【摘要】 目的分析肛门、直肠梅毒的临床病理学表现,探讨其具有诊断提示性意义的组织病理学改变,避免漏诊或误诊。方法回顾性分析12例肛门、直肠梅毒的临床资料和组织学表现,与实验室血清学检查相结合对其进行诊断和鉴别诊断。结果全部病例初诊时临床、病理均误诊。组织学表现为皮肤、黏膜糜烂或溃疡,大量中性粒细胞浸润伴上皮内微脓肿及隐窝微脓肿。溃疡周围或鳞状上皮呈假上皮瘤样增生或直肠黏膜固有腺体减少,溃疡底部及周围大量浆细胞及淋巴细胞弥漫性浸润。7例出现以淋巴细胞、浆细胞浸润为主的慢性炎性肉芽组织并初期纤维化,淋巴滤泡旺炽性反应性增生,小血管增生并大量浆细胞围管性浸润5,例出现明显闭塞性小动脉内膜炎。其中6例散在朗罕巨细胞及上皮样细胞肉芽肿,5例呈现浆细胞围神经浸润。实验室检查均呈现TP-Ab阳性,RPR效价均>1∶32,提示为梅毒感染活动期,最终诊断Ⅰ期梅毒硬下疳10例,Ⅱ期梅毒扁平湿疣2例。结论肛门、直肠梅毒临床极易误诊,病理学表现具有诊断提示性意义,临床及病理医师提高对梅毒病变的认识,将其列入常规诊断及鉴别诊断思路,同时借助实验室血清学检查,可减少或避免漏诊和误诊。更多还原

【Abstract】 Purpose To analyze the clinical and pathologic presentations and to investigate the pathological characteristics of syphilis in the anorectum in order to avoid misdiagnosis.Methods The clinical data and histopathological changes were reviewed in 12 cases of anorectal syphilis.The diagnosis and differential diagnosis were made in combination of laboratory tests.Results 12 cases were misdiagnosed in primary clinicopathological setting.Most of cases showed erosion and ulcer in skin or mucosa,abundant neutrophil infiltrations with microabscess formation.Squamous epithelium showed pseudoepitheliomatous hyperplasia and glandular structures decreased in the rectum lamina propria.Abundance of plasma cells and lymphocytes infiltrated in the fundus and peripheral portion of ulcer.7 cases showed chronic inflammation with plasmacytic,lymphocytic infiltration and fibrosis.Lymphoid follicles showed florid reactive hyperplasia.Small blood vessel hyperplasia was noted with plasma cells surrounding them.5 cases showed occlusive arteriolar inflammation.Granulomatous nodules and Langerhans giant cells were scattered in 6 cases.Plasma cells surrounded and infiltrated nerve in 5 cases.All the cases showed TP-Ab positivity and RPR>1 ∶ 32,suggesting active syphilis infection.10 cases of chancre and 2 cases of flat condyloma were diagnosed.Conclusions The histopathological changes of syphils are thought not very specific.So misdiagnosis is very common.If we keep aware of syphilis in the differential diagnosis,improve the abilities of diagnosis and combine serum test findings,we can avoid misdiagnosis and mistreatment.更多还原