0 of 1 questions completed
Presented by Jonathan Epstein, MD and prepared by Jason Kern, MD
Case 1: A 40 year old man was noted to have a peri-anal polypoid mass. The most likely diagnosis is:
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Time has elapsed
Week 611: Case 1
A 40 year old man was noted to have a peri-anal polypoid mass. The most likely diagnosis is:Correct
Histology: The skin shows neutrophils within the superficial keratin layer. There is hyperplastic squamous epithelium with pseudoepitheliomatous hyperplasia. In the dermis is a prominent plasma cell infiltrate. An immunohistochemical stain against syphilis shows innumerable red filamentous organism consistent with Treponema Pallidum.
Discussion: The finding of psoriasiform hyperplasia with a dense plasma cell infiltrate in the genital regions should always prompt a differential diagnosis of syphilis. In the past, a Warthin-Starry stain was the preferred method to identify organisms histologically. However, it was often difficult to read this stain and distinguish organisms from non-specific background staining. Currently, the best method of finding the organisms is with immunohistochemistry which is very specific and also easier to read. In the current case, it is teeming with organisms consistent with secondary syphilis. In addition to plasma cells, it is common to have associated acute inflammation in the epidermis which, if not recognized as a component of syphilis, could be misconstrued to be suggestive of a fungal as opposed to a syphilitic infection.Incorrect