Papilloma is a benign neoplasm of the skin, the hallmark of which is a papillary base of connective tissue covered with epithelium on top. Papillomas occur 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 transitional or squamous epithelium in the form of soft dense formations of 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 off-brown hue. Sometimes papillomas grow in different directions and become like cauliflower or a rooster's comb.
Papillomas are removed for cosmetic effect if they appear in visible areas of the body - neck, arms, face, but if they appear in many areas of the mucosa, such as the larynx, can be provoked patency disorders that threatenthe patient's life. In the case of the larynx, the papilloma can block the airways, causing voice problems or inability to breathe normally, in the case of the bladder, the papillomas provoke 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 provoked by a viral infection - 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, some provoking factors contribute to the activation of the papillomavirus, due to which soft neoplasms begin to appear on the skin or mucous membranes. Experts include the main factors that provoke papillomas, stress, reduced immunity, weakening of the body due to treatment, vitamin deficiency in the body, skin trauma.
In general, people are infected with the papillomavirus sexually, but there may be cases of home infection with very low immunity or in the presence of damaged skin areas on the body that may come into contact with an HPV carrier. The appearance of papillomas indicates the activation of the existing virus, which is equally possible for women and men. The baby can become infected with this virus as it passes through the birth canal of an infected mother.
Classification of HPV manifestations
Human papillomavirus, which infects mucous membranes and skin, can be classified into the following forms:
- clinical form that can be detected during 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 can be detected only during endoscopy: reversible formations (growing to the inside of the mucous membranes), flat warts, and warts in the cervical canal;
- latent form, characterized by lack of clinic and detected exclusively by the results of the analyzes;
- female form or cervical form, expressed by cervical cancer 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 as high, but a cancerous tumor can occur in the rectum or oral cavity. In men, the risk 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 that appear on the body. Their species are directly proportional to the strain of the resulting virus, which, entering the human body, contributes to the process of excessive cell division in the skin, which leads to papillomas.
HPV strains can be oncogenic or non-oncogenic. There are many more non-oncogenic varieties and they, as a rule, bring nothing to the patient except external aesthetic discomfort.
Such a phenomenon can be easily eliminated, thus solving the problem. However, if neoplasms occur in the area of the mucous membranes, this indicates serious pathological processes. Such a displacement means that a person has become infected with an oncogenic HPV strain, making complex antiviral therapy 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
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 daily life, which leads to statistics showing that 30% of the world's population has experienced such HPV at least once in their lives.
Simple papillomas or vulgar (common) warts are more common in other areas of the upper limbs, namely the hands, but can sometimes appear on the body, feet and soles, palms, fingers. Their peculiarity is that such warts appear in places with damaged skin due to a decrease in local immunity. Such papillomas appear in the area of the soles or palms due to contact with poor quality household chemicals, profuse sweating, various skin lesions, dermatitis.
Vulgar wart looks like skin papillary neoplasms with a diameter of a few millimeters at the beginning of the disease. In this case, the head of the wart has a homogeneous and soft texture and rises above the surface of the skin. It is weakly pigmented and its root penetrates deep into the skin, where it receives food from the vessels. As a result of such nutrition, the warts gradually grow, and 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 lesions like these look like small yellowish flat plaques that rise slightly above the surface of the skin. Their structure is dense, with a deep subcutaneous root, as evidenced by the frequent pain when pressing on the wart or when it is damaged in everyday life. The location of such papillomas is most often the face and hands. Sometimes they can appear 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 feature of squamous papillomas is the difficulty in their treatment. After surgical treatment of these tumors, scars and scars usually remain in place.
Genital warts
Genital warts appear in the groin or mucous membranes. Externally, these are thin papillary neoplasms with a diameter of 2-3 millimeters. Such warts grow rapidly, forming a large skin growth from a small single papilla resembling a cauliflower or rooster.
The main danger of genital warts is the high risk of infection, inflammation of tumors 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 major problem associated with genital warts is the high risk of recurrence, which does not decrease even with the use of antiviral treatment and the removal of tumors. Several strains of the virus can cause genital warts, some of which can be dangerous to women in terms of the malignancy.
Phillips papillomas
Threaded papillomas with a thin stem, the tip 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 distinguished from other varieties.
