Yonsei Med J.  2010 Mar;51(2):276-278. 10.3349/ymj.2010.51.2.276.

Rectal Syphilis Mimicking Rectal Cancer

• Cha JM
• Choi SI
• Lee JI

• KMID: 1126031
• DOI: http://doi.org/10.3349/ymj.2010.51.2.276

Abstract

Rectal syphilis, known as a great masquerader, can be difficult to diagnose because of its variable symptoms. Gastroenterologists should be aware of the possibility of rectal syphilis when confronted with anorectal ulcers, and should gather a detailed history about sexual preferences and practices, including homosexuality. We report a case of primary rectal syphilis mimicking rectal cancer on radiologic imaging. In this report, we described the clinical, endoscopic, and radiologic features of this rare case.

Keyword

Rectum; syphilis; ulcer; chancre; Treponema pallidum

MeSH Terms

Humans
Male
Middle Aged
Rectal Diseases/*diagnosis/pathology/radiography
Rectal Neoplasms/*pathology/radiography
Syphilis/*diagnosis/pathology/radiography

Figure

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  Fig. 1 Sigmoidoscopic findings indicated a large, well-demarcated ulcer that was not typical of carcinoma on the lower rectum.

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  Fig. 2 Radiologic findings of rectal syphilis. (A) CT of the abdomen and pelvis suggested rectal cancer by revealing irregular rectal wall thickening with multiple perirectal lymph node enlargements (white arrow). (B) Coronal MRI showed wall thickening of the distal rectum in the mucosa and submucosa layer with high signal intensity (white arrowheads) and perirectal fat infiltration in T2-weighted images.

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  Fig. 3 Histologic features of the rectal syphilis. (A) The rectal chancre showed diffuse chronic inflammatory cell infiltration predominantly composed of plasma cells in the lamina propria and some blood vessels (Hematoxylin and eosin stain, ×200). (B) Large numbers of spirochetes (white arrows) were present on a special staining of the rectal biopsy specimen (Warthin-Starry stain, ×1,000).

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