论文部分内容阅读
目的探讨肛门直肠梅毒的临床病理学特点,总结经验,避免漏诊或误诊。方法收集4例肛门直肠梅毒患者的临床及病理形态学资料,用HE染色观察直肠黏膜组织损伤的病理形态学特点,实验室梅毒螺旋体血凝测定及快速血浆反应素试验,佐证梅毒的病理诊断。结果临床4例均误诊,实验室检查均呈梅毒螺旋体血凝测定阳性,快速血浆反应素试验阳性。1例肛周黏膜鳞状上皮呈假上皮瘤性增生,上皮内有中性粒细胞浸润、微小脓肿形成,真皮层大量浆细胞浸润伴小血管周围围管性浸润;3例直肠壁黏膜固有层内均有大量浆细胞浸润,小血管内皮细胞肿胀及梅毒性小血管炎,直肠黏膜表面溃疡,大量浆细胞、淋巴细胞、组织细胞浸润;其中1例直肠黏膜下显著慢性炎症,淋巴滤泡呈旺炙性反应性增生;1例于直肠黏膜下见多个肉芽肿性结节,偶见朗汉斯巨细胞。4例确诊后均给予青霉素静脉输注,患者痊愈出院;其中1例于半月后复发,再次给予青霉素静脉输注,痊愈出院。结论肛门直肠梅毒的组织病理学表现仅具有相对特征性,非特异性改变,临床极易误诊为肛门直肠肿物及脓肿,其最终诊断仍需结合实验室梅毒血清学检查。临床及病理医师均应提高对肛门直肠梅毒的认识,减少漏诊、误诊和误治。
Objective To investigate the clinicopathological features of anorectal syphilis and to summarize the experience to avoid misdiagnosis and missed diagnosis. Methods The clinical and histopathological data of 4 patients with anorectal syphilis were collected. The histopathological features of rectal mucosal tissue were observed by HE staining. The pathological changes of syphilis were confirmed by laboratory tests of blood coagulation and rapid plasma reaction. Results All the 4 cases were misdiagnosed. The results of laboratory tests showed positive results of blood coagulation test of Treponema pallidum and positive of fast plasma testin. One case of perianal mucosal squamous epithelium was pseudopothelioma hyperplasia, neutrophil infiltration in the epithelium, the formation of small abscesses, a large number of plasma cells infiltration in the dermis with peripheral vascular infiltration of small vessels; 3 cases of rectal wall lamina propria There are a large number of plasma cells infiltration, small blood vessel endothelial cell swelling and syphilitic vasculitis, rectal mucosal ulceration, a large number of plasma cells, lymphocytes, tissue cells infiltration; 1 case of rectal mucosal significant chronic inflammation, lymphoid follicles were Wang Sunburn reactive hyperplasia; 1 case of multiple granulomatous nodules seen in the rectal mucosa, occasionally Long Hans giant cells. 4 cases were diagnosed with penicillin intravenous infusion, the patient was discharged; one case of recurrence after half a month, once again given penicillin intravenous infusion, recovered and discharged. Conclusions The histopathological manifestations of anorectal syphilis have only relatively characteristic and nonspecific changes. It is very easy to misdiagnose as anorectal masses and abscesses in clinical rectal syphilis. The final diagnosis of syphilis still needs to be combined with laboratory syphilis serological tests. Clinical and pathologists should raise awareness of anorectal syphilis and reduce missed diagnosis, misdiagnosis and mistreatment.