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1.  Endoscopic Aspects of Gastric Syphilis 
Case Reports in Medicine  2012;2012:646525.
Introduction. Considered as a rare event, gastric syphilis (GS) is reported as an organic form of involvement. Low incidence of GS emphasizes the importance of histopathological analysis. Objective. We aim to characterize GS endoscopic aspects in an immunocompetent patient. Case Report. A 23-year-old man presented with epigastric pain associated with nausea, anorexia, generalized malaise and 11 kg weight loss that started 1 month prior to his clinical consultation. Physical examination was normal except for mild abdominal tenderness in epigastrium. Endoscopy observed diminished gastric expandability and diffuse mucosal lesions, from cardia to pylorus. Gastric mucosa was thickened, friable, with nodular aspect, and associated with ulcers lesions. Gastric biopsies were performed, and histopathological analysis resulted in dense inflammatory infiltration rich in plasmocytes. Syphilis serologies were positive for VDRL and Treponema pallidum reagents. Immunohistochemical tests were positive for Treponema pallidum and CD138. The patient was treated with penicillin, leading to resolution of his clinical complaints and endoscopic findings. Conclusion. Diagnosis suspicion of GS is important in view of its nonspecific presentation. Patients with gastric symptoms that mimic neoplastic disease should be investigated thoroughly based on the fact that clinical, endoscopic, and histological findings can easily be mistaken for lymphoma or plastic linitis.
doi:10.1155/2012/646525
PMCID: PMC3423921  PMID: 22924047
2.  Diagnosis of Gastric Syphilis by Direct Immunofluorescence Staining and Real-Time PCR Testing 
Journal of Clinical Microbiology  2006;44(9):3452-3456.
We report on a case of gastric syphilis in a patient with chronic dyspepsia. The diagnosis was established by serology and the demonstration of spirochetes in diffusely inflammed gastric mucosa by staining with a fluorescent monoclonal antibody specific for pathogenic treponemes and by the detection of specific treponemal DNA sequences by a real-time PCR.
doi:10.1128/JCM.00721-06
PMCID: PMC1594693  PMID: 16954299
3.  Characteristic waffle-like appearance of gastric linitis plastica: A case report 
Oncology Letters  2014;9(1):262-264.
Linitis plastica is a gastric cancer of diffuse histotype that presents in the fundic gland area, and is characterized by thickening of the stomach wall and deformation of the stomach, resulting in a leather bottle-like appearance. A 66-year-old female was admitted to Kagawa University Hospital (Kagawa, Japan) with epigastric pain. X-ray examination revealed reduced gastric distension and deformation of the stomach, which exhibited a leather bottle-like appearance. Endoscopy indicated a depressed lesion in the gastric antrum, and abnormal folds, which crossed to form a waffle-like appearance in the upper gastric body. Analysis of biopsy specimens from the depressed lesion revealed a poorly differentiated adenocarcinoma. Morphological changes in the gastric folds indicated that the tumor had invaded the upper gastric body, therefore, a total gastrectomy was performed. Subsequent pathological findings demonstrated that the tumor had spread from the primary lesion to the upper gastric body. Therefore, the present report recommends that the diagnosis of the spread of linitis plastica-type gastric cancer should include assessments of the primary lesion, as well as evaluation of morphological changes in the gastric folds.
doi:10.3892/ol.2014.2688
PMCID: PMC4246919  PMID: 25435971
linitis plastica; scirrhous gastric cancer; diffuse type cancers; signet ring cell adenocarcinoma; waffle-like appearance
4.  Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early gastric cancer 
AIM: To evaluate the histological features of gastric mucosa, including Helicobacter pylori infection in patients with early gastric cancer and endoscopically found superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer.
METHODS: The biopsy specimens were taken from the antrum, corpus and upper angulus of all the patients. Giemsa staining, improved toluidine-blue staining, and H pylori-specific antibody immune staining were performed as appropriate for the histological diagnosis of H pylori infection. Hematoxylin-eosin staining was used for the histological diagnosis of gastric mucosa inflammation, gastric glandular atrophy and intestinal metaplasia and scored into four grades according to the Updated Sydney System.
