title: Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland. Electronic address: paivi.tommola@kolumbus.fi.
authors.forename: Päivi
authors.initials: P
authors.lastname: Tommola
authors.affiliation: Department of Pathology, University of Helsinki, Helsinki, Finland.
authors.forename: Ralf
authors.initials: R
authors.lastname: Bützow
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Leila
authors.initials: L
authors.lastname: Unkila-Kallio
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.affiliation: Research Programs Unit, Program of Immunobiology, University of Helsinki, Helsinki, Finland; Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Meri
mesh_terms: D001402:B-Lymphocytes / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003713:Dendritic Cells / Q000378:metabolism; D005260:Female; D006801:Humans; D008221:Lymphoid Tissue / Q000378:metabolism / Q000473:pathology*; D008264:Macrophages / Q000378:metabolism; D013601:T-Lymphocytes / Q000378:metabolism; D014844:Vulva / Q000276:immunology* / Q000473:pathology; D056650:Vulvodynia / Q000276:immunology* / Q000473:pathology
chemical_list: D015415:Biomarkers
keywords: immune activation; inflammation; vestibulodynia; vulvar pain; vulvar vestibulitis