肛门、直肠梅毒5例临床病理分析

Clinico Pathologic Features of Anorectal Syphilis in 5 Cases

目的分析肛门直肠梅毒的临床及组织病理学特点,提高临床及病理医生对梅毒的认识,避免漏诊、误诊。方法回顾性分析5例肛门直肠梅毒的临床及组织病理学形态,结合实验室资料进行诊断,并分析误诊原因。结果患者均为男性,均有不洁性生活史。其中一期梅毒1例,二期3例,三期1例,初诊时临床、病理均漏诊。组织病理学特点:肛周皮肤、肛管、直肠黏膜的表面轻度糜烂,大量中性粒细胞浸润,微脓肿形成;鳞状上皮假上皮瘤样增生,棘层增厚,上皮脚下延,表皮细胞内及细胞间水肿,真皮层大量浆细胞及淋巴细胞浸润,血管周围尤为显著。结论肛门、直肠梅毒临床少见,临床和病理医生容易漏诊、误诊。掌握梅毒的临床特点和组织病理形态学特征,提高对梅毒的认识。

Objective To analyze the clinical and pathologic characteristic of syphilis in the anorectum in order to improve the recognition of clinical and pathologic doctor for syphilis and aviod misdiagnosis. Methods The clinical data and histopathological changes were reviewed in 12 cases of anorectal syphilis. The diagnosis was made in combination of laboratory tests in order to analyze the causes of misdiagnosis. Results Patients were men, and have a history of unclean sex life, 1 case with primary syphilis, 3 cases with secondary syphilis, 1 cases with tertiary syphilis, all the patients were misdiagnosed in primary clinicopathological setting. Most of them showed erosion and ulcer in skin or mucosa. Abundant neutrophil, plasma cells and lymphocytes infil- trations with microabscess foemation in skin biopsy detection. Conclusion Syphilis in the anorectum is rare in clinic. So misdiagnosis is very common. Clinical and pathologic doctor should be familiar the clinical and pathologic characteristic of syphilis in the anorectum in order to improve the recognition for syphilis.