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Y. Ogawa, K. Yamazaki, D. Murat, E. Goto, S. Shimmura, H. Fujishima, M. Kuwana, S. Okamoto, Y. Kawakami, K. Tsubota; Pathogenic Fibrosis and Inflammation of Conjunctival Chronic Graft–Versus–Host Disease . Invest. Ophthalmol. Vis. Sci. 2006;47(13):255.
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Conjunctival chronic graft–versus–host disease (GVHD) can mimic ocular cicatricial pemphigoid (OCP). The purpose of this study is to elucidate histopathologic features of the conjunctiva in chronic GVHD after allogeneic hematopoietic stem cell transplantation.
Conjunctival specimens from 10 patients who had presented with dry eye as part of their symptoms of chronic GVHD were examined by immunohistochemistry and transmission electron microscopy. Conjunctival specimens from 7 patients with Sjögren’s syndrome (SS) were used as controls.
Notable findings in the conjunctiva from patients with chronic GVHD were marked fibrosis of the subepithelial stroma and an increase in the number of CD34+ stromal fibroblasts. Electron microscopic observations of the conjunctiva from patients with chronic GVHD revealed that stromal fibroblasts were attached to various inflammatory cells, including lymphocytes, macrophages and plasma cells, via primitive or rudimentary contacts. In addition, the presence of a well–developed rough endoplasmic reticulum in the fibroblasts and newly synthesized collagen fibrils in the extracellular matrix indicated an active production of extracellular matrix components. Electron micrographs revealed multilayered and thickened basal laminae of blood vessels and epithelia in the conjunctiva of patients with chronic GVHD, however, these observations were infrequently observed in the conjunctiva of patients with SS.
Our results suggest substantial differences in the conjunctiva histopathology of patients with chronic GVHD and SS. In addition, it is likely stromal fibroblasts are actively involved in the pathogenic process of chronic GVHD in the conjunctiva by producing excessive extracellular matrix components, leading to fibrotic changes similar to OCP.
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