VULVAR VESTIBULITIS - A HISTOPATHOLOGIC STUDY OF 36 CASES, INCLUDING HUMAN PAPILLOMAVIRUS IN-SITU HYBRIDIZATION ANALYSIS

Vulvar vestibulitis is a recently described clinical condition of unkn own etiology. Human papillomavirus (HPV) infection has been implicated as a causal pathogen by some investigators. Because reports on this e ntity are few, we studied the pathologic features of vestibulectomy sp ecimens from 36 women with a clinical diagnosis of vulvar vestibulitis . The patients' ages ranged from 19 to 53 years (mean, 31 years). Bila teral excisions were performed in 34 patients and a unilateral excisio n in two. Minor vestibular glands or ducts were identified in 28 patie nts (78%). Chronic inflammation was present in all specimens. The infl ammatory infiltrate consisted predominantly of T lymphocytes and plasm a cells with smaller numbers of B lymphocytes. Lymphoid follicles were present in four patients, ulcers in two. The predominant site of infl ammation was the squamous mucosa, especially the lamina propria, where the degree of inflammation was graded as mild in 11 patients, moderat e in 21 patients, and severe in four patients. To a lesser degree, the inflammation also typically involved the periglandular/periductal con nective tissue of the minor vestibular glands, where it was graded as mild in 25 patients and moderate in three patients. Foci of squamous m etaplasia were observed in 27 of 28 patients with demonstrable vestibu lar ducts or glands. Nodular hyperplasia of a vestibular gland (so-cal led ''adenoma'') occurred in one patient. In six selected cases, fungi were not identified on silver stains. Morphologic findings of HPV inf ection, such as koilocytotic atypia or squamous dysplasia, were absent . In-situ hybridization studies for HPV types 6, 11, 16, 18, 31 and 35 were negative in all 36 cases. We conclude that (a) vestibulectomy sp ecimens from patients with a clinical diagnosis of vulvar vestibulitis typically show a chronic inflammatory cell infiltrate that predominan tly involves the mucosal lamina propria and periglandular/periductal c onnective tissue and (b) a pathogenetic role for HPV types 6, 11, 16, 18, 31 and 35 is not substantiated.