Histopathologic Differences between Primary and Secondary Vestibulodynia Provide Insights into Pathophysiology
V Korcheva, MF Goetsch, R Anderson, CM LeClair, TK Morgan. OHSU, Portland, OR
Background: Chronic vestibulitis (vestibulodynia) is severe localized introital pain elicited by vaginal entry. It is common, affecting 15% of women. The cause is unknown, but prior studies have provided mixed data regarding the potential role of ERa, neural hypertrophy, and/or chronic inflammation. We hypothesize that mixed results in the literature may be related to differences between "primary" and "secondary" disease. Primary sufferers report severe pain from the first introital touch. Secondary sufferers present later in life with no prior history of introital pain. Our objective was to compare the histopathologic features of both primary and secondary vestibulodynia.
Design: We performed a retrospective analysis of archived vestibular biopsies obtained at the OHSU Vestibulodynia Clinic from 2002-2008 (n=111). We also reviewed four negative control biopsies prospectively collected at our clinic. Patient records were reviewed by expert gynecologists (mfg, cml) to classify each case as either primary or secondary vestibulodynia. The vestibular biopsies were H&E stained and serial sections immunostained for nerves (S100), mast cells (CD117), and ERa. Sections were scored by two pathologists (tkm, vk) for chronic inflammation, neural hypertrophy/hyperplasia, mast cell density, and basal cell ERa expression using previously published criteria. Significance between groups was tested by Chi-square and the Mann-Whitney U test.
Results: Chart review identified 49 primary and 62 secondary vestibulitis cases. Histopathologic scoring showed excellent reproducibility between pathologists (kappa statistics 0.70-79) and multiple differences between groups were identified. Primary vestibulitis showed significant neural hypertrophy/hyperplasia compared to secondary vestibulitis (P<0.0001) and controls. Secondary vestibulitis had more chronic inflammation (p<0.01) and mast cells/hpf (p<0.05). There was also a trend towards less ERa in secondary vestibulitis (P=0.08), which may be related to inflammation.
Conclusions: Our data show for the first time that primary and secondary vestibulitis have different histologic features, which may explain the mixed results of prior studies that did not discriminate between these categories. Either primary and secondary vestibulitis are separate disease entities, or inflammation represents an early stage in the disease process that culminates in neural hypertrophy/hyperplasia.
Category: Gynecologic & Obstetrics
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 158, Monday Morning