Papilloma is a benign neoplasm of the skin, a distinctive feature of which is a papillary base of connective tissue covered with epithelium above. Papillomas occur in humans in different areas of the body (skin, mucous membranes, internal organs and other localizations) and in most animals.
Papillomas develop from transient or squamous epithelium in the form of dense soft formations on the so-called stalk. The size of these formations usually varies from 1 to 2 centimeters in diameter, and their outer surface has a white or dirty brown color. Sometimes papillomas grow in different directions and become like cauliflower or a rooster comb.
Papillomas are removed for a cosmetic effect if they appear in visible areas of the body - neck, arms, face, however, if they occur in many areas of the mucosa, for example, in the larynx, opening disorders can be provoked that threatenpatient's life. In the case of the larynx, the papilloma can block the airways, causing problems with the voice or the inability to breathe normally, in the case of the bladder, the papillomas provoke hematuria. If multiple papillomas form in the body, then this indicates the onset of papillomatosis.
Etiology of papillomas
For the most part, the appearance of papillomas is provoked by a viral infection - the human papilloma virus (HPV), although sometimes papillomas can occur congenitally or as complications of inflammatory diseases.
When HPV enters the human body, its activity usually begins to appear after a long time. Often, several provocative factors contribute to the activation of papillomavirus, due to which soft neoplasms begin to appear on the skin or mucous membranes. The main factors that provoke papillomas, experts include stress, decreased immunity, weakening of the body due to treatment, lack of vitamin in the body, skin damage.
Basically, people are sexually infected with the papillomavirus, however, cases of home infection with a very low immunity or in the presence of damaged areas of skin on the body that may come in contact with an HPV carrier are alsopossible. The appearance of papillomas indicates the activation of the existing virus, which is equally possible for women and men. A baby can become infected with the virus as it passes through the birth canal of an infected mother.
Classification of HPV manifestations
Human virus papyrus that infects mucous membranes and skin can be classified into the following forms:
- clinical forms that can be detected during a routine examination: genital, papular and papillary warts, exophytic warts, as well as cervicitis and cervical erosion in women;
- subclinical form, in which the formations have no symptoms, they are not visible and they can be detected only during endoscopy: inverted formations (growing towards the inner part of the mucosa), flat warts, and warts in the canalof the cervix;
- latent form, characterized by the absence of a clinic and detected exclusively by test results;
- female form or the shape of the cervix, expressed by cervical cancer or dysplasia of various stages.
When women become infected with highly oncogenic HPV as a result of sexual contact, the likelihood of malignant neoplasms in the cervical canal increases dramatically. When infected with other types of the virus, the chances of oncology are not as high, however, a cancerous tumor can occur in the rectum or oral cavity. In men, the chances of cancer due to HPV exist in the anus, penis and rectum.
Types and shapes of papillomas
It is very important to accurately identify papillomas that appear on the body. Their types are directly dependent on the type of virus that results, which, entering the human body, contributes to the process of excessive cell division in the skin, resulting in papillomas.
HPV strains can be oncogenic or non-oncogenic. There are many more non-oncogenic varieties and, as a rule, they bring nothing to the patient except external aesthetic concern.
Such a manifestation can be easily removed, solving the problem. However, if neoplasms arise in the mucosal area, this indicates serious pathological processes. Such a shift means that a person is infected with an oncogenic HPV strain, therefore, complex antiviral therapy is extremely necessary. To distinguish between different types of papillomas, it is enough to simply compare them with each other and identify the distinguishing features of one or another species.
Simple warts
Simple papillomas or warts are the most common type of papilloma virus caused by several species at the same time. These types of HPV are transmitted not only sexually, but also through contact and daily life, which leads to statistics showing that 30% of the world's population have encountered such HPV at least once in their lifetime.
Simple papillomas or vulgar (common) warts are most often located on the upper extremities, respectively on the hands, but sometimes they can also occur on the body, feet and legs, palms, fingers. Their peculiarity is that such warts appear in places with damaged skin due to the decrease of local immunity. Such papillomas occur in the area of the feet or palms due to contact with poor quality household chemicals, profuse sweating, various skin lesions, dermatitis.
Vulgar warts on the outside look like papillary neoplasms of the skin a few millimeters in diameter at the beginning of the disease. In this case, the wart head has a homogeneous and smooth structure and rises above the surface of the skin. Pigment is poorly pigmented, and its root goes deep into the skin, where it receives nourishment from the vessels. As a result of such a diet, warts gradually grow, while not only their size changes, but also the degree of pigmentation. Also, hair often grows in the center of such papillomas, which is a variant of the norm and does not show a malignant neoplasm.
