Tertiary Syphilis - Erler Zimmer 3D anatomy Series MP2113

This dissection model highlighting tertiary syphilis is part of the exclusive Monash 3D anatomy series, a comprehensive series of human dissections reproduced with ultra-high resolution color 3D printing.

Clinical History.

A 66-year-old man presents with postprandial epigastric pain. Of note, he is deaf and nonverbal. On examination, he has a tender epigastrium and several tender nodular lesions on his forehead and scalp. Blood tests show low hemoglobin, impaired liver function, and are positive for anti-treponemal antibodies. After hospitalization, she has major gastrointestinal bleeding, and this is despite surgery.

Pathology

This specimen is the vault of the patient's skull. On the external surface there are multiple necrotic lesions circumscribed in the parasagittal area to the left of the midline. The lesions are brown in color and measure up to 3-4 cm in maximum diameter. The lesions have eroded the outer table of the skull, and the adjacent periosteum is thickened with fibrinous inflammation. These lesions are chronic syphilitic lesions or gums of the skull, which are characteristic of benign tertiary syphilis.

Additional Information.

Syphilis is a chronic infection caused by the spirochete bacterium Treponema pallidum. Sexually transmitted infection is the most common, but it can also be acquired congenitally from transplacental transmission of the bacteria. Those with the highest risk of infection include those of sexually active age, intravenous drug users, patients with HIV infection, and homosexual males. Syphilis infection rates decreased significantly with the introduction of penicillin in 1943, which remains the main treatment today. However, infection rates have been increasing since the early 2000s.

Syphilis is divided into three stages with distinct clinical and pathological features with characteristic proliferative endarteritis affecting small vessels. Primary syphilis usually occurs 3 weeks after the initial infection. This typically manifests as a single painless, erythematous lesion called chancre at the site of inoculation. Syphilis spreads throughout the body from this chancre, which then heals spontaneously after 3-6 weeks.
Secondary syphilis occurs weeks to a few months after resolution of the primary cancer in 75% of untreated patients. During this stage, patients commonly have generalized symptoms, such as malaise, lymphadenopathy, and rashes. Palm/plantar eruptions are the most common site, but skin eruptions may also be widespread. These rashes may be maculopapular, scaly, or pustular. Condylomata lata are elevated gray plaques that arise on moist mucous membranes, such as the oral or genital regions. Other less common manifestations include hepatitis, gastrointestinal invasion or ulceration, and neurosyphilis-discussed below.

Tertiary syphilis has three main features: cardiovascular syphilis, neurosyphilis, and gummy syphilis. These occur after a latency period of 5 years or more in one-third of untreated patients.

Cardiovascular syphilis involves an aortitis for which the exact pathophysiology is unclear. The vasculitis involves the ascending thoracic aorta leading to progressive dilatation of the aortic root that can cause aortic valve insufficiency and aneurysms. Clinical manifestation usually occurs 15-30 years after the initial infection.

Neurosyphilis may be symptomatic or asymptomatic. It occurs in 10% of untreated patients. Early clinical manifestations include headache, meningitis, hearing loss, and ocular involvement, most commonly uveitis, causing vision loss. Late manifestations may occur up to 25 years after initial infection. The main features are meningovascular neurosyphilis, paretic neurosyphilis, and dorsal tabas. Meningovascular involvement involves chronic meningitis and endarteritis that can lead to
strokes. Tabes dorsalis is caused by degeneration of the posterior columns within the spinal cord. This causes loss of proprioception, ataxia, loss of pain sensation, and loss of reflexes. Paretic neurosyphilis is caused by invasion and damage to the brain parenchyma, most commonly the frontal lobes. This leads to progressive cognitive impairment and mood disorders.

Gum syphilis is characterized by the formation of nodular lesions most commonly bony, cutaneous, and mucosal lesions of the upper airway and mouth called gums. Gums can occur anywhere, including the viscera. Gum formation is rare but occurs more frequently in patients with HIV infection. Skeletal involvement causes pain and pathologic fractures.

What advantages does the Monash University anatomical dissection collection offer over plastic models or plastinated human specimens?

• Each body replica has been carefully created from selected patient X-ray data or human cadaver specimens selected by a highly trained team of anatomists at the Monash University Center for Human Anatomy Education to illustrate a range of clinically important areas of anatomy with a quality and fidelity that cannot be achieved with conventional anatomical models-this is real anatomy, not stylized anatomy.
• Each body replica has been rigorously checked by a team of highly trained anatomists at the Center for Human Anatomy Education, Monash University, to ensure the anatomical accuracy of the final product.
• The body replicas are not real human tissue and therefore not subject to any barriers of transportation, import, or use in educational facilities that do not hold an anatomy license. The Monash 3D Anatomy dissection series avoids these and other ethical issues that are raised when dealing with plastinated human remains.