Gastric syphilis mimicking adenocarcinoma: a case report

Abstract

Syphilis is an unexpected diagnosis in the stomach, and the reduced incidence of syphilis has made its clinical presentation less widely appreciated. We report a 43-yr-old man suffering from epigastric tenderness with an initial diagnosis of gastric carcinoma; gastric syphilis was confirmed by demonstrating spirochetes in a gastric biopsy specimen by silver impregnation. Excessive lymphoplasmacytic infiltration with diffuse thickening of gastric rugae should raise suspicion of gastric syphilis, which should be considered in the differential diagnosis of diffuse erosive gastritis and infiltrative lesions of the stomach.

Fig. 1

Double-contrast radiography demonstrating an infiltrating encircling mass extending from the mid-body to the pylorus with poor dispensability.

Fig. 2

A computed tomographic scan of the abdomen shows mural thickening involving the prepyloric antrum and duodenal bulb with focal obliteration of the fat plane between the pancreas head and gastric antrum.

Fig. 3

Gastroscopy revealed a diffuse mucosal nodularity with several ulcerations with intervening hyperemic friability from the antrum to mid-body.

Fig. 4

Biopsy specimens revealed marked lymphoplasmacytic infiltrate with polymorphonuclear leukocytes and with destruction of gastric glandular epithelium (H&E, ×200).

Fig. 5

The mucosa of gastric specimen shows reddish-purple, swollen, and thickened erythematous rugal folds with erosion.

Fig. 6

Gastrectomized specimen showing diffuse extensive lymphoplasmacytic infiltration along the mucosa and submucosa (H&E, ×40).

Fig. 7

Modified Steiner silver stain showing many spirochetes within the lamina propria (original magnification ×1,000).