RU2325648C1 - Method of diagnostics of stomach mucous coat inflammatory infiltration accompanied by syphilis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for diagnostics of stomach mucous coat inflammatory infiltration accompanied by syphilis. Invention implies morphometric analysis of stomach mucous biopsy material with detection of quantitative contents of plasmacytes and biopsy material cell density. If plasmacytes count 45.7±6.5%, biopsy material cell density is 802±94% per 100 mc² infiltration of syphilitic origin is diagnosed.

EFFECT: improved accuracy and information value of method and its simplification.

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Description

The invention relates to the field of medicine, dermatovenerology and can be used to diagnose infiltrates in patients with syphilis.

Closest to the proposed one is a method for diagnosing infiltrate, which consists in sampling a gastrobioptate and the subsequent identification of Tr.pallidum in gastrobiopsy specimens using the silvering method, however, in everyday practice, the implementation of this method is technically quite complicated [1], its accuracy is also insufficient, because gastric juice contributes to the death of the pathogen, which leads to a decrease in detectability.

A new technical problem is to increase the accuracy and information content of the method while simplifying the method.

To solve the problem in a method for the diagnosis of inflammatory infiltrate of the gastric mucosa in patients with syphilis, which consists in the collection and study of biopsy material of the gastric mucosa and its morphological study, an additional morphometric study of the biopsy specimen is carried out with determination of the quantitative content of plasmacytes and the density of the cellular composition of the biopsy specimen and at the content of plasmacytes 45, 7 ± 6.5% and a density of the cellular composition of the biopsy, equal to 802 ± 94% per 100 μm ² , diagnosed with syphilitic infiltration nature.

The method is as follows: in patients with positive treponemal tests and in the presence of gastroenterological complaints, an esophagogastroduodenoscopy is performed and, if an infiltrate is detected, the material is taken, which is immediately placed in a 10% formalin solution. Fragments are carried out in alcohols of increasing concentration according to the standard procedure [2]. Sections 5-6 μm thick are stained with eosin - hemotoxylin, picrofuxin according to Van Gieson, alcian blue (for mucus).

As criteria for assessing chronic gastritis use the Sydney System [3]. The degree of activity, the severity of metaplasia, atrophy of the mucosa and the degree of contamination with Helicobacter pylori are assessed.

The composition of the inflammatory infiltrate is calculated - the specific gravity (in%) of each cell form (mast cells, eosinophilic leukocytes, neutrophilic leukocytes, lymphocytes, monocytes, plasma cells, fibroblasts). In addition, the density of the inflammatory infiltrate per unit area (per 100 μm ² ) is calculated, and when the plasmacyte content is 45.7 ± 6.5% and the density of the cellular composition of the biopsy is equal to 802 ± 94% per 100 μm ^{2, a} syphilitic infiltrate is diagnosed.

The proposed criteria were obtained on the basis of an analysis of the data of a clinical study of 103 patients who complained of complaints from the gastroduodenal zone with a positive complex of serological reactions to syphilis and had complaints from the gastroduodenal zone. In the examined group, the age range of patients ranged from 15 to 42 years for women, from 16 to 52 years for men. All patients underwent gastroscopic examination of the stomach with a sampling of biopsy material. In 50 of the examined patients, a pathology of the gastric mucosa was found, in 15 pathology of the duodenum. Patients underwent specific therapy (a course of antibiotics), after which, for 6 months, pathology and complaints from the gastroduodenal zone were not found.

Example 1

Patient N., born in 1954, on April 16, 2004, was admitted to the hospital clinic of the Siberian State Medical University as an emergency with complaints of lack of appetite for a month, weight loss, nausea, noise in the head, dizziness, to relieve vomiting on his own , the last 10 days refused food.

From the history of the disease. Considers herself sick since April, when he notes the appearance of pain in the chest. Associates his condition with hypothermia. The pain in the chest gradually subsided, but there was an aversion to food.

From the history of life. Past diseases: childhood infections, pneumonia at the age of 30 years, SARS.

Objective inspection. General condition is satisfactory. The skin is dry, turgor is reduced. The sclera is icteric. Vesicular breathing. Heart sounds are deaf, rhythmic, heart rate 88 per minute, blood pressure 90/60 mm Hg The tongue is wet, coated with a white coating. The abdomen is soft, not swollen, painful in the left hypochondrium on palpation. Liver on the edge of the costal arch. The spleen is not enlarged. The symptom of Pasternatsky is negative. Urinating is painless. The chair is decorated daily.

Survey EGDS from 04.17.2004. We pass the esophagus, there are no defects in its mucosa. The socket of the cardia closes completely. In the lumen of the stomach a small amount of fluid, mucus. The gastric mucosa, starting from in / 3 and distal to the antrum, has a flattened appearance, contains superficial, fibrin-coated, polygonal shapes that tend to merge mucosal defects, which are mainly localized on the back wall and slight curvature at the level of the angle of the stomach. Peristaltic activity of the gastric wall of the proximal stomach is absent. On palpation, the mucosa at the angle and n / 3 of the body is rehydrated, with some difficulty it is taken into the forceps, does not stretch. Biopsy - 5 fr., Cytology - 2 glasses. The gatekeeper is round in shape, closes completely. Onion 12p. guts without pathology.