RESULTS: The overall prevalence of H pylori infection in superficial gastritis was 28.7%, in erosive gastritis 57.7%, in gastric erosion 63.3%, in gastric ulcer 80.8%, in early gastric cancer 52.4%. There was significant difference (P<0.05), except for the difference between early gastric cancer and erosive gastritis. H pylori infection rate in antrum, corpus, angulus of patients with superficial gastritis was 25.9%, 26.2%, 25.2%, respectively; in patients with erosive gastritis 46.9%, 53.5%, 49.0%, respectively; in patients with gastric erosion 52.4%, 61.5%, 52.4%, respectively; in patients with gastric ulcer 52.4%, 61.5%, 52.4%, respectively; in patients with early gastric cancer 35.0%, 50.7%, 34.6%, respectively. No significant difference was found among the different site biopsies in superficial gastritis, but in the other diseases the detected rates were higher in corpus biopsy (P<0.05). The grades of mononuclear cell infiltration and polymorphonuclear cell infiltration, in early gastric cancer patients, were significantly higher than that in superficial gastritis patients, lower than that in gastric erosion and gastric ulcer patients (P<0.01); however, there was no significant difference compared with erosive gastritis. The grades of mucosa glandular atrophy and intestinal metaplasia were significantly highest in early gastric cancer, lower in gastric ulcer, the next were erosive gastritis, gastric erosion, the lowest in superficial gastritis (P<0.01). Furthermore, 53.3% and 51.4% showed glandular atrophy and intestinal metaplasia in angular biopsy specimens, respectively; but only 40.3% and 39.9% were identified in antral biopsy, and 14.1% and 13.6% in corpus biopsy; therefore, the angulus was more reliable for the diagnosis of glandular atrophy and intestinal metaplasia compared with antrum and corpus (P<0.01). The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H pylori-positivity was 50.7%, 34.1%; of erosive gastritis 76.1%, 63.0%; of gastric erosion 84.8%, 87.8%; of gastric ulcer 80.6%, 90.9%; and of early gastric cancer 85.5%, 85.3%, respectively. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H pylori-negativity was 9.9%, 6.9%; of erosive gastritis 42.5%, 42.1%; of gastric erosion 51.1%, 61.9%; of gastric ulcer 29.8%, 25.5%; and of early gastric cancer 84.0%, 86.0%, respectively. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis, erosive gastritis, gastric erosion, and gastric ulcer patients with H pylori positivity was significantly higher than those with H pylori negativity (P<0.01); however, there was no significant difference in patients with early gastric cancer with or without H pylori infection.
CONCLUSION: The progression of the gastric pre-cancerous lesions, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis and gastric ulcer was strongly related to H pylori infection. In depth studies are needed to evaluate whether eradication of H pylori infection will really diminish the risk of gastric cancer.
doi:10.3748/wjg.v11.i6.791
PMCID: PMC4250585  PMID: 15682469
Helicobacter pylori; Glandular atrophy; Intestinal metaplasia; Early gastric cancer
5.  Gastric emphysema secondary to laparoscopic gastric band erosion 
INTRODUCTION
Gastric band erosion is a known complication of adjustable gastric band surgery. There are no previous reports of gastric band erosion associated with gastric emphysema (GE) or emphysematous gastritis (EG), a rare condition with a mortality rate exceeding 50%.
PRESENTATION OF CASE
We report the first known case of GE found in a 58-year-old lady presenting with acute onset epigastric abdominal pain and haematemesis in the setting of a chronically eroded gastric band. GE was visualised in the anterior gastric wall of the stomach without evidence of EG. Endoscopic and surgical examination of the stomach was undertaken along with band removal followed by defect repair.
DISCUSSION
GE can result from obstructive, traumatic and pulmonary causes. EG is a rare and often lethal form of GE resulting from bacterial invasion of the gastric wall through a mucosal defect leading to sepsis and gastric necrosis. Early reports documented early definitive operative debridement of necrotic gastric wall of patients with EG while recent reports have demonstrated a feasible non-operative approach among highly selected patients with no evidence of gastric necrosis. There are no previous reports on the treatment of patients with gastric band erosion and suspected EG.
CONCLUSION
Patients presenting acutely with symptomatic gastric band erosion, radiological evidence of GE with evidence of leucocytosis, peritonism or sepsis may develop EG. A high index of suspicion, low threshold for operative exploration and optimal management with antimicrobial therapy and close supportive care are necessary to ensure the best survival outcomes for these patients.
doi:10.1016/j.ijscr.2014.07.024
PMCID: PMC4189050  PMID: 25216194
Gastric emphysema; Emphysematous gastritis; Gastric band; Bariatric surgery; General surgery
6.  Increased risk of gastric adenocarcinoma after treatment of primary gastric diffuse large B-cell lymphoma 
BMC Cancer  2013;13:499.
Background
There have been sporadic reports about synchronous as well as metachronous gastric adenocarcinoma and primary gastric lymphoma. Many reports have dealt with metachronous gastric adenocarcinoma in mucosa-associated lymphoid tissue lymphoma of stomach. But to our knowledge, there have been no reports that document the increased incidence of metachronous gastric adenocarcinoma in patients with gastric diffuse large B-cell lymphoma. This retrospective study was conducted to estimate the incidence of metachronous gastric adenocarcinoma after primary gastric lymphoma treatment, especially in diffuse large B-cell lymphoma.
Methods
The retrospective cohort study of 139 primary gastric lymphoma patients treated with radiotherapy at our hospital. Mean observation period was 61.5 months (range: 3.7-124.6 months). Patients profile, characteristics of primary gastric lymphoma and metachronous gastric adenocarcinoma were retrieved from medical records. The risk of metachronous gastric adenocarcinoma was compared with the risk of gastric adenocarcinoma in Japanese population.
Results
There were 10 (7.2%) metachronous gastric adenocarcinoma patients after treatment of primary gastric lymphomas. It was quite high risk compared with the risk of gastric carcinoma in Japanese population of 54.7/100,000. Seven patients of 10 were diffuse large B-cell lymphoma and other 3 patients were mixed type of diffuse large B-cell lymphoma and mucosa associated lymphoid tissue lymphoma. Four patients of 10 metachronous gastric adenocarcinomas were signet-ring cell carcinoma and two patients died of gastric adenocarcinoma. Metachronous gastric adenocarcinoma may have a more malignant potential than sporadic gastric adenocarcinoma. Old age, Helicobacter pylori infection and gastric mucosal change of chronic gastritis and intestinal metaplasia were possible risk factors for metachronous gastric adenocarcinoma.
