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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1025-1030 |
| Number of pages | 6 |
| Journal | Journal of the American Academy of Dermatology |
| Volume | 73 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2015 |
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All Science Journal Classification (ASJC) codes
- Dermatology
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Histologic features of secondary syphilis : A multicenter retrospective review. / Flamm, Alexandra; Parikh, Kruti; Xie, Qiang; Kwon, Eun Ji; Elston, Dirk M.
In: Journal of the American Academy of Dermatology, Vol. 73, No. 6, 01.12.2015, p. 1025-1030.Research output: Contribution to journal › Article
TY - JOUR
T1 - Histologic features of secondary syphilis
T2 - A multicenter retrospective review
AU - Flamm, Alexandra
AU - Parikh, Kruti
AU - Xie, Qiang
AU - Kwon, Eun Ji
AU - Elston, Dirk M.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - 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.
AB - 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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UR - http://www.scopus.com/inward/citedby.url?scp=84947752142&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2015.08.062
DO - 10.1016/j.jaad.2015.08.062
M3 - Article
C2 - 26464219
AN - SCOPUS:84947752142
VL - 73
SP - 1025
EP - 1030
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
SN - 0190-9622
IS - 6
ER -