In patients with chronic GVHD, mononuclear cells were mainly found
around medium-sized ducts in the interlobular areas, whereas there were
only a small number of mononuclear cells in the acinar area (
Figs. 1A 1B ). Infiltrating lymphocytes in the periductal areas were
predominantly T cells, regardless of the severity of dry eye
(Figs. 1C 1D) . In patients with severe dry eye, the intralobular interstitium was
fibrotic, and partially myxedematous
(Figs. 1E 1F) . The margins of the
lobules were irregularly replaced by fibrotic tissue, and the small
ducts of fibrotic areas appeared to dilate and proliferate
(Figs. 1E 1F) . In contrast, fibrosis in the intralobular interstitium
was not apparent, and the acini had an almost normal structure in one
patient with mild dry eye (case 1;
Figs. 1A 1B ). Mallory staining
confirmed dense and severe fibrosis of the interstitium, which was more
intense in the periductal areas than in the acinar areas
(Fig. 1G) .
CD34 was expressed in the periductal areas and at the margins of the
acinar areas, where the fibrosis was apparent
(Fig. 1H) . The majority
of CD34
+ cells had a spindlelike shape consistent
with the morphology of fibroblasts
(Fig. 1I) . An increase in the number
of CD34
+ fibroblasts was more prominent in
patients with severe dry eye than in those with mild dry eye. There
were CD34
+ cells in the walls of small blood
vessels, and those cells appeared to be endothelial cells. Laminin
staining revealed multilayered and thickened basal lamina around ducts
(Fig. 1J) . The basal laminae of blood vessels were also multilayered in
all patients with chronic GVHD.