Papilloma is a benign skin neoplasm, 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, in internal organs and other localizations) and in most animals.
Papillomas develop from transitional or squamous epithelium into the form of soft dense formations on the so-called stalk. The size of these formations usually ranges from 1 to 2 centimeters in diameter, and their outer surface has a white or dirty brown tint. Sometimes papillomas grow in different directions and look like cauliflower or a rooster's comb.
Papillomas are removed for 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, on the larynx, patency disorders can be provoked that threaten the patient's life. 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 provoke hematuria. If multiple papillomas are formed on the body, then this indicates the onset of papillomatosis.
Etiology of papillomas
For the most part, the occurrence of papillomas is provoked by a viral infection - 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, 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, injury to the skin.
Basically, people are infected with papillomavirus sexually, however, cases of domestic infection with a very low immunity or in the presence of damaged skin areas on the body that may come into contact with an HPV carrier are also possible. 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 while 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 into the following forms:
- 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 do not have symptoms, they are not visible and they can only be detected during endoscopy: inverting formations (growing towards the inside of the mucous membranes), flat warts, as well as condylomas in the cervical canal;
- latent form, characterized by the absence of a clinic and detected exclusively by test results;
- 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 sharply. When infected with other types of the 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 are in direct dependence on the strain of the resulting virus, which, getting into 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 much more non-oncogenic varieties and they, as a rule, bring nothing to the patient except external aesthetic discomfort.
Such a manifestation can be easily removed, thereby solving the problem. However, if neoplasms arise in the area of mucous membranes, this indicates serious pathological processes. Such a dislocation means that a person has become 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 distinctive features of a particular 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 by contact and everyday life, which leads to statistics indicating that 30% of the world's population have encountered such HPV at least once in their life.
Simple papillomas or vulgar (common) warts are most often localized on the upper extremities, namely, on the hands, but sometimes they can also occur on the body, soles and feet, palms, 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 or palms due to contact with poor-quality household chemicals, profuse sweating, various damage to the skin, dermatitis.
Vulgar wart externally looks like skin papillary neoplasms a couple of millimeters in diameter 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 poorly pigmented, and its root goes deep into the skin, where it receives nutrition from the vessels. As a result of such nutrition, the 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 yellowish flat plaques that rise slightly above the surface of the skin. Their structure is dense, with a deep subcutaneous root, as evidenced by frequent soreness when pressing on the wart or when it is damaged in everyday life. The localization of such 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 feature of flat papillomas is the difficulty of their treatment. After surgical treatment of these neoplasms, scars and scars usually remain in their place.
Genital warts
Genital warts occur in the groin area or mucous membranes. Outwardly, these are thin papillary neoplasms 2-3 millimeters in diameter. Such condylomas quickly grow, forming a large skin growth from a small single papilla, resembling 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 into the body at a 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 treatment and with the 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 thin stem, the top 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, by looking at the photo of filamentary papillomas, they can be differentiated from other varieties.
Such neoplasms appear most often after the age of 45 years in areas where thin skin prevails - on the chest, armpits, on the neck. The increase in the size of such neoplasms represents 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 carrying out 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, then it helps to block breathing and interferes with the person's speaking function.
Lewandowski-Lutz papillomas
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 manifests itself in the form of numerous red-brown spotted warts in the area of the feet and hands. A feature of the pathology is the fact that when papillomas are located on areas of the body that are exposed to ultraviolet radiation, in a third of all cases, they are reborn into malignant neoplasms and grow into the area of neighboring tissues.
Locations of papillomas
The most common in the practice of doctors are filamentous, vulgar or pointed papillomas, as well as condylomas. The place of localization of filamentous warts is the face, vulgar ones 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 so happens that anyfrom these warts can occur 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 a decrease in immunity, new papillomas may reappear, which will lead to more serious health consequences, for example, the subsequent occurrence of genital warts is fraught with the development of cervical cancer in womenuterus. Plantar warts are most common on rough soles and toes. Occasionally, 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, 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 symptomatology directly depends on the location and type of disease. Depending on the above signs, HPV symptoms 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, in no case should they be ignored, since very often the cause of its occurrence can be of an oncogenic nature.
