Prayson R A, Stoler M H, Hart W R
Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio 44195.
Am J Surg Pathol. 1995 Feb;19(2):154-60. doi: 10.1097/00000478-199502000-00004.
Vulvar vestibulitis is a recently described clinical condition of unknown etiology. Human papillomavirus (HPV) infection has been implicated as a causal pathogen by some investigators. Because reports on this entity are few, we studied the pathologic features of vestibulectomy specimens from 36 women with a clinical diagnosis of vulvar vestibulitis. The patients' ages ranged from 19 to 53 years (mean, 31 years). Bilateral excisions were performed in 34 patients and a unilateral excision in two. Minor vestibular glands or ducts were identified in 28 patients (78%). Chronic inflammation was present in all specimens. The inflammatory infiltrate consisted predominantly of T lymphocytes and plasma cells with smaller numbers of B lymphocytes. Lymphoid follicles were present in four patients, ulcers in two. The predominant site of inflammation was the squamous mucosa, especially the lamina propria, where the degree of inflammation was graded as mild in 11 patients, moderate in 21 patients, and severe in four patients. To a lesser degree, the inflammation also typically involved the periglandular/periductal connective tissue of the minor vestibular glands, where it was graded as mild in 25 patients and moderate in three patients. Foci of squamous metaplasia were observed in 27 of 28 patients with demonstrable vestibular ducts or glands. Nodular hyperplasia of a vestibular gland (so-called "adenoma") occurred in one patient. In six selected cases, fungi were not identified on silver stains. Morphologic findings of HPV infection, such as koilocytotic atypia or squamous dysplasia, were absent. In-situ hybridization studies for HPV types 6, 11, 16, 18, 31 and 35 were negative in all 36 cases. We conclude that (a) vestibulectomy specimens from patients with a clinical diagnosis of vulvar vestibulitis typically show a chronic inflammatory cell infiltrate that predominantly involves the mucosal lamina propria and periglandular/periductal connective tissue and (b) a pathogenetic role for HPV types 6, 11, 16, 18, 31 and 35 is not substantiated.
外阴前庭炎是一种最近才被描述的病因不明的临床病症。一些研究者认为人乳头瘤病毒（HPV）感染是其致病病原体。由于关于该病症的报道较少，我们研究了36例临床诊断为外阴前庭炎的女性患者前庭切除术标本的病理特征。患者年龄在19至53岁之间（平均31岁）。34例患者进行了双侧切除，2例进行了单侧切除。28例患者（78%）发现了小前庭腺或导管。所有标本均存在慢性炎症。炎性浸润主要由T淋巴细胞和浆细胞组成，B淋巴细胞数量较少。4例患者出现淋巴滤泡，2例出现溃疡。炎症的主要部位是鳞状黏膜，尤其是固有层，其中11例患者炎症程度为轻度，21例为中度，4例为重度。在较小程度上，炎症通常也累及小前庭腺的腺周/导管周结缔组织，其中25例患者炎症程度为轻度，3例为中度。在28例可显示前庭导管或腺体的患者中，27例观察到鳞状化生灶。1例患者出现前庭腺结节性增生（所谓的“腺瘤”）。在6例选定病例中，银染未发现真菌。未发现HPV感染的形态学表现，如挖空细胞异型性或鳞状发育异常。对6、11、16、18、31和35型HPV的原位杂交研究在所有36例病例中均为阴性。我们得出结论：（a）临床诊断为外阴前庭炎的患者的前庭切除术标本通常显示慢性炎性细胞浸润，主要累及黏膜固有层和腺周/导管周结缔组织；（b）6、11、16、18、31和35型HPV的致病作用未得到证实。
