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目的探讨神经梅毒的临床病理特征、诊断、治疗及预后。方法应用光镜、免疫组化染色、特殊染色等方法对神经梅毒进行观察。结果患者男性,56岁,头痛半年伴右侧肢体无力半个月,收住神经外科。MRI示左顶叶可见环状强化的结节样异常信号影,大小1.3 cm×1.5 cm,脑膜瘤或转移瘤可能。术中见肿块位于左顶叶脑内,边界清,质硬。镜下见以浆细胞为主的炎细胞弥漫或围血管浸润,小血管内皮细胞增生肿胀,多处可见凝固性坏死、炎性肉芽组织及脓肿形成。特殊染色(包括两次Warthin-Starry染色)均阴性。初步病理诊断:“左顶叶”脑组织重度急慢性炎,伴淋巴、浆细胞高度增生(以浆细胞增生为主)。患者10天后门诊检查,血清梅毒快速血浆反应素试验及血清梅毒螺旋体抗体凝集试验阳性,收住皮肤科。脑脊液梅毒血清确认试验(凝集法)阳性。对左顶叶手术标本再次行Warthin-Starry染色,经反复寻找找到梅毒螺旋体。最终病理诊断:“左顶叶”神经梅毒(树胶肿型)。结论梅毒感染早期的神经梅毒罕见,神经梅毒临床表现复杂多样,极易误诊、误治(误诊率高达72%)。神经梅毒的基本病理改变是以浆细胞浸润为主的病变及小动脉的血管内膜炎,诊断需结合病史(输血史、性伴侣感染史及吸毒史等)、临床表现、影像学及血清学检查,并应用Warthin-Starry特殊染色找到梅毒螺旋体,为确诊提供可靠依据。
Objective To investigate the clinicopathological features, diagnosis, treatment and prognosis of neurosyphilis. Methods The neurosyphilis was observed by light microscopy, immunohistochemistry and special staining. Results Male patients, 56 years old, headache for six months with right limb weakness for half a month, admitted to neurosurgery. MRI showed ring-like enhancement of the left parietal lobular anomalous signal shadow, the size of 1.3 cm × 1.5 cm, meningioma or metastases may be. Intraoperative see the mass in the left parietal lobe brain, clear boundary, hard. Microscopically, plasma cells dominated by inflammatory cell infiltration or perivascular infiltration, small blood vessel endothelial cell hyperplasia, coagulation necrosis can be seen in many places, inflammatory granulation tissue and abscess formation. Special staining (including Warthin-Starry staining twice) was negative. Preliminary pathological diagnosis: “left parietal lobe ” severe acute and chronic brain inflammation, with lymph, plasma cell hyperplasia (mainly plasma cell proliferation). Patients 10 days after the out-patient examination, serum syphilis rapid plasma testin and serum syphilis spirochete antibody agglutination test was positive, received dermatology. Cerebrospinal fluid syphilis serum confirmation test (agglutination method) positive. Warthin-Starry staining was performed on the left parietal lobe again, and the syphilis was found repeatedly. The final pathological diagnosis: “left parietal lobe ” neurosyphilis (gum swollen). Conclusion The early syphilis in syphilis infection is rare. The clinical manifestations of neurosyphilis are complex and diverse. It is easily misdiagnosed and mistaken (the misdiagnosis rate is as high as 72%). The basic pathological changes of neurosyphilis are plasmacytoma-infiltrating lesion and arteriolar intima of arteriole. The diagnosis should be based on the history (transfusion history, sexual partner’s history of infection and history of drug abuse), clinical manifestations, imaging and serology Check and find the Treponema pallidum with Warthin-Starry special stain to provide a reliable basis for the diagnosis.