Conclusion
There was an increased risk of gastric adenocarcinoma after treatment of primary gastric lymphoma, especially of diffuse large B-cell lymphoma.
doi:10.1186/1471-2407-13-499
PMCID: PMC3816307  PMID: 24159918
Gastric lymphoma; Metachronous gastric adenocarcinoma; Diffuse large B-cell lymphoma; Radiotherapy
7.  EXPERIMENTAL SYPHILIS IN THE RABBIT  
In a series of more than 200 rabbits in which generalized lesions were observed following local inoculation with Treponema pallidum, there were a number of animals in which characteristic lesions were noted upon mucous membranes or along mucocutaneous borders. These lesions were distributed with about equal frequency between the nose or nasolacrimal system and the eyelids on the one hand, and the genital and anal regions on the other. The lips and buccal mucosa appeared to be less subject to localized infections unless the papillomatous growths noted on the lips and under side of the tongue should prove to be in some way connected with such an infection. In many instances, the local reaction was initiated by an acute inflammatory process, and in the case of nasal and genital infections, a definite exudate was formed. The succeeding stages of the reaction consisted in an infiltration of the parts involved, together with a variable degree of proliferation of fixed tissue cells, leading eventually to necrosis and ulceration. The resulting lesions differed according to their location and the character of the reaction in the individual case. Localized infections of the nose occurred in several forms, first, as a rather diffuse affection of the nasal mucosa characterized by the presence of a mucopurulent exudate, second, as a more or less circumscribed process of infiltration with an especial predilection for the region of the anterior nares, and third, as a granulomatous process involving the alæ in particular. Involvement of the nasal mucosa was very commonly associated with lacrimal overflow and with some degree of conjunctivitis. The lesions of the eyelids were usually small, elevated papules or lesions of an ulcerative character some of which were surrounded by a zone of infiltration. In exceptional instances, large granulomatous lesions occurred along the margins of the lower lids. Infection of the penis and sheath gave rise to conditions analogous to those of the nose. In one group of animals, there was a diffuse affection characterized by redness and swelling of the parts with a mucopurulent exudate, in another there were circumscribed or diffuse infiltrations, while in a third the lesions formed were indurated granulomatous masses. Secondary necrosis with erosion or ulceration was a common feature of all these conditions. Localized infections in the region of the anus differed from those in other localities chiefly in the absence of an exudative group of affections and in the frequency with which lesions of a papillomatous type occurred. Lesions of mucous membranes and mucocutaneous borders developed at periods of time varying from a few weeks to several months after inoculation. Most of them were rather enduring and in several instances persisted in an active condition for considerably more than a year.
PMCID: PMC2128283  PMID: 19868457
8.  Gastritis cystica profunda recurrence after surgical resection: 2-year follow-up 
Background
Gastritis cystica profunda (GCP) is an uncommon disease characterized by multiple cystic gastric glands within the submucosa of the stomach.
Case description
Here, we present a case of a 63-year-old man with intermittent epigastric discomfort in whom gastroscopy revealed multiple irregular elevated nodular lesions with smooth surfaces at the anterior of the antrum. Surgical resection of the nodular lesions was performed, and the diagnosis of gastritis cystica profunda (GCP) was confirmed by histological examination. Another elevated nodular lesion approximately 10 mm in diameter with an ulcer was found on the gastric side of the remnant stomach near the resection side from 6 to 24 months after the surgical resection. Endoscopic ultrasonography (EUS) and repeated biopsies of the new elevated lesion were performed. Homogeneous, anechoic masses originating from the submucosa without gastric adenocarcinoma in histological examination showed GCP recurrence may occur.
Conclusions
We report a case of GCP recurrence within 6 months after surgical resection. GCP should be considered in the differential diagnosis of elevated lesions in the stomach.
doi:10.1186/1477-7819-12-133
PMCID: PMC4030027  PMID: 24885818
Gastritis cystica profunda; Gastric cancer; Endoscopic ultrasonography
9.  EXPERIMENTAL SYPHILIS IN THE RABBIT  
From the study of a large series of rabbits with outspoken manifestations of generalized syphilis, lesions of the skin and appendages were found to constitute one of the largest and most varied groups of such affections. The conditions noted consisted of alopecias, onychia and paronychia, and lesions of the skin proper. It was found to be a matter of some difficulty to make a positive diagnosis of syphilitic alopecia, but there were three and possibly four conditions which appeared to be attributable to such an infection. The first of these took the form of a general or local roughening of the coat with falling of the hair which produced the typical moth-eaten appearance associated with syphilitic alopecia in the human subject. A second form of alopecia was essentially an abnormal looseness of the hair which permitted large areas of the body to be completely denuded. The third type of alopecia was associated with definite skin changes, and the hair was readily removable together with an adherent mass of epithelial scales. Paronychia was comparatively rare but was readily recognized by a characteristic infiltration and exfoliation of the skin about the base of the nails. The incidence of onychia is uncertain. Late in the course of the investigation it was found that alterations in the nails which were not entirely characteristic in themselves might occur in consequence of a syphilitic involvement of the nail beds which could not be detected by ordinary methods of examination. The cases which were recognized as syphilitic were those which showed an associated paronychia. Lesions of the skin were found to be one of the most frequent manifestations of a generalized infection in the rabbit. These lesions were divided into three classes: first, granulomatous lesions, second, infiltrations, and third, erythemata. The granulomata were lesions of a fleshy character which tended to grow to a very large size and presented all the characteristics of circumscribed primary lesions of the scrotum. The conditions described as cutaneous infiltrations included two general types of lesions, one a flattened and rather diffuse process, the other an elevated and sharply circumscribed papule. As a class, these lesions were very prone to secondary alterations and in this way gave rise to a great variety of conditions which in general resembled the diffuse primary lesions of the scrotum and the papular lesions resulting from local dissemination. A third type of lesion resembling the macular erythemata of man was observed in a small number of animals, and while no definite proof of the specific origin of these lesions was obtained, the evidence available was strongly suggestive. In addition, several other cutaneous affections were noted which have not as yet been thoroughly investigated. It is suggested, however, that these processes may bear some relation to infection with Treponema pallidum.