Such neoplasms appear most often after the age of 45 in areas where thin skin predominates - on the chest, armpits, neck. Increasing the size of such neoplasms is their further elongation. The head of filamentous papillomas is usually yellowish or pink, the pigmentation is not pronounced, most often very weak.
Internal moles
Any neoplasm on the surface of a person's internal organs can be classified as a subset of internal moles. These are intragastric warts, papillomas in the rectum, tumors in the throat and mouth, tumors on the walls of the bladder. A distinctive feature of these papillomas is the inability to recognize them 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 to block breathing and interferes with human speech function.
Lewandowski-Lutz papillomas
Epidermodysplasia of warts or Lewandowski-Lutz papillomas is a very rare pathology that mainly affects children or adolescents. It happens that such a disease can be inherited and spread in the family.
The clinical picture of the disease manifests itself in the form of numerous reddish-brown spotted warts in the legs and arms. 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 adjacent tissues.
Papilloma locations
Filamentous, vulgar or pointed papillomas, as well as warts, are the most common in the practice of doctors. The site of localization of filamentous warts is the face, vulgar warts are more often located in the legs or arms, and warts are exclusively on the mucous membranes (head of the penis and urethra in men, in the labia minora and vagina in women), but it happens that each of these warts can appear in an unusual place for themselves.
It is not difficult to remove such papillomas in modern conditions, but the danger is the fact that with reduced immunity, new papillomas can appear, 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 women. Plantar warts are most common on rough soles and toes. Sometimes 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, once they have seen the manifestations of the disease, it 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 directly depend on the location and type of disease. Depending on the above symptoms, the symptoms of HPV can be as follows:
- Genital warts appear on the mucous membranes of the genitals, mouth, larynx, rectum and on the inner surface of the stomach. Symptoms of genital pathology are itching and an unpleasant odor. If such symptoms start to bother you, they should not be ignored in any case, as very often the cause of its appearance can be oncogenic.
- Intraductal papillomas in the area of the mammary glands, signs of which are redness in the nipples, mild itching and burning. Also, if you press the nipple with such a papilloma, then from it begins to flow ihor or green discharge. The danger of intraductal papilloma is its gradual and possible degeneration into breast cancer. Plantar warts are active calluses in the area of the soles, which when walking or pressing on them cause sharp pain.
- Papillomas in the larynx are not initially expressed in any specific symptoms, but gradually this pathology leads to a change in a person's voice, a feeling of coma in the throat and impaired respiratory function. The patient also begins to have difficulty swallowing.
- Flat warts in adolescents most often appear on the outside of the hands and lower face. The symptoms are very vague and most often manifest as a mild, rare itching of tumors.
Pathogenesis
In the presence of HPV in the human body, it is most often possible to conclude that the immune system is reduced. Once inside the body, the viruses begin the process of infecting the basal epithelial layer, making the main predisposition to affect the area of transition from squamous stratified epithelium to cylindrical. Infected cells can have 2 forms of the virus - episomal (outside the cell chromosomes) of benign nature and introsomal (integrated into the cell genomes) with malignant parasitism.
The incubation period of papilloma virus 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 hidden, 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 simultaneously begin to manifest itself through active reproduction. In this case, a stage of the disease occurs at 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 self-medicates from this pathology, but in 10% of other cases the disease can become chronic with prolonged course, recurrence andpossibility of malignant disease of the process.
Diagnosis of diseases
Ultrasound for papillomas
When papillomas are diagnosed, ultrasound is used not as the main method of examination, but as an additional one, confirming the accuracy of the presumed diagnosis. In general, ultrasound is used to diagnose papillomas in the internal organs when it comes to their malignant transformation.Ultrasound is used among instrumental testing techniques to diagnose intraductal papilloma.
Conducting an ultrasound examination in this case does not allow the specialist to examine the mammary glands, but helps to differentiate the intraductal papilloma with respect to the suspected breast cancer, makes it possible to exclude galactorrhea in prolactinoma. Also, ultrasound can help detect the appearance of tumors with papilloma of the bladder. However, ultrasound in this case is effective only if the neoplasms exceed 1 centimeter in diameter.
PCR diagnostics at diagnosis
The diagnosis of the disease in question is made by doctors, dermatologists and venereologists. Because the number of virus types varies, it is important to determine exactly which type the patient is infected with and whether the strain is oncogenic. Visually, it is possible to make an accurate diagnosis only in the case of classic genital warts, which is why, if HPV infection is suspected, specialists always use PCR scraping.
