J Korean Assoc Oral Maxillofac Surg.  2022 Apr;48(2):125-129. 10.5125/jkaoms.2022.48.2.125.

Histopathology and ultrastructural findings of pediatric sialolithiasis: a brief communication

• Mustakim KR
• Nguyen TTH
• Eo MY
• Kim SM

• KMID: 2529927
• DOI: http://doi.org/10.5125/jkaoms.2022.48.2.125

Abstract

Sialolithiasis is a condition in which the salivary gland excretory duct is obstructed due to the formation of calcareous deposits and is uncommon in children compared to adults. The treatment modalities range from a conservative approach involving hydration to a surgical approach. Though several studies have analyzed the sialolith micromorphology structures, studies on pediatric sialoliths remain scarce. This brief communication aims to describe the sialolith micromorphology to understand the mechanism of mineralization and growth of pediatric sialoliths. A 6-year-old Korean female presented with swelling under her tongue. The intraoral examination revealed a painless yellowish hard mass beneath the tongue near the Wharton’s duct which was suspected as a sialolith. After receiving the informed consent, the sialolithotomy was performed under local anesthesia. The obtained stone was analyzed through histopathology and transmission electron microscope examinations to understand the mechanism of mineralization and growth of pediatric sialolith. The micromorphology and growth processes of pediatric sialolith remain undescribed. More comprehensive microscopic studies are needed regarding their distinctive characteristics. By expanding knowledge about sialoliths micromorphology, development of new preventive, diagnostic and patient-tailored treatment methods of pediatric sialolithiasis will be enhanced.

Keyword

Pediatrics; Sialolithiasis; Histopathology; Transmission electron microscopy; Ultrastructure

Figure

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  Fig. 1 A. Preoperative condition. B. The axial computed tomography view confirmed the sialolith at the Wharton’s duct orifice. C. Sialolithotomy procedure using blunt dissection technique. D. The obtained 3-mm-diameter stone for light microscope (LM) and transmission electron microscope (TEM) examinations. E. One-month follow-up condition.

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  Fig. 2 A. The stone revealed varied calcification degrees (H&E staining, ×4). Scale bar=500 µm. B. Laminated concentric patterns (black arrow) and mineralized nodules (black asterisk) (H&E staining, ×10). Scale bar=200 µm. C. Eosinophilic core (black asterisk) and amorphous materials (black arrow) (H&E staining, ×10). Scale bar=200 µm. D. Amorphous basophilic materials (H&E staining, ×20). Scale bar=100 µm. E. The detail of laminated structures with concentric pattern and mineralized nodules of the sialolith (H&E staining, ×20). Scale bar=100 µm. F. The branch consists of mineralized nodules (black arrows) (H&E staining, ×20). Scale bar=100 µm. G. Globular structures (black arrows) (H&E staining, ×40). Scale bar=50 µm. H. Needle-like crystallization (black asterisk) (H&E staining, ×40). Scale bar=50 µm. I. Bacteria (yellow arrow) in the outer shell containing salivary ductal epithelium (yellow asterisk) (H&E staining, ×40). Scale bar=50 µm.

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  Fig. 3 Transmission electron microscope images of pediatric stone. A. In the internal lamellas, the globular structure was dominant (blue asterisk), while the crystalline pattern was heterogeneous in several outer layers, with some regions of needle-like patterns (black asterisk). Finger-like globuli were recorded (black arrows), magnification 3,000×. B. Clusters of vesicle structures with tear-like structures adjacent to the major vesicles (blue arrow), magnification 3,000×. C. Needle-like crystallites were arranged in clusters (blue asterisks), magnification 6,000×. D. Globular exosomal-like structures approximately 0.5 µm in diameter were detected in the internal lamellas (blue arrows). Membranous bodies were observed adjacent to the vesicles (black asterisks). Some globules were noticed to have internal and surface opaque contraction (black arrowhead), magnification 6,000×. E. Two patterns of calcification related to structure: intra-vesicular (blue arrowheads) and extra-vesicular (black arrowheads) patterns. Some vesicle structures had double membranes (blue asterisks), magnification 6,000×. F. Area of high-density vesicles showing intra-vesicular (blue arrowheads) and extra-vesicular (black arrowhead) deposition, magnification 6,000×.

Reference

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