PMC9647331_01
Computed tomography image of the left inguinal lymphadenopathy in a patient with primary syphilis. The left inguinal lymphadenopathy is indicated by the arrow. The soft tissue surrounding the swollen lymph nodes shows an increased density. A scale bar length is shown in the image.
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Abdominal to pelvic computed tomography revealed a left inguinal hernia and confirmed 5-6 swollen left inguinal lymph nodes (Fig. 1), with maximum sizes of 1-4 cm. The soft tissue surrounding the swollen lymph nodes showed increased computed tomography density, but swollen lymph nodes were not found in other areas, including in the right inguinal region (Fig. 1).
Microscopic findings of left inguinal lymphadenopathy in a patient with primary syphilis. Histologically, the left inguinal lymph node shows multifocal abscesses (A, areas inside the dotted lines; B, high magnification) in the central portion of the lymph node and purulent exudate (A, area indicated by arrows; C, high magnification) in the periphery. Lymphoid follicles and lymph node capsules are not evident. A multinucleated giant cell (B [arrow] and inset) is present in the abscess as is a vague granuloma (D, indicated by arrows). Perivascular localization of plasma cells is seen (E). Neutrophils are evident in the vessels, suggesting endarteritis and/or obliterative arteritis (F). (A-F) Hematoxylin and eosin staining. The lengths of the scale bars are shown.
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The lymphoid follicles were inconspicuous, and multifocal abscesses were noted in the central portion of the lymph node (Fig. 2A, B). The lymph node capsule was inconspicuous and might have been replaced by suppurative inflammation or suppurative exudate (Fig. 2A, C). Many histiocytes had infiltrated the lymph node and several vague granulomas were suggested (Fig. 2D). A few multinucleated histiocytes (Fig. 2B, inset) were observed in one abscess. The lymph node cortex consisted mainly of lymphocytes and plasma cells associated with proliferating vessels, suggestive of marked interfollicular hyperplasia (Fig. 2E). Plasma cells were located around the vessels (Fig. 2E), but did not show a sheet-like arrangement. Neutrophils were present in many vessels, suggesting endoarteritis (Fig. 2F) and phlebitis.
Immunohistochemical findings of left inguinal lymphadenopathy in a patient with primary syphilis. Immunohistochemistry with anti-Treponema pallidum antibodies (A-C) shows that positive-staining microorganisms are present, particularly in the lymph node cortex that also shows vascular proliferation. Spiral microorganisms are present in the wall and around the proliferating vessels (B, higher magnification of A; C, highest magnification). The lengths of the scale bars are shown.
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The microorganisms were mainly present around or in the walls of the proliferating vessels (Fig. 3A-C) and were scattered throughout the suppurative areas.