PAPILLOMA, PAPILLOMATOZ

From Big Medical Encyclopedia

PAPILLOMA, PAPILLOMATOSIS (papilloma; lat. papilla of pacifiers + - oma; papillomatosis; papilloma, papillomat[is] + - osis; synonym: papillary polyp, papillary fibroepithelioma) — the benign tumor developing from a flat or transitional epithelium, having an appearance of the papillary growth acting over a surface of a surrounding epithelium. The term a papillomatosis designate the process which is characterized by formation of numerous papillomas. Along with benign true tumors quite often refer to papillomas similar in morfol, the relation hyperplastic processes of various origin — most often the papillary growths of an epithelium and stroma having the inflammatory nature.

Papillomas meet on skin, a mucous membrane of an oral cavity, a nose, subordinate clauses (okolonosovy, T.; sinus paranasales) bosoms, throat, phonatory bands, renal pelvis, ureters and bladder.

Etiology

Etiology in most cases virus. So, papilloma of skin of the person is intertwined with acellular filtrates a lab. an animal, and in keratosic cells of papilloma by means of a supermicroscope the virus comes to light. At the same time in process of «aging» of papilloma the virus from these cells disappears. During development of papilloma in kernels of the epithelial cells which are over bazalnykhm a layer of an epithelium large acidophilic inclusions, in cytoplasm such inclusions come to light; meet many times less often.

The causative agent of papilloma is the papillomavirus of the person — a virus of a sort of papillomaviruses this (Papillomavirus). Papova viruses (see).

The papillomavirus of the person is highly specific in relation to the owner. Its cytopathic effect is established in cultures of cells of kidneys of monkeys, the person and a mouse. The reliable system for titration of infectivity of this in vitro virus is absent. In culture of cells the papillomavirus transforms cells of the person with very low frequency.

The papillomavirus can be normal found out in urine what allows to suggest that the person has this virus, in addition to cells of skin and mucous membranes, can breed in cells of a kidney from where gets to urine.

Special methods lab. the diagnoses directed to detection of papillomaviruses of the person no.

The pathological anatomy

Macroscopically papilloma usually represents delimited, to dia, to 1 — 2 smch a tumor dense or soft to the touch on a thin long or short leg, is more rare — on the wide basis. In rare instances papillomas reach the big sizes. At a papillomatosis the surface of skin or mucous membrane on a considerable extent is covered with papillary growths. The surface of papilloma uneven, small - or coarse-grained, reminds a cauliflower or cock combs. Papilloma of skin can have various coloring — from white to dirty-brown (depending on a krovenapolneniye of vessels of a stroma and pigmentation in a basal layer of an epithelium); papilloma of a mucous membrane more often happens colourless or pearl-white, but sometimes gains crimson or black color in connection with hemorrhages in its fabric. Papilloma of a bladder can be condensed due to deposits of salts of calcium.

Fig. 4. Microdrug of papilloma of a mucous membrane of an oral cavity: the surface of papilloma is covered with layer of a multilayer flat keratosic epithelium (1) with the deep akantotichesky tyazha plunging into a connective tissue stroma rich with thin-walled vessels (2); coloring hematoxylin-eosine; x 20. Fig. 5. Microdrug of papilloma of a mucous membrane of a gullet: numerous papillary growths of a multilayer flat epithelium and connective tissue stroma are visible; coloring hematoxylin-eosine; x 20.

Microscopically papilloma (tsvetn. fig. 4) consists of two fabric components — a connective tissue stroma and an epithelium. On character of an epithelium distinguish planocellular (covered with a multilayer flat epithelium) and transitional cell (covered with a transitional epithelium) papillomas. Connecting fabric of a stroma of a tumor can be friable or dense, often edematous, sometimes with the phenomena of sliming, large or smaller number of vessels and, as a rule, with signs of an inflammation. When the stroma of papilloma is developed considerably and sclerosed, speak about a fibropapilloma. In the epithelium covering papilloma the number of cellular layers, cells of an epithelium larger, than normal is usually increased. At the same time in papilloma of skin the noticeable hyperkeratosis is observed; in the papillomas arising on mucous membranes, keratinization is usually expressed more weakly (tsvetn. fig. 5), cells of a surface layer of an epithelium are faintly painted. Sometimes the papillomas of mucous membranes covered with the multilayer flat keratosic epithelium which developed as a result meet metaplasias (see).

In some papillomas the phenomena can be expressed acanthosis (see), followed by usually high mitotic activity of cells of a basal layer of an epithelium.

Various papillomas of skin can differ from each other in features gistol, structures. So, existence of vacuolated epithelial cells in a basal layer and sites of a parakeratosis is characteristic of usual papillomas of skin, at a senile keratosis there are papillomas with atypia and polymorphism of epithelial cells, in basal and cellular papilloma existence of the same dark cells and horn cysts is characteristic.

The clinical picture

the Clinical picture is characterized, as a rule, by a long current and the hl depends. obr. from localization of defeat. E.g., papillomas of face skin and a neck can cause cosmetic defect, papillomas of a mucous membrane of a throat — to cause disturbances of phonation and breath, papilloma of an ureter — to narrow or obturirovat its gleam with disturbance of outflow of urine, papilloma of a bladder quite often is exposed to an ulceration, with a separation of separate nipples and bleeding. Transitional cell papilloma of adnexal bosoms of a nose can, remaining morphologically high-quality, to have infiltrative growth and to burgeon in surrounding fabrics. The malignancy occurring, as a rule, at the expense of an epithelial component of a tumor is sometimes noted.

Treatment

Treatment of hl. obr. operational, also methods of a cryolysis and sclerosing treatment apply. Indications for operational treatment are both cosmetic defects, and the localization of papilloma causing considerable funkts, frustration causing its frequent traumatization with repeated bleedings and inflammatory processes and also danger of a malignancy. Remote papillomas subject gistol, to a research. At localization of papilloma in the field of the mouth of an ureter make a cystectomy and change of an ureter.

Operational treatment at a papillomatosis consists in excision of the greatest number of papillomas, electrothermic coagulation of small papillomas and a surrounding mucous membrane. At the same time it is necessary to monitor removal of all elements of papilloma since implantation of its separate fragments can lead to a recurrent tumor.

Forecast, as a rule, favorable. However in nek-ry cases a recurrence, sometimes repeated is possible, or there is a malignancy of a tumor.



Bibliography: Apatenk about A. K. Epithelial tumors and malformations of skin, page 40, 44, M., 1973; Golovin D. I. Atlas of tumors of the person, page 63, M., 1975; The Guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and A. V. Smolyannikov, page 407, M., 1976; Strukov A. I. and With ER about in V. V. Pathological anatomy, page 112, 171, M., 1979; Fenner F. of ides of river. Biology of viruses of animals, the lane with English, t. 1 — 2, M., 1977; L e v e of W. F. and. Schaumburg-Lever G. Histopa-thology of the-skin, Philadelphia — Toronto, 1975.


I. G. Balangding, M. N. Lantsman.

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