Papilloma is a benign skin neoplasm, a distinctive feature of which is a papillary base of connective tissue covered with epithelium on top. Papillomas appear in humans in various areas of the body (on the skin, mucous membranes, in internal organs and other locations) and in most animals.
Papillomas develop from the transitional or flat epithelium in the form of soft, dense formations on the so-called pedicle. The size of these formations usually ranges from 1 to 2 centimeters in diameter, and the outer surface of them has a dirty white or brown tint. Sometimes the papillomas grow in different directions and become like cauliflower or a rooster comb.
Papillomas are removed for cosmetic effect if they occur in visible areas of the body - on the neck, arms, face, however, if they occur in many areas of the mucous membrane, for example, on the larynx, patency disturbances can be caused that threaten the life of the patient. In the case of the larynx, the papilloma can obstruct the airways, causing voice problems or an inability to breathe normally, in the case of the bladder, the papillomas cause hematuria. If several papillomas form on the body, this indicates the onset of papillomatosis.
Etiology of papillomas
For the most part, the occurrence of papillomas is caused by a viral infection - the human papillomavirus (HPV), although sometimes papillomas can occur congenitally or as complications of inflammatory diseases.
When HPV enters the human body, its activity usually begins to manifest after a long time. Often, certain provoking factors contribute to the activation of the papillomavirus, due to which soft neoplasms begin to appear on the skin or mucous membranes. The main factors provoking papillomas, experts include stress, decreased immunity, weakening of the body due to treatment, vitamin deficiency in the body, skin damage.
Basically, people are sexually infected with HPV, but cases of household infection with very low immunity or in the presence of damaged skin areas on the body that may come in contact with an HPV carrier are also possible. The appearance of papillomas indicates the activation of the existing virus, which is also possible for women and men. A baby can be infected with this virus through the birth canal of an infected mother.
Classification of forms of manifestation of HPV
Human papillomavirus which infects mucous membranes and skin can be classified into the following forms:
- clinical form detectable on routine examination: genital warts, papular and papillary warts, exophytic warts, as well as cervicitis and cervical erosion in women;
- subclinical form, in which the formations do not show symptoms, they are not visible, and they can be detected only during endoscopy: inverted formations (growing inwardly of the mucous membranes), flat warts, as wellas warts in the cervical canal;
- latent form, characterized by the absence of clinical evidence and detected exclusively by the results of analyzes;
- female form or cervical form, expressed by cancer of the cervix or dysplasia of various stages.
When women are 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 virus, the likelihood of oncology is not so high, however, a cancerous tumor can occur in the rectum or oral cavity. In men, the likelihood of cancer due to HPV exists in the anus, penis, and rectum.
Types and forms of papillomas
It is very important to correctly identify papillomas appearing on the body. Their types directly depend on the resulting strain of the virus, which, entering the human body, contributes to the process of excessive cell division of the skin, resulting in papillomas.
Strains of HPV can be oncogenic and non-oncogenic. There are many other non-oncogenic varieties, and, as a rule, they bring nothing to the patient, except external cosmetic discomfort.
Such an event can be easily suppressed, thus solving the problem. However, if neoplasms occur in the area of the mucous membranes, this indicates serious pathological processes. Such a dislocation means that a person has been infected with an oncogenic strain of HPV, 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 distinctive features of one or another subspecies.
Simple warts
Papillomas or simple warts are the most common type of papillomavirus caused by several strains at the same time. These strains of HPV are transmitted not only sexually, but also through contact and in everyday life, leading to statistics indicating that 30% of the world's population have encountered such HPV at least once in their lifetime.
Simple papillomas or common (ordinary) warts are more often than other places localized on the upper extremities, namely on the hands, but sometimes they can also occur on the body, the soles of the feet and the feet. feet, palms, fingers. Their peculiarity is that such warts appear in places where the skin is damaged due to a decrease in local immunity. These papillomas occur in the area of the soles of the feet or palms due to contact with poor-quality household chemicals, profuse sweating, various damage to the skin, dermatitis.
