RT Journal Article
SR Electronic
T1 Oropharyngeal lesions and cervical lymphadenopathy: syphilis is a differential diagnosis that is still relevant
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 731
OP 736
DO 10.1136/jcp.2010.077586
VO 63
IS 8
A1 Kristian Ikenberg
A1 Erik Springer
A1 Wolfgang Bräuninger
A1 Katrin Kerl
A1 Daniela Mihic
A1 Simone Schmid
A1 Anja Schmitt
A1 Sibel Yeginsoy
A1 Beata Bode
A1 Achim Weber
YR 2010
UL http://jcp.bmj.com/content/63/8/731.abstract
AB 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.