Report of Two Atypical Cases and Review of the Literature
Paulina Ciurea1, Adrian Saftoiu1, Monica Banita2, Violeta Comanescu3,
Ion Rogoveanu1, Daniela Neagoe1, Sergiu Cazacu1, Tudorel Ciurea1
1) 1st Medical Clinic, Department of Internal Medicine. 2) Department
of Histology. 3) Department of Morphopathology, Faculty of Medicine,
University of Medicine and Pharmacy Craiova
Background. Gastric involvement in syphilis appears
in the secondary stage and is characterized by thick gastric
folds associated with erosions and ulcerations, a picture that
sometimes mimics a gastric adenocarcinoma with linitis plastica
or a gastric lymphoma.
Methods. We examined endoscopic biopsy specimens of
two patients with unremarkable symptoms: epigastric pain, nausea,
vomiting and weight loss. The microscopic sections were analyzed
with the usual histological techniques and by immunohistochemistry
for vascular endothelial growth factor (VEGF) assessment.
Results. Upper gastrointestinal endoscopy indicated
a picture that mimicked gastric carcinoma. However, the examination
of biopsy specimens did not reveal the presence of malignant
cells or microorganisms, but indicated in both cases a nonspecific
gastritis with vasculitis, glandular destruction and reactive
atypia. VEGF expression in gastric mucosa was very intense (++++).
Serological testing (VDRL) was positive and the lesions regressed
promptly after specific treatment, supporting the diagnosis
of syphilitic gastritis.
Conclusion. VEGF could play an important role in the
pathogenesis of syphilitic gastritis, by increasing vascular
permeability that leads to an intense inflammatory process,
accompanied by vasculitic changes.
Gastric syphilis _ vascular endothelial growth factor _ gastric
carcinoma _ gastric lymphoma