PMCID: PMC2128292  PMID: 19868455
10.  Case of Secondary Syphilis Presenting with Unusual Complications: Syphilitic Proctitis, Gastritis, and Hepatitis▿ 
Journal of Clinical Microbiology  2011;49(12):4394-4396.
We report the first known case of syphilis with simultaneous manifestations of proctitis, gastritis, and hepatitis. The diagnosis of syphilitic proctitis and gastritis was established by the demonstration of spirochetes with anti-Treponema pallidum antibody staining in biopsy specimens. Unusual manifestations of secondary syphilis completely resolved after 4 weeks of antibiotic therapy.
doi:10.1128/JCM.01240-11
PMCID: PMC3233005  PMID: 21998411
11.  Progressive painless lower limbs weakness in a dialyzed patient: undiagnosed tertiary syphilis: a case report 
Cases Journal  2010;3:23.
Introduction
Syphilis is a sexually transmitted disease, remaining under-estimated, under-recognized due to the variability of clinical presentation and ageing of the population with chronic comorbidities. Hence, some manifestations of the past are nowadays superimposed on the course of chronic diseases. Clinical suspicion should be guided by past medical history of contracting any other sexual disease in a heterosexual person or man who has sex with man.
Case presentation
We describe a rare case of tertiary syphilis in a hemodialyzed diabetic patient whom was career of chronic liver disease due to the evolution of chronic hepatitis B virus infection complicated by a hepatocellular carcinoma. Initial orientation in diagnosing this rare presentation of progressive painless lower limbs weakness was attributed to possible side effects of ongoing anti viral therapy including lamivudine and adefovir. We continued administering both drugs while patient notified a spectacular improvement under Ceftriaxone therapy introduced empirically for a possible chest infection. Routine ophthalmologic examination realized in a teaching hospital, scheduled without knowing the course of late infection showed the presence of a syphilitic uveitis.
Conclusion
This case emphasizes the need for a high index of clinical suspicion for syphilis before the occurrence of symptoms related to its end organ damage dominated by neurosyphilis form. Early diagnosis is the key to preventing significant morbidity and mortality and improving prognosis. However, in the setting of chronic diseases such as chronic kidney diseases either before setting up methods of renal replacement therapy or under immune-suppressive therapy; clinical presentation might resemble any disease, delaying the certitude of the diagnosis by prescribing a rapid plasma reagin.
doi:10.1186/1757-1626-3-23
PMCID: PMC2836290  PMID: 20180955
12.  A Case of Early Gastric Cancer Arising from Gastritis Cystica Profunda Treated by Endoscopic Submucosal Dissection 
Case Reports in Gastroenterology  2014;8(3):270-275.
Gastritis cystica profunda (GCP) consists of hyperplasia and cystic dilatation of the gastric glands extending into the submucosa. It occurs in the residual stomach post surgery and in the unoperated stomach. GCP is considered a benign lesion, but there is controversy about its malignant potential. We report a case of early gastric cancer arising from GCP treated by endoscopic submucosal dissection (ESD) in a 55-year-old unoperated man. Upper gastrointestinal endoscopy revealed a 15-mm diameter submucosal tumor (SMT) in the upper corpus of the stomach. The surface had angiotelectasia and slight depression covered with normal mucosa. Neither ulceration nor erosion was seen. Narrow-band imaging endoscopy showed no abnormalities suggesting gastric cancer. Endoscopic ultrasonography visualized the internally low-echoic SMT, harboring tiny cystic lesions, mainly within the second and third layers of the gastric wall. The SMT was removed by ESD to avoid retention and allow for comprehensive diagnosis. It was diagnosed as GCP with partial well-differentiated adenocarcinoma without involvement of the lateral and deep margins, lymphatic invasion, vascular invasion and perineural invasion. The gastric epithelium comprised normal mucosa without dysplasia. ESD seems to be useful for the diagnosis of SMT, including GCP harboring gastric cancer, and avoids unnecessary surgical procedures.
doi:10.1159/000368076
PMCID: PMC4209264  PMID: 25408629
Endoscopic submucosal dissection; Endoscopic ultrasonography; Gastric cancer; Gastritis cystica profunda; Submucosal tumor
13.  Gastric obstruction secondary to metastatic breast cancer: a case report and literature review 
Introduction
Gastrointestinal tract soft tissues metastasis is a well-known occurrence with invasive lobular breast cancer subtypes. Gastric involvement is more common, with reports of both diffuse and localized involvements. Usually, a gastric localized involvement presents as wall thickening with an appearance similar to that of a gastrointestinal stromal tumour; rarely does a localized metastatic deposit grow aggressively to present as a large tumour causing obstructive symptoms. Our case highlights one such unusual presentation in a patient presenting with non-specific gastrointestinal symptoms. To the best of our knowledge, there have been no previous reports on a similar presentation occurring from a localized metastasis.
