PD62-09 IMMUNOHISTOCHEMICAL STAINING OF VESTIBULAR TISSUE: A CASE SERIES FROM PATIENTS SUSPECTED OF HAVING NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Basic Research & Pathophysiology (PD62)1 Sep 2021PD62-09 IMMUNOHISTOCHEMICAL STAINING OF VESTIBULAR TISSUE: A CASE SERIES FROM PATIENTS SUSPECTED OF HAVING NEUROPROLIFERATIVE VESTIBULODYNIA Alyssa Yee, Maria Uloko, Andrew S. Goldstein, and Irwin Goldstein Alyssa YeeAlyssa Yee More articles by this author , Maria UlokoMaria Uloko More articles by this author , Andrew S. GoldsteinAndrew S. Goldstein More articles by this author , and Irwin GoldsteinIrwin Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002099.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neuroproliferative vestibulodynia (NPV) is associated with an increased density in endodermal vestibular tissue of CD117 and PGP9.5 positive staining cells, consistent with mast cells and nerves, respectively. After performing vestibulectomy for NPV, surgeons rarely confirm diagnosis by immunostaining of the excised vestibular specimen. The first objective of this study was to verify the suspected NPV diagnosis by examining excised vestibular tissue for increased density of CD117 positive staining cells in vestibular epithelium and stroma, and PGP9.5 positive staining cells in the vestibular stroma. The second objective was to localize the greatest density of CD117 and PGP9.5 positive staining cells in this tissue. This would help surgeons best appreciate the ideal depth required to maximize elimination of high density of pathologic cells. METHODS: Vestibular tissues were fixed in formalin paraffin blocks and sliced into 5 μm sections, each section stained with hematoxylin and eosin and analyzed by light microscopy. Antibodies to CD117 and PGP9.5 were used for immunostaining. Multiple regions of stained slides were examined and photographed using a Zeiss AxioCam HR high resolution digital microscope. By counting the number of dark brown stained cells in a high-power field (HPF = x 20 magnification), density of CD117-positive cells and PGP9.5 positive cells were determined. Control subjects have values of 8 mast cells or less per HPF. RESULTS: Specimens from 27 women (mean age 28±14 years) who underwent complete vestibulectomy with vaginal advancement flap surgery from June 2019 to February 2021 had immunohistochemical staining to confirm NPV. High densities of both CD117-positive cells (mean density 42±16 per HPF) in vestibular epithelium and stroma, and PGP9.5-positive cells (mean density 30±18 per HPF) were noted in vestibular stroma in all specimens. The highest density of CD117 positive cells was in the epithelial basement membrane; the highest density of PGP9.5 positive cells was in stromal sub-epithelial folds. Sharing immunostaining findings and photos with patients post-operatively validated surgery for them. CONCLUSIONS: Verifying underlying pathology of suspected NPV is empowering and relevant for patients. Since the maximum density CD117 and PGP9.5 positive cells were in the epithelial basement membrane and sub-epithelial folds respectively, the surgeon should focus on excision of only the 3-4 mm of vestibular epithelium and sub-epithelial stroma. More research on NPV is needed. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1075-e1076 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alyssa Yee More articles by this author Maria Uloko More articles by this author Andrew S. Goldstein More articles by this author Irwin Goldstein More articles by this author Expand All Advertisement Loading ...