Faculty Bibliography

Paraffin-embedded tissue from all 17 autopsies performed following 56 stillbirths associated with maternal syphilis during a 3-year period (1987-1989) was reexamined to compare immunofluorescent antigen (IFA) testing with silver staining for the detection of Treponema pallidum. Congenital syphilis (CS) originally was diagnosed in 9 of the 17 cases of stillbirth, on the basis of positive silver stains (7 cases) or morphological findings alone (2). Upon review, silver staining revealed T. pallidum in 10 of 17 cases and IFA testing revealed the pathogen in 15 of 17 cases, enabling diagnosis of CS in 16 of 17 cases of stillbirth associated with a reactive maternal rapid plasma reagin (RPR) card test. Most stillbirths associated with a reactive maternal RPR test during this time period involved CS, and IFA testing for T. pallidum is superior to silver staining for the identification of treponemes.

OBJECTIVE: To describe five cases of early syphilis with gastric involvement and to review the literature pertaining to this disorder. DATA IDENTIFICATION: Five patients were diagnosed with gastric syphilis at Kings County Hospital and the Brooklyn Veterans Affairs Hospital between 1987 and 1990. English-language articles pertaining to gastric syphilis were identified by searching MEDLINE and by manually reviewing bibliographies of retrieved articles. STUDY SELECTION: Sources containing information pertinent to the clinical manifestations and diagnosis of gastric syphilis were selected. DATA SYNTHESIS: The most common clinical manifestations of gastric syphilis are abdominal pain, vomiting, and weight loss. Endoscopic findings in the stomach range from minimal nodularity and erythema to deep ulceration. Complications of gastric syphilis include hemorrhage, gastric outlet obstruction, and perforation. The diagnosis can be confirmed by serologic testing and by demonstration of spirochetes on silver and immunofluorescent stains of gastric mucosal biopsy specimens. Response to treatment is usually prompt and complete. CONCLUSIONS: The current syphilis epidemic will likely result in an increased incidence of gastric syphilis. Unless syphilis is considered as a cause of gastric mucosal inflammation and ulceration, misdiagnosis may delay appropriate treatment, and serious complications can occur.

The recognition of angiodysplasia either at the time of surgery or at the time of routine gross and microscopic examination has often been difficult. Until now the primary methodology used in defining the lesion has been the intravascular injection of radiopaque dyes and other compounds. This technique, however, is prohibitively time consuming and expensive, and does not encourage routine use in surgical pathology practice. We report two cases of angiodysplasia, both occurring in unlikely areas, in which the pathologic lesion was demonstrated without the use of an intravascular injection technique. One case involved 35 cm of proximal transverse colon and the other involved 23 cm of colon distal to the ileocecal valve. A simple method of demonstrating angiodysplasia by intraluminal formalin fixation (37% concentrated, unbuffered), with tying of both resected ends for 3 hours, followed by dissection of the mucosa from the muscle wall, is described. Areas of ectatic, pericryptal, thin-walled blood vessels with adjacent dilated, engorged submucosal veins are readily seen on gross direct inspection highlighted by transillumination. Histologic sections taken from these areas show early lesions of angiodysplasia characterized by ectatic, engorged submucosal veins and some dilated venules and capillaries in the mucosal lamina propria.