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Oropharyngeal lesions and cervical lymphadenopathy: syphilis is a differential diagnosis that is still relevant
  1. Kristian Ikenberg1,
  2. Erik Springer2,
  3. Wolfgang Bräuninger3,
  4. Katrin Kerl4,
  5. Daniela Mihic1,
  6. Simone Schmid1,
  7. Anja Schmitt1,
  8. Sibel Yeginsoy1,
  9. Beata Bode1,
  10. Achim Weber1
  1. 1Department of Pathology, Institute for Surgical Pathology, University Hospital of Zurich, Zurich, Switzerland
  2. 2Institute of Pathology, Johannes Gutenberg University of Mainz, Mainz, Germany
  3. 3Clinic of Dermatology, Johannes Gutenberg University of Mainz, Mainz, Germany
  4. 4Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Achim Weber, Department of Pathology, Institute for Surgical Pathology; University Hospital of Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland;{at}


Background Syphilis (lues), a chronic infectious disease caused by Treponema pallidum, has been increasing in incidence during the last few years. Therefore, while clinically it is often not suspected, syphilis is increasingly becoming a differential diagnosis in routine pathology.

Aim To report our experience with five cases of cervical lymphadenopathy and/or oropharyngeal lesions, clinically thought to be lymphomas, lymph node metastases or carcinoma, in which we made the mostly clinically unsuspected diagnosis of syphilis.

Methods Fine needle aspiration of enlarged cervical lymph nodes was evaluated by cytology and flow cytometry (fluorescence-activated cell sorting analysis), and biopsies were examined by using histology. In addition, all materials were also subjected to immunostaining, silver staining and molecular (PCR) testing.

Results Fine needle aspiration cytology revealed follicular hyperplasia in two cases and granulomatous lymphadenitis in one case. In three patients, concomitant biopsy of co-existing oropharyngeal lesions revealed histological findings compatible with syphilis. T pallidum was detected in all cytological and histological samples by immunohistochemistry/immunocytochemistry and PCR. Subsequently, a diagnosis of syphilis was confirmed clinically and by serology.

Conclusions Syphilitic lymphadenitis is still a relevant differential diagnosis of cervical lymphadenopathy, and it is clinically often not suspected. Co-exisiting oropharyngeal lesions should alert the physician to this differential diagnosis; and lesions with compatible morphology should be tested with immunohistochemistry and immunocytochemistry and/or molecular analysis to confirm the diagnosis of syphilis.

  • Cervical
  • differential diagnosis
  • FNA
  • lues
  • lymphadenopathy
  • lymph node pathology
  • oral pathology
  • sexually transmitted diseases
  • STD
  • syphilis
  • Treponema pallidum

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.