Papilloma is a benign neoplasm of the skin, a distinctive feature of which is a papilla base of connective tissue covered with epithelium on top. Papillomas appear in humans in various areas of the body (on the skin, mucous membranes, internal organs, and other locations) and in most animals.
Papillomas develop from the transitional or squamous epithelium to the form of soft and dense formations on the so-called stem. The size of these formations is usually 1 to 2 centimeters in diameter, and their outer surface has a dirty white or brown tint. Sometimes the papillomas grow in different directions and become like cauliflower or rooster comb.
Papillomas are removed to obtain a cosmetic effect if they appear on visible areas of the body, on the neck, arms, face; however, if they occur in many areas of the mucous membrane, for example, in the larynx, they can cause life-threatening patency disorders. In the case of the larynx, papilloma can block the airways, causing problems with the voice or the inability to breathe normally, in the case of the bladder, papillomas cause hematuria. If multiple papillomas form on the body, this indicates the onset of papillomatosis.
Etiology of papillomas
For the most part, the appearance of papillomas is caused by a viral infection: the human papillomavirus (HPV), although sometimes papillomas can occur congenital or as complications of inflammatory diseases.
When HPV enters the human body, its activity usually begins to manifest itself after a long time. Often, some provoking factors contribute to the activation of the papillomavirus, which is why 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, vitamin deficiency in the body, skin lesions.
Basically, people become sexually infected with the papillomavirus, however, cases of domestic infection with very low immunity or in the presence of damaged skin areas on the body that can come into contact with a carrier are also possibleHPV. 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 this virus by passing through the birth canal of an infected mother.
Classification of HPV manifestations
The human papillomavirus that infects mucous membranes and skin can be classified in the following ways:
- clinical form 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 show no symptoms, are not visible and can only be detected during endoscopy: inverted formations (growing into the mucous membranes), flat warts, as well as warts in the canalcervical;
- latent form, characterized by the absence of a clinical picture and detected exclusively by the results of the analyzes;
- female form or cervical form, expressed by cervical cancer or multi-stage dysplasia.
When women become infected with highly oncogenic HPV as a result of sexual contact, the likelihood of cervical canal malignancies increases dramatically. When infected with other types of viruses, the probability of oncology is not that high, however, a cancerous tumor can occur in the rectum or oral cavity. In men, the probability of cancer due to HPV exists in the anus, penis, and rectum.
Types and forms of papillomas
It is very important to correctly identify the papillomas that appear on the body. Their types directly depend on the resulting strain of virus, which, entering the human body, contributes to the process of excessive cell division in the skin, resulting in papillomas.
HPV strains can be oncogenic and non-oncogenic. There are many more non-oncogenic varieties and, as a rule, they do not contribute anything to the patient except external aesthetic discomfort.
Such a manifestation can be easily removed, thus solving the problem. However, if neoplasms arise 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 compare them with each other and identify the distinctive features of one or another subspecies.
Simple warts
Simple papillomas or warts are the most common type of papillomavirus, caused by several strains at once. These strains of HPV are transmitted not only sexually, but also through contact and everyday life, leading to statistics that indicate that 30% of the world's population has encountered this type of HPV at least once in the world. lifetime.
Simple papillomas or vulgar warts (common) are most often located elsewhere on the upper extremities, i. e. on the hands, but can sometimes also occur on the body, soles and feetpalms and fingers. Their peculiarity is that such warts appear in places with damaged skin due to a decrease in local immunity. Such papillomas occur in the area of the soles of the feet or palms due to contact with poor-quality household chemicals, profuse sweating, various skin damages, dermatitis.
The verruca vulgaris externally looks like papillary neoplasms of the skin a couple of millimeters in diameter at the beginning of the disease. In this case, the head of the wart has a smooth, homogeneous texture and rises above the surface of the skin. It is poorly pigmented and its root penetrates deep into the skin, where it receives nourishment from the vessels. As a result of such nutrition, 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 indicate a malignant neoplasm.
Flat papillomas
Skin growths like these look like small flat yellowish patches that rise slightly above the skin's surface. Its structure is dense, with a deep subcutaneous root, as evidenced by frequent pain when pressing the wart or when it is damaged in everyday life. The location of such papillomas is usually the face and hands. Sometimes they can occur in the anus or 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 place.
Genital warts
Genital warts occur in the groin area or on the mucous membranes. Outwardly, they are thin papillary neoplasms 2-3 millimeters in diameter. These condylomas grow rapidly, forming a large skin growth from a small single papilla, similar to a cauliflower or a cockscomb.
