It is usually divided into two types: type ⅰ, characterized by isolated or multiple cauliflower or cockscomb-shaped processes, mostly in vulva, perianal and other parts; Type ⅱ, papillary, finger-like or papular lesions, mostly distributed in the inner labia minora, hymen ring, vestibule, navicular fossa and other mucosa.
Epidemiological data show that condyloma acuminatum is closely related to genital cancer. Human papillomavirus (HPV) was detected in different types of genital tumors by nucleic acid hybridization, and also in condyloma acuminatum. It is reported that 5% ~ 10% of condyloma acuminatum in vulva, cervix and perianal region can go through the late stage and develop into carcinoma in situ or invasive carcinoma after a period of time. It was also found that 15% penile cancer and 5% female vulvar cancer occurred on the basis of the original condyloma acuminatum, especially cervical cancer, and the malignant transformation was especially related to human papillomavirus-16, 18, 3 1 and 33 types. Huge condyloma acuminatum can be secondary to canceration. Many laboratory studies further show that there is a causal relationship between human papillomavirus, condyloma acuminatum and genital cancer. Condyloma acuminatum in vulva, penis or perianal region can be transformed into squamous cell carcinoma. This transformation usually takes 5-40 years. Therefore, after suffering from condyloma acuminatum, we must actively treat it and completely cure it. It is the best choice to find a specialist for treatment, otherwise improper treatment and stimulation will accelerate the malignant transformation.
Clinical manifestations of condyloma acuminatum
Clinical manifestations are varied. Lesions in low-temperature and dry parts of genitals are often small and flat, while those in warm and humid parts are often filiform or mastoid. At first, it was a reddish pimple, and then it grew up and merged with each other. The surface is uneven, moist and soft, in the form of papilloma, comb, grass, mushroom or vegetable, red or dirty gray, and the roots are often pedicled, which is easy to erode and bleed. Purulent secretions are often trapped in the cracks of skin lesions, and each scratch will cause stench, itching and secondary infection. Due to constant local humidity and chronic stimulation, it often grows rapidly. Some female patients even have a hairy spinous process or many cauliflower-like protrusions from vulva to vagina and cervix, like rose thorns or cockscomb flowers. The number of condyloma acuminatum ranges from a few to a dozen, dozens or even hundreds. A very small number of patients, due to untimely treatment, make the condyloma grow very large and become huge condyloma, which can go deep into the body and produce many fistulas leading to urethra, or turn into cancer after 5-40 years. Large condyloma occurring in rectum can cause severe feeling after urgency. When the hormone level in the body changes dramatically during pregnancy, the genital blood supply is sufficient and the immune function of the body decreases, so the volume of genital warts increases rapidly, even to the extent of blocking the birth canal. When giving birth, warts often shed tears and bleed. Because of its fragile tissue, it will bring difficulties to suture and hemostasis. Some condyloma acuminatum can naturally shrink or even disappear at the end of pregnancy or after delivery. Generally, there are no obvious symptoms, but there is itching, dampness or friction. If there is a secondary infection, it may be accompanied by pain. When the vagina and cervix are damaged, it is manifested as increased vaginal discharge or bleeding after sexual intercourse. A huge rash can cause local foreign body sensation or pain caused by friction. Symptoms may worsen during sexual intercourse.
Some cases are subclinical infections or human papillomavirus carriers, and there are no clinical manifestations visible to the naked eye. After pregnant women suffer from condyloma acuminatum, they can transmit human papillomavirus to their babies during delivery, causing laryngeal warts and laryngeal papilloma. Even if the mother has no clinical symptoms after infection, the virus can be transmitted to the fetus through blood or placenta, so it is appropriate for women with this disease to have caesarean section during full-term pregnancy.
histopathology
Dyskeratosis, high hypertrophy of spinous layer, papillary hyperplasia, thickened and elongated epidermis, pseudoepithelioma-like appearance. Most mitotic images can be seen in the spinous cells in the basal layer, which look like cancer, but the cells are arranged regularly. The boundary between dermis and epidermis is clear, and there are vacuole cells in spinous layer. The cytoplasm of the cell is lightly stained, with a large and round nucleus in the center and deep basophils in the nucleus.