The common wart externally resembles papillary skin neoplasms a few millimeters in diameter at the onset of the disease. In this case, the head of the wart has a smooth and smooth texture and rises above the surface of the skin. It is poorly pigmented, and its root penetrates deep into the skin, where it receives nutrition from the vessels. As a result of such nutrition, warts gradually develop, while not only their size changes, but also the degree of pigmentation. In addition, the hair often grows in the center of these papillomas, which is a variant of the norm and does not indicate a malignant neoplasm.
Flat papillomas
Skin growths like these look like small, yellowish flat patches that rise slightly above the surface of the skin. Their structure is dense, with a deep subcutaneous root, as evidenced by frequent pain when pressing on the wart or when it is damaged daily. The location of these papillomas is most often the face and hands. Sometimes they can occur in the anus or on the 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 their treatment. After surgical treatment of these neoplasms, the scars and scars usually remain in their place.
Genital warts
Genital warts occur in the groin area or the mucous membranes. Externally, they are thin papillary neoplasms 2-3 millimeters in diameter. These condylomas grow rapidly, forming a large skin growth from a single small papilla, resembling a cauliflower or rooster's crest.
The main danger 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 enters the body at high speed. Also, a big problem associated with genital warts is the high risk of recurrence, which is not reduced even with the use of antiviral therapy and removal of neoplasms. Several 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 fine 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 peculiar appearance. Therefore, looking at the photo of filamentous papillomas, they can be differentiated from other varieties.
These neoplasms most often appear after the age of 45 in areas where thin skin predominates - on the chest, armpits, neck. The increase in the size of these neoplasms is their further elongation. The head of filamentous papillomas is usually yellowish or pinkish, pigmentation is not expressed, most often very weak.
Internal moles
Any neoplasm on the surface of a person's internal organs can be classified as a subgroup of internal moles. These are intragastric condylomas, papillomas in the rectum, neoplasms in the throat and mouth, neoplasms on the walls of the bladder. A distinctive feature of these papillomas is the impossibility of their recognition without performing appropriate medical procedures and diagnostics. However, the disease can be suspected by special symptoms. The danger 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, it helps block breathing and interferes with the person's speech function.
Lewandowski-Lutz papillomas
Epidermodysplasia verrucosa or Lewandowski-Lutz papilloma is a very rare condition that mainly affects children or adolescents. It happens that such a disease can be inherited and spread in a family.
The clinical picture of the disease manifests as numerous warts spotted with reddish-brown in the area of the feet and hands. A feature of the pathology is the fact that when the papillomas are located on areas of the body exposed to ultraviolet rays, in a third of cases they are reborn into malignant neoplasms and develop in the area of neighboring tissues.
Location of papillomas
Filamentous papillomas, vulgar or pointed, as well as condylomas, are the most common in medical practice. The place of localization of filamentous warts is the face, common warts are most often located in the area of the feet or hands, and condylomas are exclusively on the mucous membranes (the head of the penis and in the urethra in men, in the area of the labia minora and vagina in women), but it turns out that all of these warts can occur in an unusual place for themselves.
It is not difficult to remove such papillomas in modern conditions, however, the danger is that with a decrease in immunity, new papillomas can reappear, which will lead to more serious consequenceson health, for example, the subsequent occurrence of genital warts is fraught with the development of cervical cancer in women uterus. Plantar warts are more common on rough soles and toes. Sometimes a thorn can develop on the thumb after severe damage to the skin in the area.
In general, papillomatosis is a generalized form of pathology, in which neoplasms form all over the human body. These growths have a characteristic appearance, therefore, having seen the manifestations of the disease once, they can no longer be confused with any other disease.
Symptoms of HPV
The most common symptom of papillomavirus in the human body is the appearance of papillomas on the skin.
