When Secondary Syphilis Is Reliably Recognizable

Syphilis, often referred to as "the great mimicker," presents with a wide spectrum of clinical and histopathologic findings that can make diagnosis challenging. However, condyloma lata, a manifestation of secondary syphilis, exhibits distinctive histopathologic features that are reliably identifiable on routine hematoxylin and eosin stain. In this case series, we describe 15 histopathologic cases of condyloma lata, all of which demonstrate a consistent constellation of findings: pseudoepitheliomatous hyperplasia, a dense or lichenoid lymphoplasmacytic infiltrate, prominent neutrophilic exocytosis within an eroded epithelium with numerous neutrophils, and small spongiotic vesicles within the upper epidermis. These features are reproducible and diagnostically valuable, particularly in cases lacking clinical context or occurring at unconventional anatomic sites. Familiarity with this pattern enables pathologists to confidently identify condyloma lata on routine hematoxylin and eosin stain and avoid potential diagnostic pitfalls, including misinterpretation as a carcinoma.