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 penetrates the body at great 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 treatment and with the elimination of neoplasms. Various 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 stem, the upper part 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 photo of filamentous papillomas, they can be differentiated from other varieties.
These neoplasms appear more frequently after the age of 45 in areas where thin skin is prevalent: on the chest, armpits, and neck. The increase in the size of such neoplasms is their greatest elongation. The head of filamentous papillomas is usually yellowish or pinkish, the pigmentation is indistinct, most of the time 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 the proper medical and diagnostic procedures. 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 in the larynx, it helps block breathing and interferes with the person's speech function.
Lewandowski-Lutz papillomas
Epidermodysplasia verrucous 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 passed in a family.
The clinical picture of the disease manifests itself in the form of numerous reddish-brown stained warts in the area of the feet and hands. A feature of the pathology is the fact that when papillomas are located in areas of the body that are exposed to ultraviolet radiation, in a third of all cases they are reborn into malignant neoplasms and grow in the area of neighboring tissues.
Location of papillomas
Filamentous, vulgar, or pointed papillomas, as well as condylomas, are the most common in medical practice. The place of localization of filamentous warts is the face, vulgar warts are more 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 happens that any of these warts can occur in an unusual place for them.
It is not difficult to remove such papillomas in modern conditions, but the danger is the fact that with a decrease in immunity, new papillomas may reappear, which will lead to more serious health consequences, for example, the appearancePosterior genital warts is fraught with the development of cervical cancer in women. uterus. Plantar warts are most common on rough soles and toes. Occasionally, a thorn in the thumb can develop after severe damage to the skin in 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, having seen the manifestations of the disease once, it can no longer be confused with any other disease.
HPV symptoms
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 onset of pathology in the genital area are itching and an unpleasant smell. If such symptoms begin to bother, in no case should it be ignored, since very often the cause of their appearance can be oncogenic in nature.
- Intraductal papillomas in the area of the ducts of the mammary glands, the signs of which are redness in the area of the nipple, mild itching and burning. Also, if you press on the nipple with such a papilloma, then an ichor or green discharge begins to break out. The danger of intraductal papilloma is its gradual and possible degeneration into breast cancer.
- Plantar warts are expressed in active calluses in the area of the soles of the feet, which when walking or pressing on them, cause acute pain.
- Papillomas in the larynx 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 coma in the throat, and impaired respiratory functions. Also, the patient begins to experience difficulty swallowing.
- Flat warts in adolescents most often occur on the area of the outer sides of the hands and the lower part of the face. The symptomatology is very blurred and is most often expressed in the rare and mild itching of neoplasms.
Pathogenesis
In the presence of HPV in the human body, it is often possible to conclude that the immune system is reduced. Once in the body, the viruses initiate the process of infection of the basal epithelial layer, making the main bias towards affecting the transition area of the stratified to columnar squamous epithelium. In infected cells, 2 forms of the virus can exist: episomal (outside the cellular chromosomes) with a benign nature and introsomal (integrated into the cellular genomes) with a malignant parasitic nature.
The incubation period of the papilloma virus can vary from the time the virus enters the body to the first manifestations of the disease in a period of 14 days to a couple of years. The nature of human papillomavirus infection is usually latent, that is, hidden. At the same time, several types of pathology can settle in the human body at the same time, and under the influence of certain factors, each of them can begin to manifest itself at once 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) for 6-12 months, the human body heals itself from this pathology, however, in the remaining 10% of cases, the disease canbecome chronic with a prolonged course, relapses and the possibility of malignancy of the process.
Disease diagnosis
Ultrasound for papillomas
When diagnosing papillomas, ultrasound is not used as the main investigation method, but as an additional one, confirming the accuracy of the presumed 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 ducts of the mammary glands, however, it helps to differentiate intraductal papilloma in relation to presumed breast cancer, allows to exclude galactorrhea inprolactinoma. In addition, ultrasound can help detect the appearance of bladder papilloma neoplasms. However, ultrasound in this case is effective only if the neoplasms exceed 1 centimeter in diameter.
PCR diagnostics when performing a diagnostic
The diagnosis of the disease in question is made by doctors, a dermatologist and a venereologist. Since the number of virus types is diverse, 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 classic genital warts, so if there is a suspicion of HPV infection, specialists always use PCR scraping.
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 the amount of virus at the time of diagnosis. This is very important in terms of diagnosis, since if there is information on the percentage of the virus in the body, it is possible to determine the approximate date of infection and establish the contact persons of the patient to carry out etiotropic therapy.
