Objectives Minor salivary gland (MSG) biopsy has an important role in Sjögren's disease diagnosis and research. MSGs show within-patient variation in number of lymphocytic foci per unit area, but the optimal number of MSGs required to balance reproducibility and clinical acceptability has not been determined. Methods Monte Carlo simulations were performed to investigate impact of MSG number on (i) diagnosis based on focus score (FS) ≥1; (ii) reproducibility, defined as the extent to which 2 FS measurements obtained from 2 within-patient biopsies are the same, assuming no systematic differences have occurred in between biopsies; and (iii) smallest sample size required to detect a clinically meaningful difference in FS. Data simulation was repeated for different MSG numbers (range, 2-7). Results Higher reproducibility was noted for every unit increase in MSG number, with the median absolute difference between 2 within-patient FS measurements decreasing from 1.05 (SD = 0.25) with 2 glands to 0.52 (SD = 0.12) with 7 glands. MSG number influenced the probability of a simulated patient receiving a FS ≥1, increasing from a median of 0.67 with 2 glands to 0.77 with ≥5 glands. MSG number influenced clinical trial sample sizes. For example, 80% statistical power to detect a 40% FS reduction required a sample size per group of 62 with 2 glands and 25 with 7 glands. Conclusions For a diagnostic threshold of FS ≥1, a minimum of 5 glands should ideally be targeted. For continuous FS values, a larger number of MSGs (eg, 6) will increase reproducibility further and reduce clinical trial sample size requirements.

This article provides a broad overview of oral potentially malignant disorders (OPMD) and associated entities. The review opens with an update on the terminology surrounding OPMD before summarizing the lesions and conditions currently recognized as OPMD by the World Health Organization (WHO). Approaches to diagnosing oral epithelial dysplasia (OED) are discussed in the context of the WHO's recently modified architectural and cytological criteria for OED. The spectrum of reactive epithelial changes – which may mimic OED - is explored for comparison. The review then focuses on four significant OPMD - proliferative verrucous leukoplakia, oral submucous fibrosis, HPV-associated OED, and oral lichen planus – with clinical and histopathological examples. Next, potential pitfalls - non-preneoplastic lesions that can mimic OPMD clinically and histopathologically - are highlighted; these include chronic hyperplastic candidosis, verruciform xanthoma, granular cell tumour, and hairy leukoplakia. Molecular tests for identifying and stratifying OPMD are commented on briefly as - to date - histopathology remains the most reliable prognosticator. Clinicopathological correlation is critical to accurate histopathological diagnosis, risk stratification, and clinical management. The review closes by highlighting clinical features – e.g., associated redness – indicative of high risk.

Dear Editor, Sjögren’s disease (SjD) is characterized by B cell hyperactivity and focal lymphocytic infiltration of salivary glands. The palatine tonsils are secondary lymphoid organs that are a first line of defence against pathogens, and a unique inductive site for B cell responses with selective homing to bronchial and nasal mucosae and lacrimal and salivary glands [1]. Tonsillectomy (TE) is a common surgical procedure that is often reported to have little effect on immune function [2] based on short-term studies. However, some studies have shown a reduction in serum immunoglobulins over time, and a population-based study found TE to be associated with long-term risk of respiratory, infectious and allergic diseases [3]. Further, a recent Swedish population-based study found that TE was associated with increased risk of several autoimmune diseases, including SjD [4]. Whether a history of TE is associated with the...

Fungal rhinosinusitis (FRS) is inflammation of the paranasal sinus mucosa due to fungal infections, which can be invasive or non-invasive. The occurrence of a sphenoid mucocele with a fungal ball is rare. We report a case of sphenoid sinus mucocele with a fungal ball caused by Scedosporium apiopermum in a 32-year-old female who presented to the Emergency Department with persistent headache not relieved on medications. The radiological images showed a mucocele with clival osteomyelitis. Urgent endoscopic examination and debridement was undertaken which demonstrated a mucocele with fungal ball. Microbiological examination confirmed it to be Scedosporium apiopermum.