Syphilis

What periods are distinguished in the pathomorphological course of acquired syphilis?

Three successive periods are distinguished in the pathomorphological course of acquired syphilis.

• Primary period — characterized by the formation of the primary affect (hard chancre) and the development of the primary infectious complex.
• Secondary period — caused by the hematogenous spread of the pathogen with the development of vasculitis and the appearance of a syphilitic rash (syphilids) on the skin and mucous membranes.
• Tertiary period (visceral, gummatous) — characterized by the development of granulomatous inflammation (gummas and diffuse gummatous infiltration) with involvement of internal organs, blood vessels, and the nervous system.

What does the primary syphilitic affect (hard chancre) look like macroscopically?

Macroscopically, the primary syphilitic affect (hard chancre) initially appears as a reddish thickening of the mucous membrane measuring 3–5 mm. After 1–2 weeks, this thickening turns into a superficial ulcer, at the bottom of which is scanty pus-like exudate. Characteristic macroscopic signs of the formed ulcer are a smooth bottom and dense edges with a cartilaginous consistency.

Which cells predominate in the inflammatory infiltrate of the hard chancre upon microscopic examination?

Lymphocytes and plasma cells are detected in the inflammatory infiltrate of the hard chancre; a small number of neutrophils and epithelioid cells are also present. The infiltrate is localized at the bottom and edges of the ulcer, predominantly around small blood vessels. There are many pale treponemes between the cells.

What types of syphilids are most characteristic of skin and mucosal involvement in the secondary period of syphilis?

In the secondary period of syphilis, syphilids appear on the skin and mucous membranes, sequentially taking the form of roseolae, papules, and pustules. Pustules are filled with pale spirochetes; upon their ulceration, spirochetes abundantly enter the external environment.

What zones does a syphilitic gumma consist of upon microscopic examination?

Upon microscopic examination, a syphilitic gumma consists of three zones.

• Center — a zone of coagulative (gummatous) necrosis of a sticky consistency with destroyed elastic fibers.
• Cellular infiltrate — granulation tissue around the necrosis, containing lymphocytes, macrophages, epithelioid cells, Pirogov-Langhans giant cells, and predominantly plasma cells. Small blood vessels with phenomena of productive endovasculitis are also detected here.
• Periphery — a dense fibrous capsule with clear boundaries, formed due to the intensive development of connective tissue.

How does the intima of the aorta change macroscopically in syphilitic mesaortitis?

Macroscopically in syphilitic mesaortitis, the inner lining of the aorta (intima) undergoes sclerosis and acquires the specific appearance of "shagreen skin". It becomes uneven, wrinkled, and nodular. These changes occur as a result of the formation of cicatricial retractions in the middle layer of the aorta, where destruction of the elastic framework and uneven sclerosis of the wall take place following the proliferation and maturation of granulation tissue.

What pathomorphological signs make up the classic Hutchinson triad in late congenital syphilis?

The classic Hutchinson triad in late congenital syphilis consists of three pathomorphological signs.

• Parenchymatous keratitis — small infiltrates in the cornea and retina.
• Hutchinson teeth — deformation of the upper central incisors due to hypoplasia of the masticatory surface (the crown is wider at the neck, with a crescent-shaped notch on the cutting edge).
• Deafness — caused by damage to the labyrinth and atrophy of the VIII pair of cranial nerves against the background of syphilitic changes in the cerebral vessels.

What is "white pneumonia" and for which form of syphilis is it characteristic?

"White pneumonia" is interstitial pneumonia accompanied by the formation of whitish layers of fibrous tissue in the lungs. This pathomorphological sign (a term proposed by R. Virchow) is characteristic of early congenital syphilis, which manifests in newborns and infants during the first two months of life.

What specific changes develop in the zones of endochondral ossification in early congenital syphilis?

In early congenital syphilis, syphilitic osteochondritis and periostitis develop in the areas where bones meet cartilage (in the femurs, sternum, and ribs). As a result of these processes, particularly when the tibias are affected, excessive osteosynthesis occurs on the anterior surfaces of the lower leg, leading to the formation of a characteristic deformity known as "saber shins".