Conclusion: there was an impression of the presence of an infiltratively spreading organic lesion of the proximal stomach.

X-ray of the stomach: infiltrative cancer (?) Of the middle third of the stomach.

A study according to the proposed method.

Conclusion of the pathomorphological study: widespread inflammatory infiltration involving the submucosal layer. Neutrophilic and eosinophilic leukocytes are part of the infiltrates. In a significant amount, lymphocytes and plasma cells, dysplasia of the 2nd degree are found.

The composition of the inflammatory infiltrate: mast cells - 0%; eosinophils - 8%; neutrophils - 52%; lymphocytes - 23.2%; monocytes - About%; plasma cells - 45.7%; fibroblasts - 17.2%; density - 802% per 100 μm ² .

General blood test: within the age norm.

Diagnosis: Inflammatory infiltration of the gastric mucosa of syphilitic nature.

From the anamnesis it is known that 2 years ago had sexual contact with a stranger. Before going to the clinic, I was not examined or treated anywhere. The Wasserman reaction is sharply positive (4+), the microreaction is sharply positive (4+), the Kahn reaction is sharply positive (4+), the reagent titer is 1:60.

Penicillin was treated with 1,000,000 units every 4 hours for 28 days. After the treatment, the endoscopy was performed again: the esophagus is freely passable, the gastric mucosa is pale pink in color, shiny. At a distance of 5 cm from the outlet, a linear formed scar up to 3 cm in length is visible on the lesser curvature. The mucous membrane in the region of it is slightly hyperemic, swollen, palpation soft, easily taken into forceps, and is displaceable. The angle is not deformed. The bulb is freely passable, the color of the mucous membrane is pink.

Example 2

Woman N., 17 years old, underwent an outpatient examination at the clinic at the place of residence. Complaints when referring to pain in the epigastric region, nausea, belching. Sick for 3-4 weeks.

Complete blood count: Hb 116 g / l, er. 3.4-10 12 / l, l-you 9.2-10 ⁹ / l, s. 63%, lymph. 22%, mon 15%, ESR 17 mm / h.

Esophagogastroduodenoscopy (endoscopy): esophagus, cardia outlet without pathology. The stomach is of normal size and shape, contains mucus. The gastric mucosa in the distal region is edematous and hyperemic, contains many surface defects from 0.2 to 1.0 cm in diameter with hemorrhagic plaque. The angle is not deformed. The gatekeeper is round in shape, closes completely. Bulb of the duodenum of the normal volume, edematous and hyperemic mucosa.

Zak-zenie: Distal erosive and ulcerative gastritis with hemorrhagic component. Catarrhal bulbitis. Pathological examination of the biopsy: gastric mucosa with dense lymphocytic infiltration, dysplasia of the 2nd degree.

Serological examination revealed DAC - sharply positive results - 4+, titer (1:16). No complaints. Objectively: Visible mucous membranes are free of rash. The skin of the upper limbs, abdomen, hips - clean. On the soles are single papules.

Diagnosed with secondary recurrent syphilis.

A study according to the proposed method. Morphometric examination of the biopsy revealed 41.2% of plasmacytes, the density of cell infiltrate 806 per 100 μm ² .

The patient was referred to a dermatovenerologic dispensary to receive specific therapy.

Thus, the proposed method allows with high accuracy, informativeness to diagnose the nature of infiltrates of the gastric mucosa in patients with syphilis, which makes it possible to choose the most appropriate treatment regimen for this category of patients.

Literature

1. Fife B, Poppiti RJ JR, Lubin J, Robinson MJ "GASTRIC SYPHILIS PRIMARY DIAGNOSIS BY CASRIC BIOPSY: REPOT OF FOUR CASES" Arch Pathol Lab Med. 1993 Aug; 117 (8), 820-3 (prototype).

2. A. Merkulov // Course of histopathological technology

3. I. Aruin. L.L. Kapuller, V.A. Isakov // Morphological diagnosis of diseases of the stomach and intestines - Triad X, Moscow, 1998, 485 p.

Claims (1)

A method for the diagnosis of inflammatory infiltrate of the gastric mucosa in patients with syphilis, which consists in the collection and study of biopsy material of the gastric mucosa and its morphological study, characterized in that they also conduct a morphometric study of the biopsy specimen with the determination of the quantitative content of plasmacytes and the density of the cellular composition of the biopsy specimen and with the content of plasmacytes (45, 7 ± 6.5)% and the density of the cellular composition of the biopsy equal to (802 ± 94)% per 100 μm ² diagnose an infiltrate of syphilitic nature.