Flat papillomas
Skin growths like these look like tiny yellow plaques that rise slightly above the surface of the skin. Their structure is dense, with a deep subcutaneous root, as evidenced by the frequent bitterness when pressing the wart or by its daily damage. The localization of such papillomas is most often the face and hands. Sometimes they can occur in the anus or labia majora in women and in the scrotum in men. Due to the active blood supply, they have an active upward trend.
The main characteristic of flat papillomas is the difficulty of treating them. After surgical treatment of these neoplasms, the scars and marks usually remain in their place.
Genital warts
Genital warts occur in the groin area or on the mucous membranes. Externally, these are thin papillary neoplasms 2-3 millimeters in diameter. Such warts grow quickly, forming a large growth of skin from a small single papilla, which resembles a cauliflower or a red grape.
The main risk of genital warts is the high risk of infection, inflammation of neoplasms in the vagina or labia minora in women. They can be easily injured, after which the infection penetrates the body at a high rate. Also, a major problem associated with genital warts is the high risk of recurrence, which is not reduced either by the use of antiviral treatment and by the removal of neoplasms. Some strains of the virus can cause genital warts, some of which can be dangerous for women in terms of the malignant process.
Filiform papillomas
Threaded papillomas with a thin stalk, the apex of which is crowned by the head of the neoplasm. They are very difficult to confuse with other species due to their special appearance, therefore, looking at the picture of filamentous papillomas, they can be differentiated from other varieties.
Such neoplasms most often appear after the age of 45 in areas where thin skin predominates - in the chest, armpits, neck. The increase in the size of such neoplasms is their further elongation. The head of filamentous papillomas is usually yellow or pink, the pigmentation is not pronounced, more often very weak.
internal marks
Any neoplasm on the surface of a person's internal organs can be classified as a subset of internal moles. These are intragastric condyloma, papilloma in the rectum, neoplasm in the throat and mouth, neoplasm in the walls of the bladder. A distinctive feature of these papillomas is the inability to recognize them without performing proper medical procedures and diagnoses. However, the disease can be suspected by specific symptoms. The risk of such neoplasms is identified in each case.
If there are papillomas in the bladder, bleeding or cancer may develop over time.
If the papilloma is located in the larynx, then it helps to block breathing and interferes with the person's speech function.
Papillomat Lewandowski-Lutz
Warty epidermodysplasia or Lewandowski-Lutz papillomas is a very rare pathology that mainly affects only children or adolescents. It happens that such a disease can be inherited and spread in a family.
The clinical picture of the disease is manifested in the form of numerous spotted warts in the area of the feet and hands. Characteristic of the pathology is the fact that when papillomas are located in areas of the body that are exposed to ultraviolet radiation, in one third of all cases, they regenerate into malignant neoplasms and grow in the area of neighboring tissues.
Papilloma locations
Filamentous, vulgar or pointed papillomas, as well as warts, are the most common in medical practice. The site of filamentous warts is the face, the vulgar ones are most often located in the area of the feet or hands, and the warts are exclusively in the mucosa (head of the penis and urethra in men, in the area of the labia minora and vagina in women), but it happensthat any of these warts can occur in an unusual place for themselves.
It is not difficult to remove such papillomas in modern conditions, however, the risk is the fact that with a decrease in immunity, new papillomas may reappear, which will lead to more serious health consequences, for example, the subsequent appearance of genital warts is fraught with the development of cervical cancer in the womb. Toe warts are most common on the soles of the feet and toes. Occasionally, a thorn may develop on the thumb after severe skin damage to the area.
In general, papillomatosis is a generalized form of pathology in which neoplasms form throughout the human body. These growths have a characteristic appearance, therefore, seeing the manifestations of the disease once, it can not be confused with any other disease.
Symptoms of HPV
The most common symptom of papilloma virus in the human body is the appearance of papillomas on the skin.
The rest of the symptomatology depends directly on the location and type of disease. Depending on the above signs, the symptoms of HPV may be as follows:
- Genital warts occur on the mucous membranes of the genitals, mouth, larynx, rectum and on the inner surface of the stomach. Symptoms of the onset of pathology in the genital area are itching and an unpleasant odor. If such symptoms begin to bother you, in no case should they be ignored, as very often the cause of its occurrence may be of an oncogenic nature.
