Immunohistochemical demonstration of nerve fibers in pelvic adhesions.

Overview

OBJECTIVE: To demonstrate the presence of nerve fibers in pelvic adhesions potentially capable of conducting pain stimuli. METHODS: Pelvic adhesions from 17 patients, ten of whom had a history of pelvic pain, were examined histologically. Routine hematoxylin and eosin stains and immunoperoxidase stains for S100 protein, B lymphocytes, and T lymphocytes were performed. Mesothelial proliferation, presence of calcification and/or psammoma bodies, edema, vascularization, inflammation, fibroblastic proliferation, and collagenization were graded from 0 (absent) to 3 (extensive); their prevalences were compared between patients with and without pelvic pain. RESULTS: Nerve fibers were present in specimens from ten of the 17 patients (five of ten patients with and five of seven without pain). There was no statistically significant difference in the numbers with nerve fibers or in the presence of mesothelial proliferation, calcification and/or psammoma bodies, edema, vascularization, inflammation, fibroblastic proliferation, or collagenization between the groups. In all cases, the infiltrating lymphocytes were T lymphocytes. CONCLUSION: We were able to demonstrate the presence of nerve fibers in pelvic adhesions; however, their presence was not more prevalent among patients with pelvic pain. These findings support the concept that the formation of adhesions has different stages, with the final formation of mature connective tissue with its own vascularization and innervation.