Dermal capillaries dilate, and dense chronic inflammatory cells infiltrate around the blood vessels.
diagnose
Condyloma acuminatum is often differentiated from genital cancer, condyloma plana, pseudo condyloma, genital bowenoid papulosis and pearl papulosis.
(1) The focus of genital cancer is hard and the boundary is unclear. Squamous epithelioma has obvious deep infiltration, often forming ulcers, and sometimes pathological examination is needed. Condyloma acuminatum is generally characterized by papillary growth, superficial lesions and little infiltration.
(2) Condyloma plana is a secondary syphilis rash. Verruca plana mostly occurs around anus and external genitalia, with wide base, no pedicle, flat appearance and moist and smooth wart surface. Treponema pallidum can be found by dark field microscopy, and syphilis serum reaction is positive. See the syphilis section for details.
(3) pseudo condyloma is also called the female villous labia minora. There are fish-like or tiny villous growths inside the adult female labia minora, which do not fuse with each other and remain unchanged for a long time, and the white acetate test is negative.
(4) Bowenoid papulosis is rare, which is mainly related to human papillomavirus 16 infection. It is characterized by multiple brown-red papules in genital area, with a diameter of 2 ~ 10 mm, which is very similar to condyloma acuminatum in clinic, but similar to Bowen's disease in histology. This diagnosis must be made by an expert.
(5) Pearl-like papulosis (pearl-like penile papulosis) occurs in the glans of men, and there are pearl-like papules with the same size and arranged neatly along the coronal groove of the glans. Grain size, dome, smooth, non-fusion, long-term unchanged.
(6) Ectopic sebaceous glands: papules have no overlapping growth in mucosa, and most of them are light yellow.
(7) Infectious soft wart: a single non-fused hemispherical papule with smooth periphery and a soft wart body extruded from the center.
(8) chancre: the skin damage of external genitalia is irregular ulcer with painful horizontal carbuncle. Ducrey can be detected in the exudate smear on the ulcer surface.
The diagnosis and differentiation of condyloma acuminatum mostly rely on the clinical experience of doctors, but because sexually transmitted diseases have been extinct in China for many years, clinicians have limited experience and it is inevitable to make misjudgments. It is reported that the misdiagnosis rate in some primary hospitals can reach 50-80%. Condyloma acuminatum is mostly located in the inner side of labia majora, vaginal opening and anus. The lesion is red, bright red or dark red verrucous hyperplasia with big rice grains or soybean grains. The wart body is moist and soft, and can coexist in one or more cases, sometimes showing typical plant-like lesions. Similar to condyloma acuminatum, there is pseudo condyloma or villous labia minora, the latter is more common in the inner and lower sides of labia minora, and the color of the spiny protrusion is similar to that of labia minora, which looks like velvet, but the patients are mostly asymptomatic, but the leucorrhea increases. Other diseases that are easy to be misdiagnosed are hymen vegetation, verruca plana (secondary syphilis rash) and sebaceous gland hyperplasia.
To accurately distinguish these different diseases, a very practical and simple method is the vinegar white test, that is, 5% glacial acetic acid solution is applied to the affected part, and after 3 minutes, the wart is white and condyloma acuminatum, otherwise it is another matter. Or wrap with gauze soaked in 3-5% glacial acetic acid solution for 3-5 minutes. If the affected area turns white, it means subclinical infection.
You can also do iodine yellow test, that is, 3 minutes after applying Lugo's solution, the yellow person can be diagnosed as condyloma acuminatum. Of course, a more reliable method is to do histopathological examination. In recent two years, there have been many reports about the differential diagnosis of pseudo condyloma in domestic magazines, especially the vinegar white test. However, the diagnosis of histopathological examination is not easy, and sometimes it is difficult to make a definite diagnosis, which still depends on the professional level and experience of the examiner. The definite diagnosis of this disease depends on the establishment of an effective virus culture system and the development of DNA probes with tissue immunochemistry and molecular bioengineering technology, so that pseudo condyloma will not be misdiagnosed as condyloma acuminatum.
