Increased CD4 Positive T-Cell Recruitment in Primary Chronic Vestibulitis Suggests Potential Disease Triggers.
Erick Jacobson-Dunlop, Catherine Leclair, Martha Goetsch, Terry K Morgan. OHSU, Portland; Oregon Health & Science University, Portland
Background: Chronic vestibulitis is a common cause of localized introital pain and sexual difficulty. In a tightly controlled prospective study, we recently demonstrated that vestibulitis has more chronic inflammation, neural hypertrophy, and mast cells, than normal control vestibular biopsies. The objective of the current study was to test for significant differences in lymphocyte sub-types in vestibulitis compared with controls.
Design: We used archived tissue sections from our prior prospective study, which recruited adult premenopausal women from the Program in Vulvar Health at Oregon Health and Science University. Patients had severe entry dyspareunia for at least one year and sampling had been performed on tender and nontender vestibule mucosa. Women designated as having primary vestibulitis (n=10) had noted significant pain from the first attempted vaginal entry. Secondary sufferers (n=10) had de novo pain onset after no prior history of localized entry pain. An unaffected control group (n=4) had no history of entry dyspareunia. Histologic sections were immunostained in duplicate for CD20, CD3, CD4 and CD8. The study set was scored while blinded to phenotype for the average number of positive cells per high-powered 20x objective field. Differences between groups was evaluated by ANOVA with Bonferroni/Dunn post-hoc testing.
Results: Tender biopsies from women with primary vestibulitis showed a significant shift in the CD8:CD4 ratio (p<0.01). They had twice as many CD8 positive cells and twenty times as many CD4 positive T-cells than controls. The number of T-cells was not significantly different in secondary vestibulitis compared with controls, but they did have more CD20 positive B-cells.
Conclusions: This observation suggests CD4 positive T-cell recruitment may provide a clue to understanding potential triggers in primary disease. The predominance of CD20 positive B-cells in secondary vestibulitis suggests a more subacute disease process. Notably, many triggers for vestibulitis have been evaluated in the past without convincing results, perhaps because these studies did not distinguish between primary and secondary disease.
Category: Gynecologic & Obstetrics
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 125, Monday Morning