Clinical Paper
Clinical Pathology
Diagnostic approaches in unsuspected oral lesions of syphilis

https://doi.org/10.1016/j.ijom.2014.09.014Get rights and content

Abstract

Awareness of the increased prevalence of syphilis is essential for early diagnosis and treatment, and to prevent the spread of the disease. Although serological studies are the primary tool used to confirm the diagnosis of secondary syphilis, biopsy of unsuspected oral lesions is not uncommon in the routine oral pathology laboratory. In these cases, histopathological characteristics are likely to indicate the possibility of syphilis, and an immunohistochemical reaction can confirm it. The aim of the present study was to highlight the histological features and test the efficacy of immunohistochemistry in the detection of Treponema pallidum in oral lesions biopsied with the assumption of a non-syphilitic disease. Thirty-nine tissue samples from patients for whom the possibility of syphilis was suggested on the basis of histopathological findings, were retrieved from the surgical oral pathology service files and submitted to immunohistochemical staining for T. pallidum. The study was approved by the institutional ethics committee. Eighteen of the tissue samples were positive for T. pallidum. Following this, the contributing clinicians were contacted to check whether they had asked for serological examinations when the diagnostic report was received; for all 18 positive cases, the clinicians confirmed that the patients had tested positive at that time. This study shows the importance of clinical–pathological correlation and the value of immunohistochemistry in the diagnosis of unsuspected syphilis.

Section snippets

Materials and methods

All cases diagnosed with a chronic inflammatory process and for whom the possibility of syphilis was noted on the diagnosis report, were retrieved from the archives of the university oral pathology department; these records were from a period of 5 years (2005–2010). The study was approved by the university ethics committee. A total of 39 cases were retrieved. Haematoxylin and eosin (H&E) stained slides were reviewed to confirm the histological hypothesis of syphilis, and tissue specimens from

Results

A total of 18 out of the 39 cases retrieved were positive for the anti-T. pallidum antibody. According to information obtained subsequently from the contributors, these 18 cases had tested positive for syphilis at the time of the diagnosis and had been diagnosed with secondary syphilis. None of the remaining 21 cases tested positive. Thus, the 18 positive cases represented patients with unsuspected lesions of secondary syphilis who had received diverse differential diagnoses before the biopsy.

Discussion

Although syphilis is an old disease, it is now considered a re-emerging disease, especially in the West, where it is estimated that there are 10 to 12 million new cases each year.13 The present study showed that many clinicians do not consider syphilis in their differential diagnosis of oral lesions. The variable characteristics of these lesions (white, ulcerated, elevated, single or multiple) lead to different diagnostic hypotheses, such as lichen planus, bullous pemphigoid, squamous cell

Funding

Funded by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – National Council for the Improvement of Higher Education).

Competing interests

There is no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee in Research ofthe University of São Paulo, School of Dentistry, São Paulo, Brazil (Protocol 35/11 CAAE 0035.0.017.000-11).

Patient consent

Just intra buccal images are listed. Patient consent was obtained to print the intraoral photographs.

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