THE ROLE OF B LYMPHOCYTES AND PRESENCE OF GERMINAL CENTERS IN PATIENTS WITH LOCALIZED PROVOKED VULVODYNIA

Abstract

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.