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Syphilis in Hematopathology Practice: A Diagnostic Challenge.

Efrain Gutierrez-Lanz1, Lauren B Smith, Anamarija M Perry1

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Syphilis (Treponema pallidum) is reemerging, presenting diagnostic challenges in surgical pathology. Recognizing key lymph node and aerodigestive tract features is crucial for accurate diagnosis.

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Area of Science:

  • Pathology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Syphilis, caused by Treponema pallidum, is a reemerging infectious disease.
  • Increasing frequency in surgical pathology and hematopathology, often presenting as lymphadenopathy.
  • Can mimic lymphoma in lymph nodes and aerodigestive tract with lymphoplasmacytic infiltrates.

Purpose of the Study:

  • Summarize histologic features of syphilitic lymphadenitis and aerodigestive tract lesions.
  • Review differential diagnoses and diagnostic pitfalls.
  • Highlight the importance of considering syphilis in challenging cases.

Main Methods:

  • Literature review using PubMed search.

Main Results:

  • Syphilitic lymphadenitis shows thickened capsule, plasma cell-rich infiltrate, reactive hyperplasia, and vasculitis.
  • Aerodigestive tract syphilis presents with plasma cell-rich infiltrates.
  • Immunohistochemistry for T pallidum is useful but has cross-reactivity.

Conclusions:

  • Syphilis diagnosis in lymph nodes and aerodigestive tract is challenging due to varied morphology and low clinical suspicion.
  • Differential diagnosis is broad, including reactive, infectious, and neoplastic conditions.
  • Pathologists must be aware of syphilitic features to include it in the differential diagnosis.