title: Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis.
abstract: OBJECTIVE
  Vestibulitis is currently diagnosed based only on clinical criteria. To achieve histopathological diagnostic criteria, we carried out a computerized image analysis method.
  
  
  METHODS
  Vestibular tissues removed from 40 women with severe vestibulitis were immunostained for mast cell count and degranulation by C-kit and mast cell tryptase, respectively. Vestibular nerve cells total area was evaluated after S-100 stain. Controls were 7 women aged 18-48. The images were converted to a digital signal, and analyzed using Image Proplus V4 software.
  
  
  RESULTS
  We found a significant increase in inflammatory infiltrate, number of mast cells and degranulated mast cells in vestibulitis compared to normal controls. The inflammatory cells were localized around the superficial minor vestibular glands. The total nerve fiber area was ten times higher in vestibulitis patients than in controls. A significant positive correlation was found between the total nerve fiber area and the number of mast cells in the vestibulitis group of patients.
  
  
  CONCLUSIONS
  We documented two diagnostic histopathological criteria for vestibulitis: (1) the presence of eight or more mast cells per 10 x 10 microscopic field, and (2) the total calculated area of the nerve fibers is ten times higher than expected. These findings re-establish the inflammatory nature of the vestibulitis. It is speculated that the trigger for the local outburst of nerve fibers could be related to the activation of the mast cells by a topical agent.
authors.affiliation: Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel. mdjacob@tx.technion.ac.il
authors.forename: Jacob
authors.initials: J
authors.lastname: Bornstein
authors.forename: Nimrod
authors.initials: N
authors.lastname: Goldschmid
authors.forename: Edmund
authors.initials: E
authors.lastname: Sabo
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002452:Cell Count; D015550:Cell Degranulation; D004414:Dyspareunia / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008407:Mast Cells / Q000502:physiology*; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D012372:ROC Curve; D012697:Serine Endopeptidases; D053802:Tryptases; D014844:Vulva / Q000294:innervation* / Q000473:pathology / Q000601:surgery; D014847:Vulvitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
chemical_list: D012697:Serine Endopeptidases; D053802:Tryptases