The rest of the symptoms depend directly on the location and type of disease. Depending on the signs above, 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 appearance of pathology in the genital area are itching and an unpleasant smell. If such symptoms begin to bother, then in no case should they be ignored, since very often the cause of their appearance can be oncogenic in nature.
- Intra-ductal papillomas in the area of the ducts of the mammary glands, the signs of which are redness of the nipple, slight itching and burning. In addition, if you press on the nipple with such a papilloma, the ichor or green discharge begins to ooze. The danger of intraductal papilloma is its gradual and possible degeneration into breast cancer.
- Plantar warts are expressed as active calluses in the area of the soles of the feet, which, when walking or pressing on them, cause pain in an acute form.
- Papillomas in the region of the larynx are not initially expressed in any specific symptomatology, but this pathology gradually leads to a change in a person's voice, a feeling of coma in the throat, and impaired respiratory functions. In addition, the patient begins to experience difficulty in swallowing.
- Flat warts in adolescents most commonly occur in the area of the outer sides of the hands and lower part of the face. The symptomatology is very fuzzy and most often results in mild itching and rare neoplasms.
Pathogenesis
In the presence of HPV in the human body, it is most often possible to conclude that the immunity is reduced. Once in the body, viruses start the process of infecting the basal epithelial layer, which is the main bias in affecting the transition zone of the stratified to columnar squamous epithelium. In infected cells, 2 forms of the virus can exist - episomal (apart from cell chromosomes) of benign nature and introsomal (integrated into cellular genomes) with malignant nature of parasitism.
The incubation period for papillomavirus can vary between the time the virus enters the body and the first manifestations of the disease within 14 days to a few years. The nature of the human papillomavirus infection is usually latent, that is, hidden. At the same time, several varieties of pathology can settle in the human body at the same time, and under the influence of certain factors, each of them can at some point begin to manifest itself in active reproduction. In this case, a stage of the disease occurs, at which the clinical manifestations begin to be identified.
Very often (up to 90% of all cases of HPV infection) for 6-12 months the human body is cured of this pathology, however, in 10% of the remaining cases the disease can becomechronic with a long course, relapses and the possibility of malignancy of the process.
Diagnosis of diseases
Ultrasound for papillomas
When diagnosing papillomas, ultrasound is not used as the main method of research, but as an additional method, confirming the correctness of the suspected diagnosis. Basically, ultrasound is used to diagnose papillomas in internal organs with regards to their malignant transformation.
Ultrasound is used among the methods of instrumental verification when diagnosing intraductal papilloma.
Performing an ultrasound examination in this case does not allow the specialist to examine the ducts of the mammary glands, however, it helps to differentiate intraductal papilloma from suspected breast cancer, allows to exclude galactorrheain prolactinoma. In addition, ultrasound can help detect the appearance of neoplasms with bladder papilloma. However, ultrasound in this case is effective only if the neoplasms exceed 1 centimeter in diameter.
PCR diagnostics during diagnosis
The diagnosis of the disease in question is carried out by doctors, a dermatologist and a venereologist. Since the number of types of virus is varied, it is important to determine precisely which type the patient is infected with and whether this strain is oncogenic. Visually, it is possible to make an accurate diagnosis only in the case of classical genital warts, which is why, if there is a suspicion of infection with HPV, specialists always use PCR scraping.
The polymerase chain reaction (PCR) prompts researchers not only to determine the presence of HPV in the body, but also demonstrates its type, oncogenicity and the number of viruses at the time of diagnosis. This is very important in terms of diagnosis, because if there is information about the percentage of virus in the body, it is possible to determine the approximate time of infection and establish the contact persons of the patient in order toconduct etiotropic therapy.
Based on the results of PCR diagnostics, it is possible to determine the chronic course of the infection or its one-time epidemic due to a decrease in immunity. This information gives the specialist the possibility of prescribing a treatment adapted to a specific case. Usually, PCR diagnosis is done 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 of taking samples of human tissues for their subsequent examination by staining with special stains. The biopsy is very common for cancer, as well as for suspected HPV. On the eve of treatment for papillomaviruses, doctors must rule out the oncological nature of the neoplasms.
