Pancreatic syphilis mimicking cancer

Since the incidence of syphilis is increasing, the number of pancreatic lesions is expected to increase too. Pancreatic syphilis can be congenital or acquired. The pancreas is affected in 10–80% of patients with congenital syphilis. Infection of the pancreas occurs most often during the second half of pregnancy. Morphologically, there are five types of congenital pancreatic syphilis: gummy; diffuse interstitial pancreatitis, which can be combined with multiple miliary gummas and atrophy of the pancreatic parenchyma; indurative fibrous type; with atrophy of the lobules (atrophic type); and with a predominant lesion of the pancreatic ducts —sialangitis pancreatica. In congenital syphilis, the pancreatic head is mostly affected. Early and severe damage to the islets of Langerhans is typical. Acquired pancreatic syphilis is less common than congenital syphilis. Morphologically, it has three types: the edematous-infiltrative type, in secondary syphilis; the gummy type (pancreatitis gummosa), in tertiary syphilis; and sclerotic pancreatitis, or pancreatitis sclerotica, or “syphilitic cirrhosis of the pancreas”. The latter type is usually the outcome of the first two morphological types. Clinically acquired pancreatic syphilis proceeds according to the type of recurrent chronic pancreatitis, i.e., with periodic exacerbations (pancreatic attacks), but the pain is rarely intense, and the phenomenon of “deviation” of enzymes into the blood is rarely observed. This clinical type more often corresponds to the edematous-infiltrative morphological type of syphilitic organ damage, and less often to the gummy type. It should be noted that acquired pancreatic syphilis occurs against the background of specific damage to the liver, heart, aorta, kidneys, skin, stomach, central nervous system, etc. The differential diagnosis of gummy pancreatic lesions and pancreatic cancer is especially complicated. Antisyphilitic treatment should be administered. Due to a toxic-allergic reaction, the symptoms of pancreatitis may exacerbate at the start of a specific therapy.