Gastric Syphilis: 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

Abstract

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.

Key words


Gastric syphilis _ vascular endothelial growth factor _ gastric carcinoma _ gastric lymphoma