Based on the results of PCR diagnostics, it is possible to determine the chronic course of infection or its single flare due to decreased immunity. This information gives the specialist the opportunity to prescribe the appropriate therapy for a specific case. Generally, 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 for taking samples of human tissue for further examination by staining with special dyes. Biopsy is very common for cancer, as well as for suspected HPV. On the eve of papillomavirus treatment, doctors must rule out the oncological nature of neoplasms.
Biopsy is a highly accurate diagnostic technique that, if HPV is suspected, can be expressed in cytological or histological studies.
A cytology study is a study of cells in the body under a microscope, designed to show specialists the changes that a viral infection has caused in these cells. For the prevention and early detection of cervical cancer, cells are removed from this organ for cytological examination in a woman. If oncogenic HPV types are detected in women, even in the absence of external manifestations and signs, they are assigned cytological studies annually, which allows them to timely see the signs of cervical dysplasia. The fact is that the dysplasia of this organ is completely curable, and if the development of the process does not begin, then cervical cancer in the body will not develop at all, even with one type of oncogenic virus.
To accurately diagnose HPV, a histological study is carried out, for which a superficial cell scrap of the patient is not taken for analysis, but a piece of tissue, which allows to examine the correct location of the cell layers, the characteristics of the tissue and identify the oncological characteristics. When performing a histological examination with the help of solutions, the sample of tissue taken is dehydrated and embedded in paraffin, after which cuts are made with a microtome, which makes it possible to obtain layers with a thickness of 0. 1 millimeter. The removed layers are stained with special dyes to reveal pathological cells during 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 still no manifestations, the patient is prescribed etiotropic cytostatic therapy, which effectively "sleeps" the virus for several years.
If a person is a carrier of HPV, they should undergo regular PCR diagnostics to identify the initial signs of the development of the disease. In addition, the carrier of this virus is obliged to use barrier contraceptive methods in order not to infect their sexual partners.
When detecting papillomavirus, it is mandatory to use antiviral agents in treatment. In general, immunomodulatory and vitamin preparations are indicated for absolutely all patients with HPV.
When papillomas appear on the mucosa or on the skin, depending on the location and symptoms, cryodestruction, electrocoagulation and laser removal of growths are used. Sometimes papillomas are also removed with a more modern technique - the use of radio waves. In case of signs of papilloma malignancy, it is surgically removed along with the surrounding healthy tissues around the growth. It is also important to know that papilloma removal does not lead to a complete cure, as the virus remains in the body and can reappear.
There are no drugs 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 identify the developmentof a pathology.
Since the papillomavirus is most often transmitted sexually, it is worth preferring a barrier method of contraception, and if a woman is planning a pregnancy, it is important to carry out diagnostic measures in a timely manner and taketherapy that reduces the child's chance of infection 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 wound. It is imperative to use a separate towel, comb, manicure devices, shoes for each member of the family in daily life, and intermittent intercourse should always be protected with condoms. It is also important after intercourse to always shower and treat the contact areas of the skin and mucous membranes, as it takes some time for the virus to enter the human body.
In modern medicine, there is also a vaccine against the papillomavirus. It has already been tested in 72 countries around the world and is effective against HPV subtypes 16 and 18, which cause cervical cancer in 90% of all diagnosed cases. Furthermore, vaccination successfully fights subtypes 6 and 11 viruses, 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 the start of sexual activity of a person. Most of the time, experts recommend using the vaccine three times for girls ages 11 to 12. The World Health Organization also recommends vaccinating children to prevent the possibility of HPV circulation.
Are Papillomas Dangerous?
Papillomavirus is a risk factor for the development of oncological pathologies. Most often, due to this virus, cervical cancer, cancer of the external genital organs (vulva, glans of the penis) occurs. However, HPV infection does not always cause cancer. There are many subtypes of this virus with a low oncogenic index, for example, subtypes 6, 11, 42, 43, 44, which form condylomata, but there are also highly oncogenic subtypes - 16, 18, 31, 33, which cause flat warts. From the moment the virus enters the body to the transformation of a neoplasm into a malignant one, it can take 10-20 years.
If there are large papillomas on the body, which can be very easily damaged in everyday life, they should be removed.
If the papillomavirus 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 cycle. Also, if some papillomas are not removed, they can degenerate into cancer neoplasms, which means that this disease must be approached in all seriousness and never let the course of the disease run its course.