Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia - 26/11/14

Doi : 10.1016/j.ajog.2014.10.1098

Päivi Tommola, MD ^a,^⁎ , Ralf Bützow, MD, PhD ^b, Leila Unkila-Kallio, MD, PhD ^a, Jorma Paavonen, MD, PhD ^a, Seppo Meri, MD, PhD ^c,^d
^a Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
^b Department of Pathology, University of Helsinki, Helsinki, Finland
^c Research Programs Unit, Program of Immunobiology, University of Helsinki, Helsinki, Finland
^d Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland

^∗Corresponding author: Päivi Tommola, MD.

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Abstract

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.

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Key words : immune activation, inflammation, vestibulodynia, vulvar pain, vulvar vestibulitis

Plan

Materials and Methods

Antigen-presenting cells

T and B lymphocytes and plasma cells

Mast cells

Clinical correlates of immunological parameters

Comment

	This study was supported by grants from the Finnish Society of Pediatric and Adolescent Gynecology and Helsinki University Hospital Research Funds (grant nos. TYH2012237, TYH2013340, TYH 2011128, and TYH 2013308).
	The authors report no conflict of interest.
	Cite this article as: Tommola P, Bützow R, Unkila-Kallio L, et al. Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia. Am J Obstet Gynecol 2014;212:x.ex-x.ex.