1989 Volume 35 Issue 5 Pages 1105-1111
The ultrastructure of two cases of pemphigus vulgaris were examined by transmission, scanning and immunoelectron microscopy. Confirming previous reports, major alterations included edema or widening of the intercellular spaces, acantholysis, destruction of desmosomes and formation of tonofilamentous bundles surrounding the nucleus of acantholytic cells. Membrane-coated granules were also observed both within the cytoplasm near the cellular membrane and in the widened intercellular spaces. Some of these intracellular granules assumed a desmosome-like appearance. Basement membrane features varied. The anchoring filament was usually not altered. The lamina densa varied from normal to a widened appearance, interrupted and even completely lacking. Exfoliation in places of basal cells from the lamina densa was also noted. Under IEM, deposition of colloid gold conjugated anti-IgG and anti-IgA antibodies was noted mostly on the cytoplasmic membrane and the widened intercellular spaces. Three dimensional morphological alterations were demonstrated by SEM. Cytoplasmic projections of the acantholytic cells were shortened and had assumed a bead appearance. Cellular interdigitations were completely lost. Before vesicular formation, intraepithelial micro-vesicles and widening of the epithelial cells could be demonstrated on cracking fractured specimens. In this stage, although interdigitations between neighboring cells were preserved, cytoplasmic projections facing the micro-vesicle were shortened.
