Triple infection of gastric syphilis, Helicobacter pylori and human immunodeficiency virus: A case report

Table 1 Endoscopic and histopathological characteristics of different gastric lesions

Diseases	Endoscopic characteristics	Histopathological characteristics
Gastric syphilis[6,17,18]	Common site is the antrum with multiple ulcers or giant ulcers. Nodular mucosal elevations and thickening of gastric folds that are similar to gastric carcinoma. Fibrotic narrowing and rigidity occur in the late-stage	Non-specific inflammation mainly plasma cells and lymphocytes. IHC staining for T. pallidum in all layers of mucosa
H. pylori-associated gastritis[19]	Common site is the junction of the gastric antrum and body. Congestion, edema, erythema, and ulcers appear on the gastric mucosa, usually superficial	Non-specific inflammation mainly neutrophils and lymphocytes on the surface of gastric mucosa. Specific IHC staining for H. pylori
Gastric carcinoma[20,21]	Mostly shows as a huge ulcer that is stained with moss adhered to the surface of the ulcer, and the edge of the ulcer is raised like a dam	Hyperplasia of atypical epithelial cells, with a glandular, patchy, or scattered distribution, with special markers, such as CK, P53, and Ki67
Gastric lymphoma[22,23]	Common site is the antrum. Mucosal erosion, ulceration, mucosal nodules or thickening, presenting as flat or polypoid elevations	Large sheets of monotonous cells within the mucosa; specific IHC staining helps the diagnosis
Gastric tuberculosis[24]	Common sites are the gastric antrum and lesser curvature. Nodular hypertrophic mass may mimic carcinoma, some present with antrum deformation and obstruction	Granulomatous inflammation with stenosis, perforation, or fistula, and positive staining for acid fast bacilli
Gastric cytomegalovirus[25,26]	Common site is the antrum. Punched-out ulcers with partial mucosal thickening and inflammation, which are similar to gastric carcinoma	Eosinophilic inclusions visible in epithelium or stroma. Specific IHC staining for cytomegalovirus

H. pylori: Helicobacter pylori; T. pallidum: Treponema pallidum; IHC: Immunohistochemistry.