Case presentation
A 65-year-old Caucasian woman awaiting an outpatient oral gastroduodenoscopy for symptoms of intermittent vomiting, epigastric pains and weight loss of six weeks’ duration presented acutely with symptoms of haematemesis and abdominal distension. An initial contrast-enhanced computed tomography scan showed a grossly dilated stomach with a locally advanced stenosing tumour mass at the pylorus. Our patient had a history of left mastectomy and axillary clearance followed by adjuvant endocrine therapy for an oestrogen receptor- and progesterone receptor-positive, grade 2, invasive lobular breast cancer. The oral gastroduodenoscopy confirmed the computed tomography findings; biopsies of the pyloric mass on immunohistochemistry stains were strongly positive for pancytokeratin and gross cystic disease fluid proteins, consistent with an invasive lobular breast cancer metastasis. She received a palliative gastrojejunal bypass and her adjuvant endocrine treatment was switched over to exemestane.
Conclusion
Our case highlights the aggressive behaviour of a localized gastric metastasis that is unusual and unexpected. Gastrointestinal symptomatology can be non-specific and, at times, non-diagnostic on conventional mucosal biopsies. A high index of clinical suspicion in patients with a previous history of invasive lobular breast cancer can aid in an early diagnosis and treatment. A combined treatment approach with chemoendocrine therapies achieves remission and improves patient survival.
doi:10.1186/1752-1947-6-232
PMCID: PMC3423049  PMID: 22870880
14.  Congenital syphilis, still a reality 
Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. Even one case of congenital syphilis is a sentinel public health event, since timely diagnosis and treatment of syphilis infected pregnant woman should prevent transmission almost entirely. Here, we are reporting a case of early symptomatic congenital syphilis presented with severe desquamating papulosquamous lesions over multiple body parts along with erosive lesions around oral cavity and nostrils.
doi:10.4103/0253-7184.112941
PMCID: PMC3730478  PMID: 23919058
Congenital syphilis; treponema pallidum; venereal disease research laboratory
15.  Case Report: Neuropathic Arthropathy of the Hip as a Sequela of Undiagnosed Tertiary Syphilis 
Background
Neuropathic arthropathy is characterized by rapidly progressive bone destruction in the setting of impaired nociceptive and proprioceptive innervation to the involved joint. It is seen most commonly in the foot and ankle, secondary to peripheral neuropathy in patients with diabetes mellitus. Other less common sites of involvement may include the knee, hip, shoulder, and spine, depending on the underlying etiology. Neuropathic arthropathy can be associated with tabes dorsalis, a unique manifestation of late, tertiary neurosyphilis that may arise in individuals with untreated syphilis many years after initial infection, and usually involves the knee, or less commonly, the hip.
Case Report
We report the case of a 73-year-old man with neuropathic arthropathy of the hip and tabes dorsalis attributable to previously undiagnosed tertiary syphilis. There was considerable delay in the diagnosis and unnecessary diagnostic testing owing to failure to consider syphilis as the cause.
Literature Review
With the advent of effective antimicrobial therapy and public health campaigns, the relationship between untreated syphilis and neuropathic arthropathy has been primarily a historic point of interest. However, current epidemiologic research suggests a resurgence of syphilis in the United States, with an increased incidence of patients presenting with manifestations of tertiary syphilis from unidentified and untreated primary infections. Treatment options for neuropathic arthropathy of the hip are limited. Arthrodesis has had poor success and treatment with THA has had high complication rates.
Conclusions
Syphilis is not merely a historic cause of neuropathic arthropathy. Neurosyphilis and tabes dorsalis should be considered in the differential diagnosis for patients presenting with rapid joint destruction consistent with Charcot arthropathy and no other apparent cause.
doi:10.1007/s11999-010-1257-0
PMCID: PMC2947698  PMID: 20151233
16.  John Hunter's alleged syphilis 
The allegation that John Hunter suffered from syphilis is challenged. It is suggested that he was the subject of non-luetic vascular disease, evidence for which may be found by a study of his symptoms and autopsy report. It is further suggested that John Hunter's famous inoculation experiment was performed not on himself but on another subject. It is claimed that there is in fact no scientific evidence for attributing John Hunter's illness to syphilis and it is urged that the stigma of this diagnosis should be expunged from his image.
PMCID: PMC2491756  PMID: 324336
17.  18F-fluorodeoxyglucose positron emission tomography/computed tomography findings of gastric lymphoma: Comparisons with gastric cancer 
Oncology Letters  2014;8(4):1757-1764.