- Intraductal papillomas in the area of the mammary gland ducts, the signs of which are redness in the nipple area, slight itching and burning. Also, if you press the nipple with such a papilloma, then a green icing or discharge starts to flow from it. The risk of intraductal papilloma is its gradual and possible degeneration into breast cancer.
- Plantar warts are expressed in active calluses in the plantar area, which, when you walk or press on it, cause soreness in a sharp form.
- Papillomas in the laryngeal area are not initially expressed in any specific symptomatology, but gradually this pathology leads to a change in a person's voice, a feeling of a coma in the throat, and impaired respiratory functions. Also, the patient begins to experience difficulty in swallowing. Flat warts in adolescents most often occur in the area of the outer sides of the hands and the lower part of the face. The symptomatology is very vague and is most often expressed in mild, rare itching of neoplasms.
Pathogenesis
In the presence of HPV in the human body, it is often possible to conclude that the immune system is weakened. Once introduced into the body, viruses begin the process of infecting the basal epithelial layer, making the main bias towards impact on the transition zone from squamous to cylindrical stratified epithelium. In infected cells, there can be 2 forms of the virus - episomal (outside the cell chromosomes) with a benign nature and introsomal (integrated into the cell genomes) with a malignant nature of parasitism.
The incubation period of papillomavirus can vary from the time the virus enters the body to the first manifestations of the disease within a period of 14 days to several years. The nature of human papillomavirus infection is usually latent, i. e. latent. At the same time, several types of pathology can be established in the human body at the same time, and under the influence of certain factors, each of them at the same time can begin to appear through active reproduction. In this case, a stage of the disease arises, in which clinical manifestations begin to be identified.
Very often (up to 90% of all cases of HPV infection), the human body self-cures itself of this pathology for 6-12 months, but in the remaining 10% of cases the disease can become chronic with along course, relapse and the possibility of malignancy of the process.
Disease Diagnosis
Ultrasound for papillomas
When diagnosing papillomas, ultrasound is used not as the main research method, but as an adjunct method, confirming the correctness of the claimed diagnosis. Basically, ultrasound is used to diagnose papillomas in internal organs when it comes to their malignant transformation.
Ultrasound is used among instrumental verification techniques to diagnose intraductal papilloma.
Performing an ultrasound examination in this case does not allow the specialist to examine the mammary gland ducts, however, it helps to differentiate intraductal papilloma in relation to suspected breast cancer, makes it possible to rule out galactorrhea in prolactinoma. Ultrasound can also help detect the appearance of neoplasms with bladder papillomas. However, ultrasound in this case is effective only if the neoplasms exceed 1 centimeter in diameter.
PCR diagnostics when making a diagnosis
Diagnosis of the disease in question is performed by doctors, dermatologists and venereologists. Since the number of virus types is diverse, it is important to determine exactly which type the patient is infected with and whether this type has an oncogenic character. Visually, it is possible to make an accurate diagnosis only in the case of classic genital warts, which is why, if there is a suspicion of HPV infection, specialists always use itching PCR.
The polymerase chain reaction (PCR) invites researchers not only to determine the presence of HPV in the body, but also to demonstrate its type, oncogenicity, and number of viruses at the time of diagnosis. This is very important in diagnostic terms, as if there is information on the percentage of virus in the body, it is possible to determine the approximate date of infection and to place the patient's contact persons to carry out etiotropic therapy.Based on the results of PCR diagnosis, it is possible to determine the chronic course of the infection or its outbreak once due to a decline in immunity. This information gives the specialist the opportunity to prescribe adequate therapy for a specific case. Usually, PCR diagnosis is performed in the form of screening. If the presence of a virus in the body is confirmed, the patient continues to be examined using other techniques.
HPV biopsy
Biopsy in medicine refers to the procedure for taking samples of human tissue for their subsequent examination by staining with special dyes. Biopsy is very common for cancer as well as for suspected HPV. On the eve of treatment of papillomavirus, doctors must rule out the oncological nature of neoplasms.
Biopsy is a very accurate diagnostic technique that, if HPV is suspected, can be expressed in cytological or histological studies.
