A 48-Year-Old Woman Comes to the Office Due to Difficulty

A 48-year-old woman comes to the office due to difficulty swallowing dry foods such as crackers.  She has no pain during swallowing or heartburn.  The patient is a college professor and has to drink water frequently during lectures to keep her mouth moist.  She also reports a gritty sensation in her eyes, which is often worse in the evening, and occasional brief episodes of joint pain.  Medical history is significant for hypothyroidism, for which she takes levothyroxine.  Physical examination shows mild conjunctival erythema and cracking of the lips.  There is diffuse, nontender thyroid enlargement, which is unchanged from prior examination.  The remainder of the examination is normal.  Biopsy of the lip mucosa is most likely to reveal which of the following findings?

A) Extracellular deposition of amorphous proteins
B) Hyperkeratosis and dysplasia limited to the epithelium
C) Intraepidermal spongiosis and acantholysis
D) Periductal lymphocytic infiltration of labial glands
E) Scattered, noncaseating, epithelioid granulomas

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