Oropharyngeal lesions and cervical lymphadenopathy: syphilis is a differential diagnosis that is still relevant.
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.


OBJECTIVE
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-existing 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.
Ikenberg
Kristian
K
Department of Pathology, University Hospital of Zurich, Zurich, Switzerland.
Springer
Erik
E
Bräuninger
Wolfgang
W
Kerl
Katrin
K
Mihic
Daniela
D
Schmid
Simone
S
Schmitt
Anja
A
Yeginsoy
Sibel
S
Bode
Beata
B
Weber
Achim
A
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000382:microbiology / Q000473:pathology*; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009960:Oropharynx / Q000382:microbiology*; D010608:Pharyngeal Diseases / Q000382:microbiology / Q000473:pathology*; D016133:Polymerase Chain Reaction / Q000379:methods; D013587:Syphilis / Q000473:pathology*; D014059:Tongue / Q000473:pathology; D014210:Treponema pallidum / Q000302:isolation & purification; D018084:Ultrasonography, Interventional / Q000379:methods
D004269:DNA, Bacterial