Bornstein Jacob, Cohen Yitzhak, Zarfati Doron, Sela Shifra, Ophir Ella
Department of Obstetrics and Gynecology, Research Laboratory and Department of Pathology, Western Galilee Hospital, Nahariya, Israel.
Int J Gynecol Pathol. 2008 Jan;27(1):136-41. doi: 10.1097/pgp.0b013e318140021b.
Recently, we have shown that vestibular hyperinnervation and the presence of 8 or more mast cells in a 10 x 10 microscopic field can be used as diagnostic criteria in localized vulvodynia (vulvar vestibulitis). We have also documented that degranulation of mast cells occurs in these cases. The present study further examines the characteristics of vestibular hyperinnervation and mast cell function in localized vulvodynia to elucidate if the 2 processes-hyperinnervation and mast cell increase and degranulation-are related. We examined vestibular tissue from 7 women aged 18 to 48 with severe localized vulvodynia and from 7 healthy control women. Parallel sections were stained by Giemsa and then immunostained for CD117 and heparanase. Nerve fibers that expressed protein gene product 9.5 were examined. Tissues from women with localized vulvodynia documented a significant increase in vestibular mast cells, subepithelial heparanase activity, and intraepithelial hyperinnervation compared with healthy women. This is the first documentation of heparanase activity in localized vulvodynia. Heparanase, which is degranulated from mast cells, is capable of degrading the vestibular stroma and epithelial basement membrane, thus permitting stromal proliferation and intraepithelial extension of nerve fibers, as seen in the present study. The hyperinnervation has been thought to cause the vestibular hyperesthesia distinctive of localized vulvodynia.
最近，我们已经表明，前庭神经纤维过度分布以及在10×10显微镜视野中存在8个或更多肥大细胞可作为局限性外阴痛（外阴前庭炎）的诊断标准。我们还记录了这些病例中肥大细胞的脱颗粒现象。本研究进一步探讨局限性外阴痛中前庭神经纤维过度分布和肥大细胞功能的特征，以阐明神经纤维过度分布与肥大细胞增多及脱颗粒这两个过程是否相关。我们检查了7名年龄在18至48岁之间患有严重局限性外阴痛的女性以及7名健康对照女性的前庭组织。平行切片先用吉姆萨染色，然后进行CD117和乙酰肝素酶免疫染色。检查表达蛋白基因产物9.5的神经纤维。与健康女性相比，局限性外阴痛女性的组织显示前庭肥大细胞、上皮下乙酰肝素酶活性和上皮内神经纤维过度分布显著增加。这是首次记录局限性外阴痛中乙酰肝素酶的活性。从肥大细胞脱颗粒的乙酰肝素酶能够降解前庭基质和上皮基底膜，从而如本研究所示，允许基质增殖和神经纤维上皮内延伸。神经纤维过度分布被认为会导致局限性外阴痛特有的前庭感觉过敏。
