Amaç: Bu çalışmadaki amacımız, lokalize provoke vulvodinisi (LPV) olan hastaların vestibular mukozasında, B lenfosit yoğunluğu ve germinal merkez varlığına bakılarak lokal immün aktivasyonun olup olmadığını araştırmaktır. Gereç ve Yöntem: LPV olup vestibülektomi ameliyatı geçiren 20 hastanın kolporafi posterior ameliyatı olan 20 kontrol hastanın vulvar vestibüler doku kesitleri incelenmiştir. B lenfositini göstermek için kullanılan CD20 antikoru ile yapılan immünohistokimyasal boyamayı takiben mikroskop altında B lenfosit yoğunluğuna ve germinal merkez varlığına bakılmıştır. Bulgular: Kontrol vakaların kesitleri ile kıyaslandığında, LPV olan hastaların vulvar vestibüler mukoza kesitlerinde B lenfosit yoğunluğu daha yüksek izlenmiştir (LPV hasta 87 vs kontrol hasta 21, p<0,01). Germinal merkez varlığı sadece LPV olan hastaların vestibüler mukoza kesitlerinde izlenmiştir (LPV hasta 0,31 vs kontrol hasta 0, p<0,011). Sonuç: LPV hastalığında, vestibüler mukozada artmış B lenfosit yoğunluğu ve beraberinde izlenen germinal merkez varlığı, lokal bir immün aktivasyonun olduğunu göstermektedir. Anormal germinal merkez cevabının olması durumunda, otoreaktif B lenfositleri ve bunun sonucunda otoimmün hastalıklar gelişebilmektedir. LPV’nin patofizyolojisinin ve otoimmünite ile ilişkisinin ortaya konmasında daha fazla sayıda çalışmaya ihtiyaç vardır.
1. Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med 2004;49(10):772-7.
2. Friedrich EG, Jr. Vulvar vestibulitis syndrome. J Reprod Med 1987;32(2):110-4.
3. Goetsch MF. Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population. Am J Obstet Gynecol 1991;164(6 Pt 1):1609-16. [CrossRef]
4. Tommola P, Butzow R, Unkila-Kallio L, Paavonen J, Meri S. Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia. Am J Obstet Gynecol 2015;212(4):476.e1-8. [CrossRef]
5. Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Low Genit Tract Dis 2016;20(2):126-30. [CrossRef]
6. Pyka RE, Wilkinson EJ, Friedrich EG, Jr., Croker BP. The histopathology of vulvar vestibulitis syndrome. Int J Gynecol Pathol 1988;7(3):249-57. [CrossRef]
7. Goetsch MF, Morgan TK, Korcheva VB, Li H, Peters D, Leclair CM. Histologic and receptor analysis of primary and secondary vestibulodynia and controls: a prospective study. Am J Obstet Gynecol 2010;202(6):614 e1-8. [CrossRef]
8. Bohm-Starke N, Falconer C, Rylander E, Hilliges M. The expression of cyclooxygenase 2 and inducible nitric oxide synthase indicates no active inflammation in vulvar vestibulitis. Acta Obstet Gynecol Scand 2001;80(7):638-44. [CrossRef]
9. Eva LJ, Rolfe KJ, MacLean AB, Reid WM, Fong AC, Crow J, et al. Is localized, provoked vulvodynia an inflammatory condition? J Reprod Med 2007;52(5):379-84.
10. Seckin-Alac E, Akhant SE, Bastu E, Tuzlalik S, Yavuz E. Elevated tissue levels of tumor necrosis factor-alpha in vulvar vestibulitis syndrome. Clin Exp Obstet Gynecol 2014;41(6):691-3.
11. Pavlasova G, Mraz M. The regulation and function of CD20: an “enigma” of B-cell biology and targeted therapy. Haematologica 2020;105(6):1494-506. [CrossRef]
12. LeBien TW, Tedder TF. B lymphocytes: how they develop and function. Blood 2008;112(5):1570-80. [CrossRef]
13. Stebegg M, Kumar SD, Silva-Cayetano A, Fonseca VR, Linterman MA, Graca L. Regulation of the Germinal Center Response Front Immunol 2018;9:2469. [CrossRef]
14. DeFranco AL. Germinal centers and autoimmune disease in humans and mice. Immunol Cell Biol 2016;94(10):918-24. [CrossRef] 15. Young C, Brink R. Germinal centers and autoantibodies. Immunol Cell Biol 2020;98(6):480-9. [CrossRef]
THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA
Year 2022,
Volume: 85 Issue: 1, 105 - 109, 25.01.2022
Objective: The aim of the study is to assess local immune activation through B lymphocytes density and the presence of germinal centers in the vestibular mucosa of patients with localized provoked vulvodynia (LPV). Materials and Methods: Vestibulectomy specimens of 29 patients with LPV and colporrhaphy posterior specimens of 20 control women were included in the study. Immunohistochemical staining with CD20 antibodies for B lymphocytes were performed and subsequently, microscopical evaluation for B lymphocytes density and the presence of germinal centers was conducted. Results: B lymphocyte densities were higher in the vestibular mucosa of patients with LPV compared to control women (87 vs 21, p<0.01). The presence of germinal centers was only observed in the specimens of patients with LPV (0.31 vs 0, p<0.011). Conclusion: The presence of germinal centers with increased B lymphocyte density underlines a local immune activation in the vestibule of patients with LPV. An abnormal germinal center response can trigger the pathway to the development of autoimmunity through the emergence of an autoreactive B cell clone and autoantibodies. LPV can potentially emerge as an autoimmune disease of the vestibule. More studies are needed to understand the pathophysiology of LPV and its association with autoimmunity.
1. Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med 2004;49(10):772-7.
2. Friedrich EG, Jr. Vulvar vestibulitis syndrome. J Reprod Med 1987;32(2):110-4.
3. Goetsch MF. Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population. Am J Obstet Gynecol 1991;164(6 Pt 1):1609-16. [CrossRef]
4. Tommola P, Butzow R, Unkila-Kallio L, Paavonen J, Meri S. Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia. Am J Obstet Gynecol 2015;212(4):476.e1-8. [CrossRef]
5. Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Low Genit Tract Dis 2016;20(2):126-30. [CrossRef]
6. Pyka RE, Wilkinson EJ, Friedrich EG, Jr., Croker BP. The histopathology of vulvar vestibulitis syndrome. Int J Gynecol Pathol 1988;7(3):249-57. [CrossRef]
7. Goetsch MF, Morgan TK, Korcheva VB, Li H, Peters D, Leclair CM. Histologic and receptor analysis of primary and secondary vestibulodynia and controls: a prospective study. Am J Obstet Gynecol 2010;202(6):614 e1-8. [CrossRef]
8. Bohm-Starke N, Falconer C, Rylander E, Hilliges M. The expression of cyclooxygenase 2 and inducible nitric oxide synthase indicates no active inflammation in vulvar vestibulitis. Acta Obstet Gynecol Scand 2001;80(7):638-44. [CrossRef]
9. Eva LJ, Rolfe KJ, MacLean AB, Reid WM, Fong AC, Crow J, et al. Is localized, provoked vulvodynia an inflammatory condition? J Reprod Med 2007;52(5):379-84.
10. Seckin-Alac E, Akhant SE, Bastu E, Tuzlalik S, Yavuz E. Elevated tissue levels of tumor necrosis factor-alpha in vulvar vestibulitis syndrome. Clin Exp Obstet Gynecol 2014;41(6):691-3.
11. Pavlasova G, Mraz M. The regulation and function of CD20: an “enigma” of B-cell biology and targeted therapy. Haematologica 2020;105(6):1494-506. [CrossRef]
12. LeBien TW, Tedder TF. B lymphocytes: how they develop and function. Blood 2008;112(5):1570-80. [CrossRef]
13. Stebegg M, Kumar SD, Silva-Cayetano A, Fonseca VR, Linterman MA, Graca L. Regulation of the Germinal Center Response Front Immunol 2018;9:2469. [CrossRef]
14. DeFranco AL. Germinal centers and autoimmune disease in humans and mice. Immunol Cell Biol 2016;94(10):918-24. [CrossRef] 15. Young C, Brink R. Germinal centers and autoantibodies. Immunol Cell Biol 2020;98(6):480-9. [CrossRef]
Demiral Keleş, İ., Yaşa, C., Önder, S., Yavuz, E., et al. (2022). THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA. Journal of Istanbul Faculty of Medicine, 85(1), 105-109. https://doi.org/10.26650/IUITFD.903684
AMA
Demiral Keleş İ, Yaşa C, Önder S, Yavuz E, Tuzlalı S, Akhan SE. THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA. İst Tıp Fak Derg. January 2022;85(1):105-109. doi:10.26650/IUITFD.903684
Chicago
Demiral Keleş, İrem, Cenk Yaşa, Semen Önder, Ekrem Yavuz, Sıtkı Tuzlalı, and Süleyman Engin Akhan. “THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA”. Journal of Istanbul Faculty of Medicine 85, no. 1 (January 2022): 105-9. https://doi.org/10.26650/IUITFD.903684.
EndNote
Demiral Keleş İ, Yaşa C, Önder S, Yavuz E, Tuzlalı S, Akhan SE (January 1, 2022) THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA. Journal of Istanbul Faculty of Medicine 85 1 105–109.
IEEE
İ. Demiral Keleş, C. Yaşa, S. Önder, E. Yavuz, S. Tuzlalı, and S. E. Akhan, “THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA”, İst Tıp Fak Derg, vol. 85, no. 1, pp. 105–109, 2022, doi: 10.26650/IUITFD.903684.
ISNAD
Demiral Keleş, İrem et al. “THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA”. Journal of Istanbul Faculty of Medicine 85/1 (January 2022), 105-109. https://doi.org/10.26650/IUITFD.903684.
JAMA
Demiral Keleş İ, Yaşa C, Önder S, Yavuz E, Tuzlalı S, Akhan SE. THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA. İst Tıp Fak Derg. 2022;85:105–109.
MLA
Demiral Keleş, İrem et al. “THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA”. Journal of Istanbul Faculty of Medicine, vol. 85, no. 1, 2022, pp. 105-9, doi:10.26650/IUITFD.903684.
Vancouver
Demiral Keleş İ, Yaşa C, Önder S, Yavuz E, Tuzlalı S, Akhan SE. THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA. İst Tıp Fak Derg. 2022;85(1):105-9.