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TOPLINE:

In a retrospective single-center series, condyloma lata, a manifestation of secondary syphilis, showed a consistent histopathologic pattern on routine hematoxylin and eosin stain, including pseudoepitheliomatous hyperplasia, lymphoplasmacytic inflammation, and marked neutrophilic exocytosis within the eroded epidermis.

METHODOLOGY:

• Secondary syphilis presents with a broad range of clinical and microscopic findings, which can make diagnosis difficult. Condyloma lata can be mistaken for other disorders, including carcinoma.
• To address this, researchers conducted a retrospective review of patients with a histopathologic diagnosis of syphilis from January 2010 to February 12, 2025, at Thomas Jefferson University.
• A total of 28 cases of syphilis were reviewed, of which 12 patients (average age, 36.8 years; 50% female) were diagnosed with condyloma lata, yielding 15 histopathologic cases; 12 of the 15 cases were in the anogenital region, and three were extragenital (nose, oral cavity, and cheek).
• Histopathologic findings for each case were reviewed independently by two pathologists, along with clinical information, and were categorized into condyloma lata or another manifestation of secondary syphilis.

TAKEAWAY:

• All 15 condyloma lata lesions presented with pseudoepitheliomatous hyperplasia characterized by bulbous hyperplasia and areas of jagged, irregular hyperplasia; epithelial cells showed an enlarged, monomorphous appearance with glassy pink cytoplasm.
• All lesions had a consistent inflammatory pattern, with a lichenoid to dense lymphoplasmacytic dermal infiltrate with “a variable number of neutrophils.”
• All condyloma lata lesions showed small upper epidermal spongiotic vesicles and positive spirochete staining with numerous organisms in the lower third of the epidermis.
• In non-condyloma lata cases of secondary syphilis in the remaining 16 cases, the most common predominant pattern was a superficial and deep perivascular dermatitis in 6 of 19 cases (31.6%); plasma cells were present in 17 of 19 cases (89.5%).

IN PRACTICE:

“This series confirms the presence of reliable, reproducible histopathologic features in condyloma lata,” with all specimens in this series showing pseudoepitheliomatous hyperplasia, a lichenoid to dense lymphoplasmacytic infiltrate, and “numerous neutrophils within an eroded epidermis, forming an overlying purulent scale-crust.” “Recognizing these features,” the authors of the study added, “can prevent misdiagnosis and ensure appropriate clinical management, particularly at extragenital sites where syphilis may be clinically unsuspected.”

SOURCE:

The study, led by Jordan T. Hyde, MD, and Jason B. Lee, MD, Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, was published online on June 4 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

Limitations included the small sample size and retrospective design. Additionally, an unknown number of false-negative non-condyloma lata cases were not included in the analysis.

DISCLOSURES:

The study did not receive any funding. The authors disclosed having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.