title: Syphilis presenting as inflammatory tumors of the liver in HIV-positive homosexual men.
abstract: Syphilis, a sexually transmitted infection caused by the spirochete Treponema pallidum, has seen a resurgence since 2001, particularly in men who have sex with men. Syphilis can affect the liver during the secondary stage as syphilitic hepatitis and during the tertiary stage as gummas. We describe 3 cases of syphilis in human immunodeficiency virus-positive homosexual men that presented as hepatic mass lesions clinically suspected of being malignant tumors. Histologically, 2 of the 3 cases showed a plump spindle cell proliferation, mixed inflammatory infiltrate with numerous neutrophils, and abscesses, whereas the third case showed granulomas and pericholangitis/cholangitis. Immunohistochemical staining for T. pallidum showed innumerable organisms in 2 of the cases. Pathologists must be aware of the possibility of syphilis causing hepatic inflammatory masses in human immunodeficiency virus-positive men who have sex with men in order to avoid misdiagnosis or delayed treatment.
authors.affiliation: *Department of Pathology, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA †Carolinas Pathology Group, Carolinas Medical Center, Charlotte, NC ‡Infectious Disease Associates of Kansas City, Kansas City, MO.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Hagen
authors.forename: Michal
authors.initials: M
authors.lastname: Kamionek
authors.forename: David S
authors.initials: DS
authors.lastname: McKinsey
authors.forename: Joseph
authors.initials: J
authors.lastname: Misdraji
mesh_terms: D003937:Diagnosis, Differential; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D008107:Liver Diseases / Q000382:microbiology* / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D013587:Syphilis / Q000150:complications / Q000473:pathology*