Gastric involvement in syphilis appears in the secondary stage and is characterized by thick gastric folds associated with erosions and ulcerations, a picture that sometimes mimics a gastric adenocarcinoma with linitis plastica or a gastric lymphoma. We examined endoscopic biopsy specimens of two patients with unremarkable symptoms: epigastric pain, nausea, vomiting and weight loss.
The microscopic sections were analyzed with the usual histological techniques and by immunohistochemistry for vascular endothelial growth factor VEGF assessment. Upper gastrointestinal endoscopy indicated a picture that mimicked gastric carcinoma. However, the examination of biopsy specimens did not reveal the presence of malignant cells or microorganisms, but indicated in both cases a nonspecific gastritis with gastric cancer linitis plastica, glandular destruction and reactive atypia.
Serological testing VDRL was positive and the lesions regressed promptly after specific treatment, supporting the diagnosis of syphilitic gastritis. VEGF could play an important role in the pathogenesis of syphilitic gastritis, by increasing vascular permeability that leads to an intense inflammatory process, accompanied by vasculitic changes.