Grade

Lymphocytes per 4 mm 2 of Salivary Tissue

0

Absent

1

Slight infiltrate

2

Moderat filtrate or less than one focus

3

One focus

4

More than one focus

Note

Focus = an aggregate of >50 lymphocytes and histiocytes

Histologic Features

Score

Tumor Grade

Total Scores

Intracystic component <20%

2

Neural invasion

2

Low grade

0 - 4

Tumor necrosis

3

Intermediate grade

5 - 6

Mitosis >4 / 10 HPF

3

High grade

> 7

Anaplasia

4

Focus Score

Diagnostic Interpretation

> 1.0/4 mm2

Focal lymphocytic sialadenitis (FLS) characteristic of the salivary component of SS

1.0 /4 mm2

Indeterminate

< 1.0/4 mm2 

Chronic sialadenitis (with or without diffuse acinar atrophy, ductal dilatation, and interstitial fibrosis

Sample adequacy

1) Size > 4.0 mm2 or contains > 4 glands

2) No extensive loss of parenchyma or diffuse fibrosi

Definition of

Lymphocytic focus

Perivascular or periductal dense aggregates of 50 or more lymphocytes, with <10% plasma cells, and located adjacent to normal-appearing acini in gland lobules with little or no duct dilation or fibrosis.