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Henebeng E, Karasko E, Robinson-Bostom L, DiMarco C. Secondary Syphilis With Elastophagocytosis: An Unusual Histologic Finding. Am J Dermatopathol 2021; 43:225-227. [PMID: 33298710 DOI: 10.1097/dad.0000000000001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Elastophagocytosis is a characteristic finding of granulomatous and elastolytic disorders. It is defined by phagocytosed elastic fibers within histiocytes, multinucleated giant cells, or both. This finding has also been associated with certain medications, malignancies, inflammatory conditions, and infectious disorders. Although Drs Ragaz and Ackerman reported elastophagocytosis in a secondary syphilis lesion in a review of actinic granuloma in 1979, more recent publications have not recognized this finding. We present a case of elastophagocytosis within a lesion of secondary syphilis in a 65-year-old man. Biopsy from his left forearm demonstrated features of secondary syphilis including subtle vacuolar alteration with mild superficial and mid perivascular lymphoplasmacytic inflammation. There were interstitial giant cells with phagocytosed elastic fibers within the superficial dermis. Spirochete immunostain was positive with confirmatory Treponema pallidum IgG antibody and RPR titer. In this report, we present a unique case of secondary syphilis.
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Affiliation(s)
- Esther Henebeng
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
| | - Erich Karasko
- Department of Dermatology, Brown Dermatology, Providence, RI
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
- Department of Dermatology, Brown Dermatology, Providence, RI
| | - Christopher DiMarco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
- Department of Dermatology, Brown Dermatology, Providence, RI
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Yuan T, Liu YG, Liang B, Zhu QX, Li H. Cauliflower-shaped lesions on a young woman's vulva. Int J STD AIDS 2021; 32:378-381. [PMID: 33533298 DOI: 10.1177/0956462420970126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 20-year-old young woman with cauliflower-shaped lesions on her vulva was misdiagnosed as condyloma acuminatum. Further evaluation revealed positive serological tests for syphilis. On histological examination, and numerous plasma cells were seen to infiltrate the dermis heavily. The cauliflower-shaped lesions on vulva completely disappeared after benzathine penicillin treatment. Cauliflower-shaped lesions are a rare manifestation of secondary syphilis.
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Affiliation(s)
- Tao Yuan
- Department of Dermatology and Venereology, 36639The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, Anhui, China
| | - Yao-Guang Liu
- Department of Dermatology and Venereology, 36639The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, Anhui, China
| | - Bo Liang
- Department of Dermatology and Venereology, 36639The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, Anhui, China
| | - Qi-Xing Zhu
- Department of Dermatology and Venereology, 36639The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, Anhui, China
| | - Hui Li
- Department of Dermatology and Venereology, 36639The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, Anhui, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, Anhui, China
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Flamm A, Parikh K, Xie Q, Kwon EJ, Elston DM. Histologic features of secondary syphilis: A multicenter retrospective review. J Am Acad Dermatol 2015; 73:1025-30. [PMID: 26464219 DOI: 10.1016/j.jaad.2015.08.062] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/15/2015] [Accepted: 08/27/2015] [Indexed: 11/18/2022]
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%). LIMITATIONS This was a retrospective review. CONCLUSION 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.
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Affiliation(s)
- Alexandra Flamm
- State University of New York Downstate Medical Center, Brooklyn, New York.
| | - Kruti Parikh
- Ackerman Academy of Dermatopathology, New York, New York
| | - Qiang Xie
- State University of New York Downstate Medical Center, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | - Eun Ji Kwon
- Dermpath Diagnostics New York, Port Chester, New York
| | - Dirk M Elston
- 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
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