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Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis
Jacob Bornstein1, Nimrod Goldschmid, Edmund Sabo
1Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel. mdjacob@tx.technion.ac.il
Insights
Histopathological criteria for vestibulitis were established using computerized image analysis. Increased mast cells and nerve fibers indicate vestibulitis, suggesting an inflammatory cause possibly linked to mast cell activation.
Area of Science:
- Gynecology
- Dermatology
- Pathology
Background:
- Vestibulitis diagnosis currently relies solely on clinical presentation.
- There is a need for objective histopathological criteria to diagnose vestibulitis.
Purpose of the Study:
- To develop histopathological diagnostic criteria for vestibulitis using computerized image analysis.
- To investigate the role of mast cells and nerve fibers in vestibulitis.
Main Methods:
- Analysis of vestibular tissues from 40 women with vestibulitis and 7 controls.
- Immunostaining for mast cell count (C-kit) and degranulation (mast cell tryptase).
- Quantification of vestibular nerve cell area (S-100) using digital image analysis software.
Main Results:
- Significantly increased inflammatory infiltrate, mast cells, and degranulated mast cells in vestibulitis patients.
- Inflammatory cells were concentrated around superficial minor vestibular glands.
- Vestibulitis patients exhibited a ten-fold higher total nerve fiber area compared to controls.
- A positive correlation was observed between nerve fiber area and mast cell count in vestibulitis patients.
Conclusions:
- Established two histopathological criteria for vestibulitis: ≥8 mast cells/10x10 field and 10x higher nerve fiber area.
- Reaffirmed the inflammatory nature of vestibulitis.
- Hypothesized that mast cell activation by a topical agent may trigger localized nerve fiber proliferation.
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.
Conclusion:
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.
