Tertiary syphilis mimicking hepatic metastases of underlying primary peritoneal serous carcinoma

Abstract

Tertiary syphilis, especially in cases involving visceral gummatous disease, can be confused with cancer of the solid organs. We report a case of tertiary hepatic syphilis that manifested with intrahepatic masses in a patient who had an underlying primary peritoneal serous carcinoma (PPSC). The patient was diagnosed with PPSC and achieved a complete remission of PPSC following six cycles of platinum-based chemotherapy. Two hepatic nodules developed during the follow-up period and were initially labeled as hepatic metastases from the underlying PPSC, based on radiological findings. A resection of hepatic nodules was performed for therapeutic and diagnostic purposes, because there were no other metastatic foci except in the liver. Unexpectedly, serology and histology confirmed tertiary syphilis. This rare case emphasizes the importance of including tertiary syphilis in the differential diagnosis of a space-occupying lesion, even with an existing diagnosis of underlying cancer.

Keywords: Liver; Neoplasm; Peritoneal carcinoma; Syphilis.

Figure 1

Abdominopelvic computed tomography scan showing ascites and contrast-enhanced peritoneal nodules.

Figure 2

Microscopic findings of the peritoneal nodules revealed papillary serous adenocarcinoma with infiltrative papillary clusters (A, H&E stain × 40) and tumor nests with characteristic retraction artifacts in the stroma (B, H&E stain × 100).

Figure 3

Computed tomography scan showing two hepatic nodules with peripheral enhancement (arrows).

Figure 4

Liver biopsy specimens revealed an inflammatory cell infiltration among the hepatocytes and sinusoids, and partial abscess formation (A, H&E stain × 100). The inflammatory infiltrate was composed primarily of eosinophils (B, H&E stain × 400).

Figure 5

Computed tomography scan showing two recurrent lesions around the previous operative sites (arrows).

Figure 6

Pathological findings of the specimens from the secondary operation showed chronic inflammation with necrosis. A: A well-demarcated inflammatory nodule was identified within the liver parenchyma (H&E stain × 40); B: Lymphoplasma cell infiltration was also noted in the peripheral portion of the nodule (H&E stain × 100); C: The nodule was filled with inflammatory necrotic debris (H&E stain × 200).