Asai Satomi, Kaneko Akihiro, Matsuda Tsukumi, Takanashi Noboru, Doi Mika, Atsumi Haruyo, Ogura Go, Nakamura Naoya, Miyachi Hayato
Department of Laboratory Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Department of Dentistry Oral Surgery, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan.
J Med Case Rep. 2020 Nov 4;14(1):211. doi: 10.1186/s13256-020-02547-x.
Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. Recently, its incidence has been increasing worldwide. We encountered a young woman who presented with induration mimicking squamous cell carcinoma in the lower lip, without major medical conditions.
A 25-year-old Japanese woman presented with a 1-month history of a painless induration in her lower lip. Because squamous cell carcinoma was suspected, a preoperation work up was performed, including laboratory tests, an ultrasonographic examination, and a biopsy. The ultrasonography findings showed an oval-shaped 17 × 11 × 12 mm tumor-like lesion with heterogeneous internal echo and an indistinct border. A pressure test and color Doppler sonography revealed that the lesion was soft with a very abundant blood flow. These findings suggested the possibility of underlying inflammatory causes rather than a neoplastic tumor. Serology tests for syphilis, including the anti-Treponema pallidum antibody and reactive rapid plasma reagin tests, were positive. The biopsy revealed no malignancy. Finally, she was diagnosed as having primary syphilis and treated with amoxicillin for 28 days. The rapid plasma reagin value gradually decreased and the initial induration in her lower lip disappeared.
This case highlights the need for prompt examinations for possible underlying infective causes, such as syphilis, when seeing a painless induration with ulcer in the lip. Ultrasonography was helpful in the differential diagnosis of a tumor-like lesion and should be included in addition to syphilis serology tests, such as anti-Treponema pallidum antibody and rapid plasma reagin tests.
梅毒是一种由梅毒螺旋体引起的性传播疾病。近来，其在全球范围内的发病率一直在上升。我们遇到一名年轻女性，她下唇出现硬结，类似鳞状细胞癌，但无重大基础疾病。
一名25岁日本女性，下唇出现无痛性硬结1个月。因怀疑为鳞状细胞癌，进行了术前检查，包括实验室检查、超声检查和活检。超声检查结果显示一个椭圆形的17×11×12毫米肿瘤样病变，内部回声不均匀，边界不清。压力试验和彩色多普勒超声显示该病变质地柔软，血流丰富。这些发现提示可能存在潜在炎症病因而非肿瘤性病变。梅毒血清学检查，包括抗梅毒螺旋体抗体和反应素快速血浆反应素试验均呈阳性。活检未发现恶性病变。最终，她被诊断为一期梅毒，并接受阿莫西林治疗28天。快速血浆反应素值逐渐下降，下唇最初的硬结消失。
该病例强调，当见到唇部无痛性硬结伴溃疡时，需要及时检查是否存在潜在感染病因，如梅毒。超声检查有助于肿瘤样病变的鉴别诊断，除梅毒血清学检查，如抗梅毒螺旋体抗体和快速血浆反应素试验外，还应进行超声检查。