- Intraductal papillomas in the area of the ducts of the mammary glands, the signs of which are redness in the nipple area, slight itching and burning. Also, if you press on the nipple with such a papilloma, then an ichor or green discharge begins to ooze from it. 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, which, when walking or pressing on it, causes soreness in a sharp form.
- 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 a coma in the throat, and impaired respiratory functions. Also, the patient begins to experience difficulty 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 blurred and is most often expressed in mild, rare itching of the neoplasms.
Pathogenesis
In the presence of HPV in the human body, it is often possible to conclude that immunity is reduced. Once in the body, the viruses begin the process of infection of the basal epithelial layer, making the main bias towards affecting the area of transition from squamous stratified epithelium to cylindrical. In infected cells, 2 forms of the virus can exist - 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 moment the virus enters the body to the first manifestations of the disease within a period from 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 at one time 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), the human body self-cures from this pathology within 6-12 months, however, in 10% of the remaining cases, the disease can become chronic with a long course, relapses and the possibility of malignancy of the process.
Disease Diagnostics
Ultrasound for papillomas
When diagnosing papillomas, ultrasound is used not as the main research method, but as an additional one, confirming the correctness of the alleged diagnosis. Basically, ultrasound is used to diagnose papillomas in internal organs when it comes to their malignant transformation.
Ultrasound is used among the instrumental verification techniques for diagnosing intraductal papilloma.
Conducting an ultrasound examination in this case does not allow the specialist to examine the ducts of the mammary glands, however, it helps in differentiating the intraductal papilloma relative to the suspected breast cancer, makes it possible to exclude galactorrhea in prolactinoma. Also, ultrasound can help detect the occurrence of neoplasms with papilloma of the bladder. 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 carried out by doctors, a dermatologist and venereologist. Since the number of types of the virus is diverse, it is important to accurately determine which type the patient is infected with and whether this strain 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 PCR scraping.
Polymerase chain reaction (PCR) invites 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 diagnostics, since if there is information about the percentage of the virus in the body, it is possible to determine the approximate date of infection and establish the patient's contact persons in order to conduct etiotropic therapy.
Based on the results of PCR diagnostics, it is possible to determine the chronic course of the infection or its one-time outbreak due to a decrease in immunity. This information gives the specialist the opportunity to prescribe therapy adequate to a specific case. Usually, PCR diagnostics is carried out 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 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 cytological study 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 HPV types 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 the dysplasia of this organ is completely curable, and if you do not start the development of 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 study is carried out, for which not a superficial cell scraping is taken from the patient for analysis, but a piece of tissue, which makes it possible to examine the correct location of cell layers, tissue features, and identify oncological characteristics. When carrying out a histological examination with the help of solutions, the taken tissue sample is dehydrated and embedded in paraffin, after which sections are made using a microtome, which make 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 the virus is detected during the diagnosis, but there are no manifestations yet, the patient is prescribed etiotropic cytostatic therapy, which effectively "lulls" the virus for several years.
If a person is a carrier of HPV, then he should regularly undergo PCR diagnostics in order to identify the initial signs of the development of the disease. In addition, the carrier of this virus is obliged to use barrier contraception so as not to infect sexual partners.
When detecting papillomaviruses, 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 mucous membranes or skin, depending on the location and symptoms, cryodestruction, electrocoagulation and laser removal of the growths are resorted to. Sometimes papillomas are also removed with a more modern technique - using radio waves. In case of signs of papilloma malignancy, it is surgically excised along with the surrounding healthy tissues around the growth. It is also important to know that removal of the papilloma does not lead to a complete cure, since the virus remains in the body and can recur.
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 must regularly undergo examinations to detect the development of pathology.
Since papillomavirus 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 timely carry out diagnostic measures and take therapy that will reduce the likelihood 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 a separate towel, a comb, manicure devices, shoes for each family member in everyday life, and intermittent 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, since it takes some time for the virus 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 HPV subtypes, which cause cervical cancer in 90% of all diagnosed cases. Also, vaccination successfully fights against 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 the onset 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 recommends vaccinating boys, too, 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 penis) occurs. 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 condylomas, but there are also highly oncogenic subtypes - 16, 18, 31, 33, provoking flat warts. From the moment the virus enters the body until the transformation of a neoplasm into a malignant one, it can take from 10 to 20 years.
If there are large papillomas on the body, which can be very easily damaged in everyday life, they must 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 circle. In addition, 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 let the course of the disease take its course.