1.Oral cavity

*Chronic Autoimmune Epithelitis - sjogren's Syndrome and Other Autoimmune Diseases...*

nasal bleeding, weakening of the sense of smell

Stomach Chronic gastritis, malabsorption, susceptibility to *H. pylori* infection

coexisting cryoglobulinemia and urolithiasis

Gluten sensitivity [19, 20]

*The main clinical manifestations of pSS due to the epithelial damage.*

Bronchi Difficulty in swallowing, dry cough, hoarseness, recurrent bronchitis and less frequent

Oral candidiasis, dental caries, periodontitis otitis media, dry nose, chronic sinusitis,

bronchioles, bronchial hyperresponsiveness and accompanying dry cough, infections

Interstitial nephritis with distal renal tubular acidosis (dRTA). Glomerulonephritis with

less common. The occurrence of MZBCL has been observed in about 8% of pSS

The most important feature of MALT lymphoma is the presence of neoplastic cells (mainly B cells, as well as T cells) within epithelial structures, which may lead to destruction of the glandular architecture, also because of the formation of solid

Lymphomas in pSS are predominantly localized in salivary glands, which has been confirmed in many studies [23], whereas in the general population, MALT lymphoma is most often located in the stomach. The occurrence of MALT lymphoma in the stomach is proven to be associated with *H. pylori* infection [24]. The primary division of MALT lymphomas depending on the location is shown in **Table 3**.

MALT NALT Nasopharynx-

BALT Bronchus-associated

LALT Larynx-associated

into a separate macroscopically and anatomically identifiable mass, but spread throughout the

GALT Gut-associated

O-MALT Organized mucosa-associated lymphatic tissue-specific type of MALT affecting Waldeyer's

D-MALT Diffuse mucosa-associated lymphatic tissue-specific type of the disease, cells not organized

associated lymphoid

lymphoid tissue

lymphoid tissue

lymphoid tissue

tissue

patients; it is 40 times higher than in the healthy population [21, 22].

**2. Focusing on MALT lymphoma**

**Localization Effect**

Lungs Interstitial lung disease

Gut Celiac disease, colitis

Liver Hepatitis, cholangitis Pancreas Pancreatitis

Nasal and oral cavity

Kidneys and urine tract

**Table 2.**

**Subtypes of lymphoma due to localization**

SALT Skin-associated lymphoid tissue CALT Conjunctiva-associated lymphoid tissue SDALT Salivary duct-associated lymphoid tissue

tonsillar ring

mucosa of different organs

*Division due to the localization of MALT lymphoma [22, 25].*

infiltrations.

**6**

**Table 3.**

**A.** Saliva substitutes: hydroxymethylcellulose-containing oral spray, proper hydration by consuming more liquids, and regularly rinsing the mouth

The stimulation of salivary flow, obtained with the use of pilocarpine or cevimeline, parasympathomimetics, and muscarinic agonists affecting M1 and M3 receptors, after considering possible contraindications for their use.

Antifungal and antimicrobial treatment with medications such as chlorhexidine; the use of nonfluoride remineralizing agents as concomitant therapy.

Diet modification is recommended: eating slightly acidic products such as lemon, supplementing diet with unsaturated fatty acids (omega-3), and avoiding sweets and sweet effervescent beverages.

Quitting smoking is strongly recommended.
