Gopal Purva, Shah Rajal B
From the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Gopal); and Miraca Life Sciences, Miraca Life Sciences Research Institute, Irving, Texas (Dr Shah).
Arch Pathol Lab Med. 2015 Sep;139(9):1156-60. doi: 10.5858/arpa.2014-0487-OA.
The incidence of syphilis is on the rise, particularly in male patients who are human immunodeficiency virus (HIV) positive, and men who have sex with men.
To describe 4 cases of primary syphilis presenting in the anal canal to increase awareness of its presentation and morphology in this location, as the diagnosis can be easily overlooked clinically and by the pathologist. Design .- Clinical presentation, hematoxylin-eosin-stained sections, and Treponema pallidum immunohistochemical staining were reviewed in detail in all 4 cases.
Three patients presented with anal canal ulcers; one presented with an ulcerated anal mass. All 4 patients were male, of whom 2 were HIV positive. Syphilis was clinically suspected in only 1 case; in 2 cases, confirmatory evaluation and treatment were prompted by pathologic diagnosis. In the fourth case, syphilis was diagnosed serologically at time of biopsy; however, the patient had an anal mass, and malignancy was clinically suspected. All 4 cases had bandlike chronic plasma cell-rich inflammation at the squamous epithelium and lamina propria junction; 2 cases had poorly formed granulomas. One case had concomitant rectal biopsy specimens with proctitis. Treponema pallidum immunohistochemistry highlighted homing of organisms in a perivascular pattern and at the junction of squamous epithelium and lamina propria.
Syphilis should be considered in the differential diagnosis of anal canal ulcers, anorectal inflammatory masses, and proctitis. Detailed knowledge of clinical history and recognition of the characteristic pattern of inflammation by the pathologist is important. Treponema pallidum immunohistochemical staining can help avoid a missed diagnosis of syphilis, which, if left unrecognized, can progress to late-stage disease with serious complications.
梅毒发病率呈上升趋势，尤其是在感染人类免疫缺陷病毒（HIV）的男性患者以及男男性行为者中。
描述4例肛管原发性梅毒病例，以提高对其在此部位表现及形态的认识，因为在临床和病理诊断中该疾病很容易被忽视。设计：对所有4例病例的临床表现、苏木精-伊红染色切片及梅毒螺旋体免疫组化染色进行详细回顾。
3例患者表现为肛管溃疡；1例表现为溃疡性肛管肿物。所有4例患者均为男性，其中2例HIV阳性。仅1例临床怀疑为梅毒；2例经病理诊断后进行了确诊评估及治疗。第4例在活检时血清学诊断为梅毒；然而，该患者有肛管肿物，临床怀疑为恶性肿瘤。所有4例在鳞状上皮与固有层交界处均有带状富含慢性浆细胞的炎症；2例有形成不良的肉芽肿。1例同时有直肠活检标本显示直肠炎。梅毒螺旋体免疫组化显示病原体呈血管周围及鳞状上皮与固有层交界处的归巢模式。
在肛管溃疡、肛肠炎性肿物及直肠炎的鉴别诊断中应考虑梅毒。详细了解临床病史以及病理学家识别特征性炎症模式很重要。梅毒螺旋体免疫组化染色有助于避免梅毒漏诊，若未被识别，梅毒可进展为晚期疾病并伴有严重并发症。