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 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 the virus in the body, it is possible to determine the approximate time of infection and to establish the patient's contact points for etiotropic therapy.
Based on the results of PCR diagnostics, it is possible to determine the chronic course of the infection or its single focus due to reduced immunity. This information enables the specialist to prescribe therapy appropriate to the specific case. Usually PCR diagnostics 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
Medical biopsy refers to the procedure of taking samples of human tissue for subsequent examination by staining with special dyes. Biopsy is very common in cancer as well as in suspected HPV. On the eve of papillomavirus treatment, doctors must rule out the oncological nature of the neoplasms.
Biopsy is an extremely accurate diagnostic technique that, if HPV is suspected, can be expressed in cytological or histological examinations.
The cytological examination is an examination of body cells under a microscope, designed to demonstrate to specialists the changes caused by a viral infection in these cells. For the prevention and early detection of cervical cancer, the cells for cytological examination in women are taken from this organ. If oncogenic types of HPV are found in women, even in the absence of external manifestations and signs, they are assigned cytological examinations annually, which allows them to see signs of cervical dysplasia in a timely manner. The fact is that dysplasia of this organ is completely curable and if you do not start the process, then cervical cancer in the body will not develop at all, even with an oncogenic type of virus.
In order to accurately diagnose HPV, a histological examination is performed, for which the patient is not taken a superficial scraping of cells for analysis, but a piece of tissue, which allows to examine the correct location of cell layers, tissue characteristics andthe oncological characteristics are identified. When performing histological examination with the help of solutions, the taken tissue sample is dehydrated and embedded in paraffin, after which incisions are made with the help of a microtome, allowing 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
The treatment of papillomavirus is always done on an individual basis. If the virus is detected at the time of diagnosis, but there are still no symptoms, 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, he or she should have regular PCR tests to identify the initial signs of the disease. In addition, the carrier of this virus is obliged to use barrier contraception in order not to infect sexual partners.
When detecting papillomaviruses, it is mandatory to use antiviral drugs in 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 growths are resorted to. Sometimes papillomas are removed with more modern techniques - with the help of radio waves. In case of signs of malignant papilloma, it is surgically excised along with the surrounding healthy tissue around the growth. It is also important to know that the removal of the papilloma does not lead to a complete cure, as the virus remains in the body and can recur.
In modern medicine there are no drugs to completely eliminate this virus from the body, therefore, when such a diagnosis is detected, even in the absence of manifestations, one should undergo regular examinations to detect the development of pathology.
As the papilloma virus is most often sexually transmitted, it is worth choosing a barrier method of contraception and if a woman is planning a pregnancy, it is important to make timely diagnostic measures and take therapy that will reduce the likelihood ofinfecting the child with this virus.
Disease prevention
It is possible to prevent the appearance of papillomas on the body by following the basic rules of personal hygiene and timely disinfection of any wounds. It is imperative to use a separate towel, comb, manicure devices, shoes for each family member in everyday life, and interruptions of sex should always be protected with condoms. It is also important after intercourse to always take a 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.There is also a vaccine against papillomavirus in modern medicine. It has already been tested in 72 countries around the world and is effective against 16 and 18 HPV subtypes, which cause cervical cancer in 90% of all diagnosed cases. Also, vaccination 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 be vaccinated before the start of 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 that boys be vaccinated to prevent the possibility of HPV circulation.
Are papillomas dangerous?
Papilloma virus is a risk factor for the development of oncological pathologies. Most often due to this virus occurs cervical cancer, cancer of the external genitalia (vulva, hub of the penis). However, HPV infection does not always lead to cancer. There are many subtypes of this virus with a low oncogenic index, such as subtypes 6, 11, 42, 43, 44, which form warts, but there are also highly oncogenic subtypes - 16, 18, 31, 33, which provoke flat warts. From the moment the virus enters the body to the transformation of a tumor into a malignant one, it can take from 10 to 20 years.
If there are large papillomas on the body that can be very easily damaged in everyday life, they should be removed.
If the papilloma virus found in the body is not treated, then the risk of infection with other infections increases dramatically. And during the 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. In addition, if some papillomas are not removed, they can degenerate into cancerous growths, which means that this disease must be taken seriously and never allow the course of the disease to develop.