The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in numerous malignant tumors, including gastric lymphoma, is well-established. However, there have been few studies with regard to the 18F-FDG PET/CT features of gastric lymphoma. The aim of the present study was to characterize the 18F-FDG PET/CT features of gastric lymphoma, which were compared with those of gastric cancer. Prior to treatment, 18F-FDG PET/CT was performed on 24 patients with gastric lymphoma and 43 patients with gastric cancer. The 18F-FDG PET/CT pattern of gastric wall lesions was classified as one of three types: Type I, diffuse thickening of the gastric wall with increased FDG uptake infiltrating more than one-third of the total stomach; type II, segmental thickening of the gastric wall with elevated FDG uptake involving less than one-third of the total stomach; and type III, local thickening of the gastric wall with focal FDG uptake. The incidence of the involvement of more than one region of the stomach was higher in the patients with gastric lymphoma than in those with gastric cancer. Gastric FDG uptake was demonstrated in 23 of the 24 patients (95.8%) with gastric lymphoma and in 40 of the 43 patients (93.0%) with gastric cancer. Gastric lymphoma predominantly presented with type I and II lesions, whereas gastric cancer mainly presented with type II and III lesions. The maximal thickness was larger and the maximal standard uptake value (SUVmax) was higher in the patients with gastric lymphoma compared with those with gastric cancer. A positive correlation between the maximal thickness and SUVmax was confirmed for the gastric cancer lesions, but not for the gastric lymphoma lesions. There was no difference in the maximal thickness and SUVmax of the gastric wall lesions between the patients without and with extragastric involvement, for gastric lymphoma and gastric cancer. Overall, certain differences exist in the findings between gastric lymphoma and gastric cancer patients on 18F-FDG PET/CT images, which may contribute to the identification of gastric lymphoma.
doi:10.3892/ol.2014.2412
PMCID: PMC4156241  PMID: 25202405
positron emission tomography; computed tomography; gastric lymphoma; gastric cancer
18.  Evaluation of Gastric Lesions Based on Helicobacter pylori and Helicobacter-Like Organisms (HLOs) in Cats; A Histopathological and Bacteriological Study 
Background:
The lesions induced by Helicobacter pylori in a candidate animal model should always be examined thoroughly. The resemblance of these lesions to those observed in humans can indicate whether the usage of this model will contribute to the understanding of the various pathogenic mechanisms involved in the development of human H. pylori-associated diseases.
Objectives:
The aim of this study was to perform a histopathological and bacteriological evaluation of gastric lesions based on H. pylori and Helicobacter-like organisms (HLOs) in cats.
Materials and Methods:
The present study was carried out on 28 cat’s (13 male and 15 female cases) gastric mucosae, which were tested by bacteriological and histopathological methods. Biochemical tests such as catalase, oxidase and urease were utilized in addition to Gram and Giemsa staining.
Results:
This research demonstrated that solely one case of H. pylori was isolated by gastric mucosal culture. Microscopically, the infected stomachs by HLOs comprised a mild to severe diffuse lymphoplasmacytic infiltration into the subglandular and gastric mucosa. Lymphoid follicles were also marked, particularly within pyloric tissues and mostly in displaced mucosal glands. For 75% of the gastritis cases, both HLOs and rapid urease tests were positive, whereas 83% of cases were more than one-year-old with gastritis. Furthermore, 75% of cats indicated gastritis, though 25% encompassed no gastritis; hence 20% had negative results for the rapid urease test and 25% for the Giemsa staining test. Such results may indicate that cats without gastritis were considered as free of HLOs pathogenic bacteria.
Conclusions:
These results suggest that most cases of gastritis were located in the antral region. Additionally, the isolation of H. pylori from domestic cats raises the possibility of zoonotic characteristics for the slightly pathogen; therefore transmission occurs from cats to human and vice versa.
doi:10.5812/jjm.9129
PMCID: PMC4217658  PMID: 25371810
Helicobacter pylori; Cat Diseases; Mucous Membrane
19.  EXPERIMENTAL SYPHILIS IN THE RABBIT  
A study was made of the infections produced in rabbits inoculated in the testicles with two strains of Treponema pallidum which had been carried in rabbits for several years. Infection resulted in all instances; the incubation period varied as a rule between 2 and 6 weeks and under properly chosen conditions could be reduced to approximately 3 weeks or less. The resulting infection pursued a typically cyclic or relapsing course which affected both the spirochetes and the associated lesions in the testicle. The spirochetes in the local lesions exhibited periodic changes less marked and less regular but identical in character with the changes which occur in the blood in cases of relapsing fever. The lesions in the testicle also showed periods of active development and quiescence or regression which followed closely upon the changes exhibited by the spirochetes. The specific reaction in the testicle showed considerable variation in the speed and sharpness with which successive phenomena occurred as well as in the character and extent of the processes themselves. These reactions were of two fundamental types. In one group of animals, the reaction was characterized by an intense cycle of acute exudation and infiltration with a lesser degree of proliferation, followed by crisis and subsequent recurrence of secondary cycles of proliferative reaction of a minor degree. In the other group of animals, the reaction was more chronic in character and consisted largely of infiltration and proliferation. The progress of the reaction was more gradual, and sharp alterations in its course were absent. The infection progressed by a succession of stages with slight and irregular remissions. In a third group of animals, the reaction was subacute, combining at the same time the processes of exudation, infiltration, and proliferation. The first cycle of reaction was fairly acute and terminated in a definite crisis with moderate regression which in turn was followed by recurrence and more or less pronounced secondary cycles of proliferation. In all cases of outspoken infection, there was diffuse involvement of testicle, tunic, epididymis, and cord, but as the infection progressed, the lesions underwent many transformations, so that a variety of lesions was formed from processes which in the beginning were of a common type. Eventually, the reaction became more irregular and the infection became centered in one or more foci which were commonly situated in the epididymis, tunics, scrotum, or mediastinum testis. These centers served as residual foci of infection. The duration of the testicular process was found to be very variable. In some animals, the entire reaction consisted of but a single sharp cycle, and the local infection was terminated by crisis within 4 to 6 weeks after inoculation. As a rule, the period of active infection was from 2 to 4 months, and quiescent or inactive lesions not infrequently lasted for from 4 to 6 months. In exceptional instances, local infection persisted for more than a year.
