VULVAR HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL CHANGES IN PATIENTS WITH PRIMARY SJÖGREN SYNDROME

Background: Primary Sjogren Syndrome (pSS) is an autoimmune disease mostly affecting women, characterized by a lymphocyte-mediated infiltration and destruction of several exocrine glands, which causes mucosal dryness. Genital involvement is frequent and characterized by vulvar and vaginal dryness, dyspareunia and pruritus, that significantly impairs sexual function. However, despite the high frequency of genital involvement, few data were published about the histopathology of external genitalia in pSS. The studies performed until now show that vaginal and vulvar dryness are due to the presence of a vulvar inflammatory infiltrate and to the atrophy of minor and major vestibular glands, whose secretions are important for the sexual function. Objectives: To evaluate the presence and the characteristics of histopathological and immunohistochemical changes in vulvar tissues in women with pSS. Methods: Women with pSS (21 patients) underwent vulvar biopsies that have been evaluated for histopathological and immunohistochemical changes and finally compared with those obtained from 26 patients with lichen sclerosus. Results: An inflammatory infiltrate (composed predominantly by T lymphocytes (CD3+), sparse CD20+ B cells and mean CD4:CD8 T-cell ratio of 1.5) was evidenced in all 21 biopsies and classified in mild (10), moderate (11) and severe (0). No correlation was shown between vulvar inflammatory infiltrate score and salivary Chisholm e Mason score. No differences were found neither in gynecological symptoms neither in clinical and demographical characteristics between patients with mild and those with moderate vulvar inflammatory score. A higher prevalence of moderate inflammatory infiltrate was observed in biopsies from women with lichen sclerosus than in pSS

VULVAR HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL CHANGES IN PATIENTS WITH PRIMARY SJÖGREN SYNDROME

Background: Primary Sjogren Syndrome (pSS) is an autoimmune disease mostly affecting women, characterized by a lymphocyte-mediated infiltration and destruction of several exocrine glands, which causes mucosal dryness. Genital involvement is frequent and characterized by vulvar and vaginal dryness, dyspareunia and pruritus, that significantly impairs sexual function. However, despite the high frequency of genital involvement, few data were published about the histopathology of external genitalia in pSS. The studies performed until now show that vaginal and vulvar dryness are due to the presence of a vulvar inflammatory infiltrate and to the atrophy of minor and major vestibular glands, whose secretions are important for the sexual function. Objectives: To evaluate the presence and the characteristics of histopathological and immunohistochemical changes in vulvar tissues in women with pSS. Methods: Women with pSS (21 patients) underwent vulvar biopsies that have been evaluated for histopathological and immunohistochemical changes and finally compared with those obtained from 26 patients with lichen sclerosus. Results: An inflammatory infiltrate (composed predominantly by T lymphocytes (CD3+), sparse CD20+ B cells and mean CD4:CD8 T-cell ratio of 1.5) was evidenced in all 21 biopsies and classified in mild (10), moderate (11) and severe (0). No correlation was shown between vulvar inflammatory infiltrate score and salivary Chisholm e Mason score. No differences were found neither in gynecological symptoms neither in clinical and demographical characteristics between patients with mild and those with moderate vulvar inflammatory score. A higher prevalence of moderate inflammatory infiltrate was observed in biopsies from women with lichen sclerosus than in pSS

Survey of Phortica drosophilid flies within and outside of a recently identified transmission area of the eye worm Thelazia callipaeda in Switzerland

Phortica drosophilid flies are the intermediate hosts and vectors of the eye worm Thelazia callipaeda. This nematode originates from Asia and was first detected in southern Europe in 1989. The aim of the study was to assess the presence and the population dynamics of Phortica flies in a recently discovered new endemic area (Ticino, Southern Switzerland, south of the Alps) of T. callipaeda (site 1), at its border (site 2), at higher altitudes (beyond 1100 meters above sea level) within (site 3) or outside (site 4) the endemic area, and in a site north of the Alps (site 5). Flies were captured using two types of fruit-baited traps, the bait being changed once per week, and by netting around the eyes of a dog and human. A total of 1695 Phortica flies were collected. One of the fruit-baited traps, which can easily be assembled with cheap components, was found to be efficient for catching Phortica spp. At site 1, 644 such flies were collected with this trap during 34 weekly catches from April to October. The number of flies caught was highest at site 2 (n=903) and it was significantly lower (n=36) at site 5 north of the Alps. Virtually no Phortica at all were caught at higher altitudes (sites 3 and 4). Females were all in all predominant in the traps, accounting for 72.6% of Phortica flies (1150/1584), although males became dominant late in the season (male/female ratio 1.26 in October). In contrast, 80.2% of Phortica flies collected around the eyes of dog and human baits by netting (n=111) were males. No female at all was captured by netting until September. PCR for T. callipaeda was negative with all Phortica flies. Morphological examination of the 523 male flies based on features of the eye margin and the number of particular genital sensilla identified 89.1% P. semivirgo, 5.7% P. variegata but also 5.2% intermediate forms. Genetic analyses of partial mitochondrial cox1 and rDNA internal transcribed spacer 1 sequences revealed that these three morphotypes were genetically not distinguishable. This study confirms the presence of Phortica spp. north to the Alps and therefore the potential risk of T. callipaeda infection outside the currently known endemic region, depending on local abundance and longevity of the drosophilid vectors

SIIV position paper: clinical approach to vulval diseases. Need for quality standards

This paper summarizes the position of the Italian Society of Vulvology on the clinical approach to vulval disease. A thor-ough history (general medical, gynaecological, and vulval history) is essential for a successful and fruitful vulvological examination. Characteristics of pruritus (itch) and pain, that are the two main vulval symptoms, should be collected and reported with precision, according to duration, temporal course, location, provocation, and intensity. Physical examina-tion must consider both the general condition of the patient and the specific vulval region, that must be examined fol-lowing a standardized methodology. The physical examination of the vulva is carried out with naked eye and adequate natural or halogen lighting. The subsequent use of instrumental magnification can be considered on particular parts of skin/mucosa, already highlighted with the first inspection. Also, palpation is essential, allowing to appreciate physical features of vulval lesions: consistency, surface, soreness, adherence to underlying plans. Finally, the five-step approach of the International Society for the Study of Vulvo-vaginal Disease about Terminology and Classification of Vulvar Der-matological Disorders (2012) is summarized. A vulval biopsy may be useful in the following situations: when clinical diagnosis is uncertain, lesion not responding to treatment; histologic confirmation for a clinical diagnosis and exclusion or confirmation of a suspected neoplastic intraepithelial or invasive pathology