title: Histologic features of secondary syphilis: A multicenter retrospective review.
abstract: BACKGROUND
  Secondary syphilis has a wide spectrum of clinical and histologic manifestations.
  
  
  OBJECTIVE
  We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings.
  
  
  METHODS
  In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present.
  
  
  RESULTS
  The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%).
  
  
  CONCLUSIONS
  This was a retrospective review.
  
  
  CONCLUSIONS
  The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm.
authors.affiliation: State University of New York Downstate Medical Center, Brooklyn, New York. Electronic address: Alexandra.frydman@downstate.edu.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Flamm
authors.affiliation: Ackerman Academy of Dermatopathology, New York, New York.
authors.forename: Kruti
authors.initials: K
authors.lastname: Parikh
authors.affiliation: State University of New York Downstate Medical Center, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Dermpath Diagnostics New York, Port Chester, New York.
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Kwon
authors.affiliation: State University of New York Downstate Medical Center, Brooklyn, New York; Ackerman Academy of Dermatopathology, New York, New York; Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Elston
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D013587:Syphilis / Q000453:epidemiology* / Q000473:pathology*; D013591:Syphilis, Cutaneous / Q000453:epidemiology* / Q000473:pathology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: dermatopathology; endothelial swelling; infectious diseases; interstitial inflammation; plasma cells; rete ridge effacement; secondary syphilis; sexually transmitted diseases