PMCID: PMC2180204  PMID: 19868411
20.  Gastric Adenocarcinoma Presenting with Gastric Outlet Obstruction in a Child 
Gastric carcinoma is extremely rare in children representing only 0.05% of all gastrointestinal malignancies. Here, we report the first pediatric case of gastric cancer presenting with gastric outlet obstruction. Upper endoscopy revealed a markedly thickened antral mucosa occluding the pylorus and a clean base ulcer 1.5 cm × 2 cm at the lesser curvature of the stomach. The narrowed antrum and pylorus underwent balloon dilation, and biopsy from the antrum showed evidence of Helicobacter pylori gastritis. The biopsy taken from the edge of the gastric ulcer demonstrated signet-ring-cell type infiltrate consistent with gastric adenocarcinoma. At laparotomy, there were metastases to the liver, head of pancreas, and mesenteric lymph nodes. Therefore, the gastric carcinoma was deemed unresectable. The patient died few months after initiation of chemotherapy due to advanced malignancy. In conclusion, this case report underscores the possibility of gastric adenocarcinoma occurring in children and presenting with gastric outlet obstruction.
doi:10.1155/2014/527471
PMCID: PMC3965945  PMID: 24707411
21.  Emphysematous Gastritis Associated with Invasive Gastric Mucormycosis: A Case Report 
Journal of Korean Medical Science  2007;22(5):923-927.
Emphysematous gastritis is a rare form of phlegmonous gastritis, characterized by air in the wall of the stomach due to invasion by gas-forming microorganisms. The most commonly involved microorganisms are streptococci, Escherichia coli, Pseudomonas aeruginosa, Clostrodium perfrigens and Staphylococcus aureus. Gastrointestinal mucormycosis is another rare condition, which is most frequently occurs in the stomach. Because emphysematous gastritis associated with invasive gastric mucormycosis is an extremely rare clinical condition and both are life-threatening diseases, early precise diagnosis and early treatment should be done to avoid mortality. Herein we present an extremely rare case of emphysematous gastritis associated with invasive gastric mucormycosis. A 43-yr-old man, suffering from alcoholism and diabetes, has experienced diffuse abdominal pain for 4 days. Abdominal computed tomography scan demonstrated gas within the stomach wall. A histologic examination of the total gastrectomy specimen showed several gas-filled bubbles in the wall, along with numerous fungal hyphae throughout the necrotic stomach wall. He died of multiorgan failure secondary to disseminated mucormycosis, despite the intensive medical therapy.
doi:10.3346/jkms.2007.22.5.923
PMCID: PMC2693866  PMID: 17982248
Gastritis; Stomach; Mucormycosis
22.  Helicobacter pylori gastric infection in gnotobiotic beagle dogs. 
Infection and Immunity  1990;58(8):2606-2612.
Establishment of infection with Helicobacter pylori and gastritis in nonhuman species is currently only successful in gnotobiotic piglets. This study was designed to determine whether H. pylori will colonize the gastrointestinal tract of gnotobiotic dogs. Gnotobiotic beagle pups were derived by standard methods. Group A (five dogs) was orally challenged with 3 x 10(8) H. pylori at 7 days of age. Group B (two dogs) received only peptone water but was contact-exposed beginning on day 23 postinfection (p.i.). Necropsy was performed on dogs on day 30 p.i. H. pylori colonized the stomach of all dogs (groups A and B). Urease map analysis correlated with the microbiologic findings and indicated that the density of colonization was less than that observed in human tissue. Organisms were also recovered from the pharynx, esophagus, duodenum, and rectum of 1, 2, 2, and 1 dog, respectively. All group A and one group B dog developed serum immunoglobulin G specific for H. pylori by day 30 p.i. Gross lesions were restricted to the stomach and consisted of small (less than 1 mm) lymphoid follicles. Microscopically, there were focal to diffuse lymphoplasmacytic infiltrates with follicle formation and mild to moderate infiltration of neutrophils and eosinophils in the gastric lamina propria. With the Warthin-Starry silver stain, organisms were seen on the surface of the gastric epithelial cells, beneath the mucus layer. We conclude that H. pylori colonizes the stomachs of gnotobiotic dogs for at least 1 month and the lesions resemble those seen in humans. H. pylori is transmissible by contact from infected to noninfected dogs.