Biopsy is a very precise diagnostic technique which, if HPV is suspected, can be expressed in cytological or histological studies.
Cytology is a study of cells in the body under a microscope designed to show specialists what changes a viral infection has made in these cells. For the prevention and early detection of cancer of the cervix, 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 annually, allowing them to timely see signs of cervical dysplasia. The fact is that dysplasia of this organ is completely curable, and if you do not start the development of the process, cervical cancer in the body will not develop at all, even with one type of oncogenic virus.
In order to accurately diagnose HPV, a histological study is performed, in which not a superficial cell scraping is taken from the patient for analysis, but a piece of tissue, which allows to examine the correct location of thecell layers, tissue features and identify oncological features. During histological examination with the help of solutions, the tissue sample taken is dehydrated and embedded in paraffin, after which sections are made using a microtome, making it possible to obtain layers of'a thickness of 0. 1 millimeter. The removed layers are stained with special dyes to reveal pathological cells on microscopic examination and to determine their nature.
Treatment of papillomatosis
Treatment of papillomavirus is always carried out according to an individual scheme. If a virus is detected during diagnosis, but there are no manifestations yet, the patient is prescribed an etiotropic cytostatic therapy, which effectively "puts to sleep" the virus for several years.
If a person is a carrier of HPV, they should be regularly diagnosed with PCR to identify the first signs of disease development. In addition, the carrier of this virus is obliged to use barrier contraception so as not to infect their sexual partners.
When detecting papillomaviruses, it is mandatory to use antiviral agents in the treatment. In general, immunomodulatory and vitamin preparations are indicated for absolutely all patients with HPV.
When papillomas appear on the mucous membranes or skin, depending on the location and symptoms, cryodestruction, electrocoagulation and laser removal of the growths are used. Sometimes papillomas are also removed with a more modern technique - using radio waves. If there are signs of papilloma malignancy, it is surgically excised along with the surrounding healthy tissue 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 reappear.
There is no drug for the complete removal 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 regularly undergo examinations for the development of pathology.
Since the papillomavirus is most often transmitted sexually, it is worthwhile to prefer a barrier method of contraception, and if a woman is considering pregnancy, it is important to perform diagnostic measures in a timely manner andto take a treatment that will reduce the risk of infection of the child with this virus.
Disease prevention
It is possible to prevent the appearance of papillomas on the body by observing the basic rules of personal hygiene and timely disinfection of any wounds. It is imperative to use separate towel, comb, manicure devices, shoes for each family member in daily life, and intermittent sex should always be protected with condoms. It is also important after sex to always take a shower and treat the contact areas of the skin and mucous membranes, as the virus takes some time to enter the human body.
In modern medicine, there is also a vaccine against papillomavirus. It has already been tested in 72 countries around the world and is effective against 16 and 18 subtypes of HPV, which cause cervical cancer in 90% of all diagnosed cases. In addition, vaccination successfully combats viruses of subtypes 6 and 11, which cause 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 a person starts sexual activity. Most often, experts recommend using the vaccine three times for girls aged 11 to 12. The World Health Organization also recommends vaccinating boys to avoid the possibility of HPV circulation.
Are papillomas dangerous?
Papilloma virusis a risk factor for the development of oncological pathologies. Most often, due to this virus, cancer of the cervix, cancer of the external genitalia (vulva, glans penis) occurs. However, infection with HPV does not always lead to cancer. There are many subtypes of this virus with 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, causing flat warts. From the time the virus enters the body until a neoplasm turns into a malignant neoplasm, it can take 10 to 20 years.
If there are large papillomas on the body, which can be damaged very easily on a daily basis, they should be removed.
If the papillomavirus, which is detected in the body, is left untreated, the risk of getting 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 cycle. In addition, if some papillomas are not removed, they can degenerate into oncological neoplasms, which means that this disease should be approached with all seriousness and never let the course of the disease take its course.