Benign mucous membrane pemphigoid. 3. Biopsy.

Abstract

Conjunctival biopsy specimens were taken from the inferior fornix of 16 eyes affected with benign mucous membrane pemphigoid (BMMP). Biopsy revealed in all cases metaplasia changing the normal columnar epithelium into squamous epithelium, with parakeratinization in eight specimens and keratinization as well, in four. Correlation was noticed between keratinization and reduced secretions of both tears and mucus.Mucus‐producing goblet cells were remarkably scarce in eight cases and totally absent in the remaining eight. This corresponds approximately to the result of an estimation of the mucus secretion by measuring the mucous thread after vital staining with a tetrazolium‐alcian blue mixture. Four of the 16 biopsies revealed fibrosis of the submucous connective tissue. The connective tissue was found to contain relatively few neutrophilic granulocytes. In two cases eosinophilic granulocytes were present in small numbers, while several lymphocytes and plasma cells were seen, in five, even an adenoid layer. Neither bullae nor acantholysis were demonstrated. Such cytological methods as examinations of smears and quantitative pipette samples can disclose epithelial changes, and examination of the mucous thread can be used as a goblet cell function test. Hence these methods can, to a certain extent, replace the procedure for estimating the goblet cell content in a conjunctival biopsy specimen. Taking biopsy specimens has the disadvantages of causing pain, tissue damage and additional cicatricial shrinkage. Furthermore, a small biopsy specimen is not always representative.