Gastric syphilis: endoscopic and histological features mimicking lymphoma

The United States is currently experiencing a syphilis epidemic. We report three cases of gastric syphilis seen during a 1-yr period. These cases were endoscopically and microscopically confused with lymphoma. Recent evidence has suggested that Helicobacter pylori has a causative role in the development of gastric carcinoma, lymphocytic gastritis, and lymphoma, as well as peptic ulcer disease and chronic gastritis. During the same period of heightened awareness for the role of H. pylori-associated gastric pathology, there has been a simultaneous rise in the incidence of syphilis throughout the United States, especially in the inner city. Gastroenterologists and pathologists must have an awareness that gastric syphilis can mimic lymphocytic gastritis and gastric lymphoma. Because of the current syphilis epidemic, gastric syphilis must be carefully considered as a diagnostic possibility in any patient with endoscopic and histological findings suggesting lymphocytic gastritis or lymphoma. This diagnosis of gastric syphilis should be weighed even when H. pylori infection is present. All three of our patients tested negative for the HIV antibody.