Department of Pathology and Laboratory Medicine, Tufts Medical Center.
Department of Pathology, University of Michigan, Ann Arbor, MI.
Am J Surg Pathol. 2018 Apr;42(4):472-478. doi: 10.1097/PAS.0000000000000987.
Syphilis, a sexually transmitted infection caused by the Gram-negative bacterium Treponema pallidum, is increasing in prevalence in the United States. It has been our experience that primary and secondary syphilis of the aerodigestive tract can afflict a large age spectrum with varied clinical and histopathologic findings, which can lead to diagnostic problems and frequent misdiagnosis. In this study, we describe the histopathologic patterns of syphilis of the aerodigestive tract to expand awareness of its varied appearance. We identify 3 patterns of inflammatory response to syphilis: plasma cell-rich, lymphohistiocytic, and lymphoma-like. We also report the presence of immunoglobulin G4-predominant plasma cells in the inflammatory response as a potential mimicker of immunoglobulin G4-related disease. Lastly, we found that use of T. pallidum immunohistochemical stain is more reliable than Steiner silver stain at the identification of spirochetes. Our study highlights that despite convention, plasma cells are not always abundant in syphilis. Awareness of the histopathologic range of syphilis in the aerodigestive tract by the surgical pathologist can lead to the correct diagnosis and guide appropriate treatment.
梅毒是一种由革兰氏阴性细菌苍白密螺旋体引起的性传播感染，其在美国的流行率正在上升。我们的经验表明，呼吸道和消化道的原发性和继发性梅毒可影响很大的年龄范围，具有不同的临床和组织病理学表现，这可能导致诊断问题和频繁误诊。在这项研究中，我们描述了呼吸道和消化道梅毒的组织病理学模式，以提高对其各种表现的认识。我们确定了对梅毒的三种炎症反应模式：富含浆细胞、淋巴组织细胞和淋巴瘤样。我们还报告了免疫球蛋白 G4 阳性浆细胞在炎症反应中的存在，这可能是免疫球蛋白 G4 相关疾病的潜在模拟物。最后，我们发现 T. pallidum 免疫组织化学染色比 Steiner 银染色更可靠地识别螺旋体。我们的研究强调，尽管存在传统观念，但梅毒中浆细胞并不总是丰富的。外科病理学家对呼吸道和消化道梅毒的组织病理学范围的认识可以导致正确的诊断，并指导适当的治疗。