Images
PMCID: PMC258862  PMID: 2370111
23.  EXPERIMENTAL SYPHILIS IN THE RABBIT  
From a study of the reaction to scrotal inoculation with Treponema pallidum in alarge series of rabbits, it was found that the specific reaction presented the following characteristics. In general, the reaction in the scrotum became apparent within 7 to 14 days after inoculation but was subject to considerable variation. The early reaction took the form of an edematous swelling and congestion associated with a new growth of vessels or of an infiltration with more or less proliferation of fixed tissue cells. These reactions were either confined to a small circumscribed area of the scrotum or were of a diffusely spreading character, and as the infection advanced, the infiltration and proliferation together with such secondary changes as exfoliation, necrosis, and ulceration became the most conspicuous features of the reaction. The course of the reaction in the scrotum was essentially the same as that in the testicle; that is, it was periodic in character and was marked by a phase of active progression followed by quiescence or regression and renewed activity. The scrotal reaction resembled that in the testicle also in the varying character of the reaction, appearing at times as a circumscribed focus of reaction and later becoming diffuse, or first as a diffuse reaction which subsequently became more localized. The lesions produced in consequence of this reaction were of two general types —one a circumscribed indurated granulomatous lesion closely resembling the human chancre, the other a diffuse infiltration more analogous to the secondary skin lesions of man. Both groups of lesions presented the greatest degree of individual variations and possessed no fixed status but were subject to frequent and marked transformations. After a period of from a few weeks to many months, the lesions in the scrotum disappeared spontaneously.
PMCID: PMC2128247  PMID: 19868423
24.  A case of hypereosinophilic syndrome presenting with intractable gastric ulcers 
We report a rare case of hypereosinophilic syndrome (HES) presenting with intractable gastric ulcers. A 71-year-old man was admitted with epigastric pain. Initial endoscopic findings revealed multiple, active gastric ulcers in the gastric antrum. He underwent Helicobacter pylori (H pylori) eradication therapy followed by proton pump inhibitor (PPI) therapy. However, follow-up endoscopy at 4, 6, 10 and 14 mo revealed persistent multiple gastric ulcers without significant improvement. The proportion of his eosinophil count increased to 43% (total count: 7903/mm3). Abdominal-pelvic and chest computed tomography scans showed multiple small nodules in the liver and both lungs. The endoscopic biopsy specimen taken from the gastric antrum revealed prominent eosinophilic infiltration, and the liver biopsy specimen also showed eosinophilic infiltration in the portal tract and sinusoid. A bone marrow biopsy disclosed eosinophilic hyperplasia as well as increased cellularity of 70%. The patient was finally diagnosed with HES involving the stomach, liver, lung, and bone marrow. When gastric ulcers do not improve despite H pylori eradication and prolonged PPI therapy, infiltrative gastric disorders such as HES should be considered.
doi:10.3748/wjg.15.6129
PMCID: PMC2797674  PMID: 20027690
Gastric ulcer; Hypereosinophilic syndrome
25.  Localized gastric amyloidosis differentiated histologically from scirrhous gastric cancer using endoscopic mucosal resection: a case report 
Introduction
Amyloidosis most often manifests as a systemic involvement of multiple tissues and organs, and an amyloidal deposit confined to the stomach is extremely rare. It is sometimes difficult to provide a definitive diagnosis of localized gastric amyloidosis by biopsy specimen and diagnosis of amyloidosis in some cases has been finalized only after surgical resection of the stomach.
Case presentation
A 76-year-old Japanese woman with epigastric discomfort underwent an esophagogastroduodenoscopy procedure. The esophagogastroduodenoscopy revealed gastric wall thickening, suggesting scirrhous gastric carcinoma, at the greater curvature from the upper to the lower part of the gastric corpus. A biopsy specimen revealed amyloid deposits in the submucosal layer with no malignant findings. We resected a representative portion of the lesion by endoscopic mucosal resection using the strip biopsy method to obtain sufficient tissue specimens, and then conducted a detailed histological evaluation of the samples. The resected specimens revealed deposition of amyloidal materials in the gastric mucosa and submucosa without any malignant findings. Congo red staining results were positive for amyloidal protein and exhibited green birefringence under polarized light. Congo red staining with prior potassium permanganate incubation confirmed the light chain (AL) amyloid protein type. Based on these results, gastric malignancy, systemic amyloidosis and amyloid deposits induced by inflammatory disease were excluded and this lesion was consequently diagnosed as localized gastric amyloidosis. Our patient was an older woman and there were no findings relative to an increase in gastrointestinal symptoms or anemia, so no further treatment was performed. She continued to be in good condition without any finding of disease progression six years after verification of our diagnosis.
Conclusions
We report an unusual case of primary amyloidosis of the stomach resembling scirrhous gastric carcinoma. This case of localized gastric amyloidosis was differentiated from scirrhous gastric cancer after performing endoscopic mucosal resection without an invasive surgical resection, as endoscopic mucosal resection provided sufficient tissue specimens from the lesion to make an accurate histological evaluation.
doi:10.1186/1752-1947-6-231
PMCID: PMC3438062  PMID: 22863214
Endoscopic mucosal resection (EMR); Localized gastric amyloidosis; Scirrhous gastric cancer

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