Tommola Päivi, Bützow Ralf, Unkila-Kallio Leila, Paavonen Jorma, Meri Seppo
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
Department of Pathology, University of Helsinki, Helsinki, Finland.
Am J Obstet Gynecol. 2015 Apr;212(4):476.e1-8. doi: 10.1016/j.ajog.2014.10.1098. Epub 2014 Oct 30.
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.
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 χ(2) test were used for statistical analyses.
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.
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.
局限性激发性外阴痛（LPV）可能有炎症病因。我们想弄清楚LPV患者的前庭黏膜中细胞介导的免疫系统是否被激活。
这是一项对照横断面研究。从27例重度LPV患者和15名对照者获取前庭黏膜标本。获取患者详细的临床病史。免疫组化采用抗CD3（T细胞）、CD20（B细胞）、IgA（黏膜浆细胞）、CD163（树突状细胞[DCs]）、CD68（巨噬细胞）和CD117（肥大细胞）的抗体。采用Mann-Whitney U检验和χ²检验进行统计分析。
患者体内发现的B淋巴细胞和成熟黏膜IgA浆细胞比对照者多（分别为P <.001和P <.001）。在LPV样本中，B细胞和T细胞排列成生发中心，代表局部免疫激活。对照者中未见生发中心。抗原呈递DCs和巨噬细胞在患者和对照者中均有发现，密度相似。发现DCs通过完整的上皮将其树突延伸至管腔空间。患者和对照者前庭黏膜基质中均发现数量相似的肥大细胞均匀散布。
我们在此证明了类似于黏膜相关淋巴组织的局部有组织的前庭相关淋巴组织。前庭相关淋巴组织可能是对LPV局部感染或炎症的一种反应而出现。
