Epidermalization of cervix and vagina: an unsolved dilemma

The protective effect of vinpocetine against Estradiol-benzoate induced cervical hyperkeratosis in female rats via modulation of SIRT1/Nrf2, and NLRP3 inflammasome

The current study was assigned to determine the putative preventive role of vinpocetine (VIN) in cervical hyperkeratosis (CHK) in female rats. Estradiol Benzoate (EB) was utilized in a dose f (60 μg/100 g, i.m) three times/week for 4 weeks to induce cervical hyperkeratosis. VIN was administered alone in a dose of (10 mg/kg/day, orally) for 4 weeks and in the presence of EB. Levels of malondialdehyde (MDA), total nitrites (NOx), reduced glutathione (GSH), interleukin-18 (IL-18), IL-1β, tumor necrosis factor-alpha (TNF-α) were measured in cervical tissue. The expression of NLRP3/GSDMD/Caspase-1, and SIRT1/Nrf2 was determined using ELISA. Cervical histopathological examination was also done. EB significantly raised MDA, NOx, TNF-α, IL-18, IL-1β, and GSDMD and up-regulated NLRP3/Caspase-1 proteins. However, GSH, SIRT1, and Nrf2 levels were reduced in cervical tissue. VIN significantly alleviates all biochemical and histopathological abnormalities. VIN considerably mitigates EB-induced cervical hyperkeratosis via NLRP3-induced pyroptosis and SIRT1/Nrf2 signaling pathway.

Vaginal Dysbiosis from an Evolutionary Perspective

Evolutionary approaches are powerful tools for understanding human disorders. The composition of vaginal microbiome is important for reproductive success and has not yet been characterized in the contexts of social structure and vaginal pathology in non-human primates (NHPs). We investigated vaginal size, vulvovaginal pathology and the presence of the main human subtypes of Lactobacillus spp./ BV-related species in the vaginal microflora of baboons (Papio spp.). We performed morphometric measurements of external and internal genitalia (group I, n = 47), analyzed pathology records of animals from 1999–2015 (group II, n = 64 from a total of 12,776), and evaluated vaginal swabs using polymerase chain reaction (PCR) (group III, n = 14). A total of 68 lesions were identified in 64 baboons. Lactobacillus iners, Gardnerella vaginalis, Atopobium vaginae, Megasphaera I, and Megasphaera II were not detected. L. jensenii, L. crispatus, and L. gasseri were detected in 2/14 (14.2%), 1/14 (7.1%), and 1/14 (7.1%) samples, respectively. BVAB2 was detected in 5/14 (35.7%) samples. The differences in the vaginal milieu between NHP and humans might be the factor associated with human-specific pattern of placental development and should be taken in consideration in NHP models of human pharmacology and microbiology.

Complications after surgery for the relief of dyspareunia in women with lichen sclerosus: a case series

INTRODUCTION

The objective of this study was to analyse complications after surgical intervention on the vulva, especially with grafting of the vaginal epithelium, for the relief of dyspareunia in women with lichen sclerosus.

MATERIAL AND METHODS

A case series of 23 women with histologically confirmed lichen sclerosus who underwent vulvar surgery because of disabling sexual dysfunction. Surgical care was provided in a university hospital (tertiary referral center) between 2008 and 2012. The interventions were posterior vestibuloplasty (perineoplasty), dehooding of the glans clitoridis and anterior vestibuloplasty with grafts of vaginal epithelium.

RESULTS

A posterior vestibuloplasty was performed in all 23 women. Short-term complications included postoperative infection with subtotal dehiscence of the advanced vaginal epithelium (n = 1), and reactivation of lichen sclerosus with the formation of bullae due to the postoperative discontinuation of dermatosteroid use (n = 1). The long-term complications included localized pain (n = 3); although the relation with the surgical intervention was unclear. Four women underwent dehooding of the glans clitoridis, all without complications. Anterior vestibuloplasty with a free full-thickness graft of vaginal mucosa was performed in five women. One woman underwent a second operation because of contraction and keratinization of the graft. The importance of estrogens for the condition of the graft was unclear.

CONCLUSIONS

After reconstructive vulvar surgery in women with lichen sclerosus, issues such as infection, reactivation of the disease and pain require attention. The use of vaginal grafts in the repair of the anterior vestibule is a novel approach and deserves further exploration.

Ectodermal structures within the uterine cervix and vagina: report of a series of cases

Ectodermal structures, in the form of sebaceous glands and hair follicles, are extremely rare within the cervix and vagina. We describe the clinicopathologic findings in 11 cases (10 cervix, 1 vagina) with a view to exploring the histogenesis of this unusual phenomenon. The cases occurred in patients aged 33 to 71. In 10 of the cases, sebaceous glands were present that were associated with hair follicle-like structures in 3 cases forming pilosebaceous units. In the other case, hair follicle- and sweat gland-like structures were present; the latter have not been previously described in the cervix. The ectodermal structures were usually either attached to the basal layer of the surface squamous epithelium or lay "free" within the superficial stroma, although in 1 case sebaceous glands were located within the squamous epithelium. The squamous epithelium overlying the ectodermal structures typically exhibited hyperkeratosis. Although we were unable to definitively resolve the debate as to whether ectodermal structures within the cervix and vagina represent misplaced embryonal tissue and a true heterotopia or a "metaplastic" process, we favor the latter as a response to prolonged irritation or chronic injury.

Hyperplasia of ectopic sebaceous glands in the uterine cervix: case report

Occurrence of ectopic sebaceous glands in the uterine cervix is a rare, unusual, and an incidental finding. Microscopically, sebaceous elements are typically situated high in the submucosa without an accompanying hair follicle (so-called free sebaceous glands). They are suggested to give rise to rare cases of sebaceous carcinoma in this location but are otherwise of little clinical significance. We report marked hyperplasia of ectopic sebaceous glands in the ectocervix, which produced detectable lesions on colposcopy. Histopathological examination showed foci of ectopic sebaceous glands located in the submucosa consisting of numerous, variably sized, clustered sebaceous lobules. Each sebaceous lobule was composed of a peripheral layer of germinative cells and centrally located, mature sebocytes with a multivacuolated cytoplasm and round or scalloped nuclei. In one area, there were over 20 sebaceous lobules that were partly connected to a sebaceous duct. To our knowledge, similar changes in ectopic sebaceous glands in the uterine cervix have not been reported till date.