Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia

• Published in: American journal of obstetrics and gynecology 2015-04, Vol.212 (4), p.476.e1-476.e8
• Main Authors: Tommola, Päivi, MD, Bützow, Ralf, MD, PhD, Unkila-Kallio, Leila, MD, PhD, Paavonen, Jorma, MD, PhD, Meri, Seppo, MD, PhD
• Format: Article
• Language: English
• Subjects: B-Lymphocytes - metabolism; Biomarkers - metabolism; Case-Control Studies; Cross-Sectional Studies; Dendritic Cells - metabolism; Female; Humans; immune activation; inflammation; Lymphoid Tissue - metabolism; Lymphoid Tissue - pathology; Macrophages - metabolism; Obstetrics and Gynecology; T-Lymphocytes - metabolism; vestibulodynia; Vulva - immunology; Vulva - pathology; vulvar pain; vulvar vestibulitis; Vulvodynia - immunology; Vulvodynia - pathology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.10.1098

Objective Localized provoked vulvodynia (LPV) may have inflammatory etiology. We wanted to find out whether the cell-mediated immune system becomes activated in the vestibular mucosa in LPV. Study Design This was a controlled cross-sectional study. Vestibular mucosal specimens were obtained from 27 patients with severe LPV and 15 controls. Detailed clinical history of the patients was obtained. For immunohistochemistry, antibodies against CD3 (T cells), CD20 (B cells), IgA (mucosal plasma cells), CD163 (dendritic cells [DCs]), CD68 (macrophages), and CD117 (mast cells) were employed. Mann-Whitney U test and χ2 test were used for statistical analyses. Results More B lymphocytes and mature mucosal IgA-plasma cells were found in patients than in controls ( P < .001 and P < .001, respectively). In LPV samples, B and T cells were arranged into germinal centers representing local immune activation. Germinal centers were not seen in controls. Antigen-presenting DCs and macrophages were found both in patients and controls with similar densities. DCs were found to extend their dendrites into the luminal space through an intact epithelium. Similar amounts of mast cells were found evenly scattered throughout the stroma of vestibular mucosa of both patients and controls. Conclusion We demonstrate here local organized vestibule-associated lymphoid tissue analogous to mucosa-associated lymphoid tissue. Vestibule-associated lymphoid tissue may emerge as a response to local infection or inflammation in LPV.