögren's syndrome,

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but as I mentioned earlier,

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a lot of metabolic disorders predispose you to these

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fine calcifications within the glandular tissue.

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Not necessarily in the ductile system.

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And those things include chronic kidney disease, HIV,

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again, lymphoepithelial lesions with stasis that may

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lead to calcification, chronic alcoholism,

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autoimmune disorders above and beyond Sjögren's syndrome,

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which includes lupus, mixed connective tissue disorder,

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venous vascular malformations with phleboliths, calcified

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lymph nodes, usually from chronic granulomatous disease,

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including sarcoid, TB, et cetera,

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fungus, and rarely neoplasms that

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may show calcifications.