肛门直肠梅毒临床病理分析

Anorectal syphilis:a clinicopathologic analysis of 4 cases

目的探讨肛门直肠梅毒的临床病理学特点,总结经验,避免漏诊或误诊。方法收集4例肛门直肠梅毒患者的临床及病理形态学资料,用HE染色观察直肠黏膜组织损伤的病理形态学特点,实验室梅毒螺旋体血凝测定及快速血浆反应素试验,佐证梅毒的病理诊断。结果临床4例均误诊,实验室检查均呈梅毒螺旋体血凝测定阳性,快速血浆反应素试验阳性。1例肛周黏膜鳞状上皮呈假上皮瘤性增生,上皮内有中性粒细胞浸润、微小脓肿形成,真皮层大量浆细胞浸润伴小血管周围围管性浸润;3例直肠壁黏膜固有层内均有大量浆细胞浸润,小血管内皮细胞肿胀及梅毒性小血管炎,直肠黏膜表面溃疡,大量浆细胞、淋巴细胞、组织细胞浸润;其中1例直肠黏膜下显著慢性炎症,淋巴滤泡呈旺炙性反应性增生;1例于直肠黏膜下见多个肉芽肿性结节,偶见朗汉斯巨细胞。4例确诊后均给予青霉素静脉输注,患者痊愈出院;其中1例于半月后复发,再次给予青霉素静脉输注,痊愈出院。结论肛门直肠梅毒的组织病理学表现仅具有相对特征性,非特异性改变,临床极易误诊为肛门直肠肿物及脓肿,其最终诊断仍需结合实验室梅毒血清学检查。临床及病理医师均应提高对肛门直肠梅毒的认识,减少漏诊、误诊和误治。

Purpose To investigate the clinicopathological characteristics of syphilis in the anorectum in order to avoid misdiagnosis. Methods Clinical data and pathological changes in 4 cases of anorectal syphilis were reviewed. The histologic changes in HE stained sections were analyzed and treponema pallidum hemagglutination assay （TPHA） and rapid plasma regain （RPR） were performed to confirm the pathologic diagnosis. Results Four cases were misdiagnosed in clinical setting. All the cases showed TPHA and RPR positive in serum tests. One case showed pseudoepitheliomatous hyperplasia and neutrophil infiltration, microabscess formation and plasma cell infiltration in the dermis. Small blood vessels surrounded by plasma cells. Three cases showed many plasma cells infiltrated in lamina propria. Endothelial swelling of small blood vessels and syphilitic vasculitis were also observed. Mucosal ulcers were associated with abundant plasma cell,lymphocyte and histiocyte infiltrations. One of them showed serious chronic inflammation and florid lymphoid hyperplasla. Some granulomatous nodules were found in the submucosa in one case. Langerhans giant cells could be found occasionally. All the cases be healed by penicillin administration. Conclusions The histopathological changes of syphilis are nonspecific. As a result, misdiagnosis is not uncommon. The correct diagnosis bases mainly on specific serum tests. To improve the ＇abilities of diagnosis and treatment we should familiarize the features of this disease.