Cytological examination is a study of body cells under a microscope, designed to demonstrate to specialists the changes that a viral infection has caused in these cells. For the prevention and early detection of cervical cancer, cells for cytological examination in a woman are taken from this organ. If oncogenic types of HPV are detected in women, even in the absence of external manifestations and signs, cytological studies are assigned to them each year, allowing them to see in time the signs of cervical dysplasia. The fact is that the dysplasia of this organ is completely curable, and if you do not start developing the process, then cervical cancer in the body will not develop at all, even with some kind of oncogenic virus.
To accurately diagnose HPV, a histological study is performed, for which the patient does not take a superficial cell itch for analysis, but a piece of tissue, which makes it possible to examine the exact location of the cell layers, featuresof tissue and identification of oncological features. When performing a histological examination with the help of solutions, the obtained tissue sample is dehydrated and embedded in paraffin, after which they are made using a microtome, which makes it possible to obtain layers with a thickness of 0. 1 mm. The removed layers are stained with special dyes to detect pathological cells during microscopic examination and to determine their nature.
Treatment of papillomatosis
Treatment of papilloma virus is always performed according to an individual scheme. If a virus is detected during diagnosis but there are no manifestations yet, the patient is prescribed etiotropic cytostatic therapy, which effectively “puts the virus to sleep” for several years.
If a person is a carrier of HPV, then he or she should undergo regular PCR diagnostics in order to identify the initial signs of disease development. Furthermore, the carrier of this virus should use barrier contraception so as not to infect sexual partners.
When you detect papillomatous viruses, it is mandatory to use antiviral agents in the treatment. In general, immunomodulatory preparations and vitamins are indicated for all HPV patients.
When papillomas appear on the mucosa or skin, depending on the location and symptoms, cryodestruction, electrocoagulation, and laser removal of the growths are required. Sometimes papillomas are also removed with a more modern technique - using radio waves. In case of signs of malignancy of the papilloma, it is surgically rested along with the healthy surrounding tissues around the growth. It is also important to know that removing the papilloma does not lead to a complete cure, as the virus remains in the body and can recur.
There is no cure for the complete elimination of this virus from the body in modern medicine, therefore, when such a diagnosis is detected, even in the absence of manifestations, a person should undergo regular examinations to identifydevelopment of pathology.
Since the papillomavirus is more often sexually transmitted, it is worth choosing a barrier method of contraception, and if a woman is planning a pregnancy, it is important to take timely diagnostic measures and receive therapy that will reduce the likelihood of infection. child with this virus.
Disease Prevention
it is possible to prevent papillomas on the body by observing the basic rules of personal hygiene and timely disinfection of any wound. It is imperative to use a special towel, comb, manicure accessories, shoes for each family member in daily life, and intermittent sex should always be protected with condoms. It is also important to always take a shower after sexual intercourse and treat the areas of skin and mucous membrane contact, as it takes some time for the virus to enter the human body.
In modern medicine, there is also a vaccine against the papilloma virus. It has already been tested in 72 countries around the world, is effective against 16 and 18 HPV subtypes, which cause cervical cancer in 90% of all diagnosed cases. Vaccination also successfully fights viruses of subtypes 6 and 11, which provoke the development of genital warts, which are difficult to treat. Due to the sexual route of infection with these viruses, it is recommended to vaccinate before starting a person's sexual activity. Most often, experts recommend using the vaccine three times for girls aged 11-12 years. The World Health Organization also recommends vaccinating boys to prevent the possibility of circulating HPV.
Are papillomas dangerous?
Papillomavirus is a risk factor for the development of oncological pathologies. Most often, due to this virus, cervical cancer appears, cancer of the external genitalia (vulva, penis glans). However, HPV infection does not always lead to cancer. There are many subtypes of this virus with a low oncogenic index, for example, subtypes 6, 11, 42, 43, 44, which form condyloma, but there are also highly oncogenic subtypes - 16, 18, 31, 33, which provoke wartsflat. From the moment the virus enters the body until the transformation of a neoplasm into a malignancy, it can last from 10 to 20 years.
If there are large papillomas on the body, which can be easily damaged in daily life, they should be removed.
If the papilloma virus, which is detected in the body, is not treated, then the risk of contracting other infections increases dramatically. And with the course of parallel infectious processes, papillomas begin to appear in other parts of the body, weakening the immune system. It turns out to be a vicious circle. Moreover, if some papillomas are not removed, they can degenerate into oncological neoplasms, which means that this disease must be approached with all seriousness and never allow the course of the disease to take its course.