The development of the human vaginal fornix and the portio cervicis.

INTRODUCTION: One of the transitional zones of the human body is situated in the cervix uteri. The developmental differentiation of epithelial and stromal characteristics in such a region is of high clinical interest. However, few studies have focused on the development of this region, and information in anatomical and clinical textbooks is limited. We therefore examined the development of the human vaginal fornix and the cervix uteri during prenatal development. MATERIALS AND METHODS: We examined 29 female embryos and fetuses between 20 and 34 weeks and two newborns using histology and immunohistochemistry. RESULTS: The characteristic shape of the portiocervicis and the vaginal fornix first became visible in mid-term fetuses because of the different muscular coats and of an uncategorized Müllerian-derived epithelium, which was rapidly replaced by a multilayered squamous epithelium. Only thereafter, in older fetuses, were there organogenetic differentiation of the epithelia and the underlying stroma of the cervical canal. UGS-derived p63/CK17-positive cells could be identified as precursor cells for the squamous epithelium, and Müllerian-derived CK7-positive cells for the columnar-type epithelium. Both cell types and different stromal zones were already present in a prenatal transformation zone. Initial functional differentiation could be observed in perinatal stages. CONCLUSIONS: Our results on prenatal human development strongly support the view that two different cell lineages meet at the transitional zone of the cervix uteri and that these lineages depend on alternative signals from the underlying stromal compartment.

Disk Battery as a Vaginal Foreign Body in a Five-Year-Old Preadolescent Child.

The self-introduction of batteries into the vagina is exceedingly infrequent among preadolescents, with only six cases have been recorded in the English-language PubMed-indexed literature. Herein, we present the case of a five-year-old female child who presented with an 18-month history of recurrent ill-smelling vaginal discharge. Pelvic radiograph displayed a radio-opaque object, most likely representing a disk battery inside her vagina. Vaginoscopy showed a 1.2 cm disk battery that was removed from the right posterior vaginal fornix. Four weeks later, the child was doing well and symptom-free. Although rare, vaginal foreign bodies should be considered in the differential diagnosis in preadolescent girls presenting with chronic and recurrent vaginal discharge. Vaginoscopy is a useful tool diagnostically and therapeutically. A clinical summary of all PubMed-indexed cases of batteries as vaginal FBs in children is provided (n=6).

Pre- and Post-partum Concentrations of Interleukin 1α, Interleukin 8, and α1-Acid Glycoprotein in Vaginal Fornix and Endometrium of Dairy Cows With Clinical Cervicitis.

Innate immunity is the principal sensor responsible of the local immune response to control mucosal bacterial contamination of the reproductive tract after parturition, triggering a pro-inflammatory process in the mucosa of the uterus, the vaginal and the cervix. However, knowledge about the inflammation process and outcome of the cervix in dairy cows is scarce even though it plays an important anatomic and functional role between the vagina and the uterus. The objective of the present study was to describe the cellular and humoral local innate immune response during clinical cervicitis (CC) in the uterus and vaginal fornix in pre- and post-partum periods of dairy cows. A retrospective descriptive study was performed involving 26 animals, characterized as clinical cervicitis cows (n = 19) and healthy cows (n = 7). Blood and mucus of the different compartments of the genital tract were sampled and records of the cows' genital exam were performed four times: -1 w (day -7 ± 2, prepartum), +1 w (day +7 ± 4), +3 w (day +21 ± 4) and +5 w (day +35 ± 4) postpartum. Clinical cervicitis was defined as cows exhibiting a cervix grade-2 and healthy cows were defined as a cow clinically normal with a grade-0 cervix at time +5 w. Blood white cell count, vaginal fornix and endometrial neutrophils percentage, and the concentrations of interleukin 1α (IL1), interleukin 8 (IL8), and α1-acid glycoprotein (AGP) in mucus were determined. The results showed that 23% of the cows were categorized as CC at time +5 w. Cases of CC with purulent vaginal discharge or subclinical endometritis shown the highest cytokine production. At +3 w, IL1, IL8, and AGP concentrations in the uterus and the fornix were significantly higher in CC than healthy cows (CH). In conclusion, the 3-week postpartum is a critical point to evaluate cytokines and acute phase proteins; where IL1 and IL8 variation kept a direct relation with neutrophils numbers and function. The presence of AGP in the endometrium infer a homeostatic proinflammatory protective balance effect, modulating the local uterine innate immune response during peripartum.

An uncommon case of inflammatory infiltration of the urinary bladder in the long-term process of the purulent inflammation of the cervix and vaginal fornix, complicated with vesicovaginal fistula of unknown etiology.

We shall discuss the case of a female patient, aged 64 years, who was suffering from long-term purulent inflammation of the vaginal fornix that later involved the vaginal stump. This inflammatory process spread to the bladder trigone and resulted in vesicovaginal fistula (VVF) formation together with a bilateral hydronephrosis that required the placement of a temporary percutaneous nephrostomy. A non-cicatrized inflammatory reaction occurred at the right-sided insertion of the nephrostomy, which has yet to be successfully treated despite intensive dermatological and surgical approaches that included skin grafting. In the course of five-year treatment we observed a gradual regression of the inflammatory infiltration of both the trigone of the bladder and the vagina as well as a gradual closing of the VVF. The extremely long-lasting and uncommon local inflammatory reactions in the vagina, bladder, and dermal layers mandated the application of conservative treatment. The possibility of difficulties and defective healing of tissues that could result from surgical correction of the VVF are discouraging for both the patient and medical staff.