Condyloma acuminatum occurring in vagina or cervix may be inconspicuous and varied. It may be misdiagnosed only by clinical examination, and cytology, colposcopy and histopathological examination are often needed.
A. Cytological examination: Pap staining of vaginal or cervical condyloma tissue smear, if mixed keratinocytes and vacuoles are found, is of diagnostic value for this disease.
B. Immunohistochemical examination: The peroxidase-anti-peroxidase antibody complex technique (PAP method) is an immunological method, which uses the antiserum of specific human papillomavirus to display the virus protein, thus proving that the virus antigen in condyloma acuminatum is faster and more effective than the conventional electron microscope method.
Pathological examination is helpful for diagnosis, and the upper vacuole cells in spinous cells are the most diagnostic.
Molecular biological techniques such as polymerase chain reaction (PCR) are used to detect human papillomavirus, and this method can also be used to determine subtypes. However, PCR experiments in most medical institutions in China are not enough as a diagnostic tool because of insufficient conditions and too many misdiagnosis phenomena. At present, gopla is trying to diagnose condyloma acuminatum with gene chip technology, but it is only suitable for laboratory research and difficult to popularize in recent years because of its high cost and dependence on PCR amplification results.
treat cordially
At present, the treatment of condyloma acuminatum is mainly external treatment, supplemented by internal treatment. There are many external treatments, including drug therapy, cryotherapy, laser therapy, microwave therapy, electrocautery therapy, surgery and so on. Drug treatment is convenient and easy to operate, but it usually needs to be repeated several times. Some drugs such as trichloroacetic acid may burn the mucosa.
First, medication. In order to reduce losses.
(1) 5% 5-Fu Ointment 5-Fu is a commonly used anti-tumor drug, which can inhibit cell proliferation with light intensity and generally needs treatment for 2 ~ 3 weeks.
(2) wart enemy: drop 0.5% wart enemy solution on the wart with a single-hole or porous plastic rod, so that the liquid medicine can slowly penetrate into the wart base. Warts will turn purple after being coated with medicine and can be dried by themselves. Be careful not to use too much medicine, so as to avoid the liquid medicine flowing to normal tissues. Wash it off with clean water after 4 hours.
(3) Acetic acid: Trichloroacetic acid is a strong acid, which can be used to burn warts and is generally used to treat type II lesions. Before smearing, dip a cotton ball in 2% caine and smear the affected area for 3-5 minutes, and then dip a cotton swab in 50% trichloroacetic acid to make the liquid medicine reach the base. Be careful not to hurt the surrounding healthy mucosal tissue when taking the medicine, and do not use it during menstruation; Take the medicine twice a week. Or use 20% salicylic acid glacial acetic acid for external application.
(4) 1-3% peptide butylamine cream for external use, twice a day, has no toxic and side effects, and can be used for condyloma acuminatum in vagina. Or wash the affected area with 1: 5000 potassium permanganate first, then apply a thick layer of ointment and wrap it with gauze, and change the medicine once a day. Four weeks is a course of treatment. Mild intensity, no toxic or side effects have been found at present, and long-term treatment is needed.
(5) Otoxin (podophyllotoxin solution) is a new and efficient drug for the treatment of condyloma acuminatum, with no irritation, for external use, 1 time, 3 ~ 5 days a day.
(6) Apply 20-25% podophyllotoxin tincture (or 0.5% podophyllotoxin solution) or liquid paraffin preparation directly to the lesion. Or dissolve 20-25% podophyllotoxin in benzoic acid tincture or mineral oil, and apply topically. Use 1 ~ 2 times a week, and scar can be removed in less than 6 weeks. Because of its toxicity, the dosage should be limited to less than 0.5ml each time, and the application area should not exceed 10cm2. After applying the medicine 1-4 hours, the local area should be cleaned. This medicine has side effects, such as erythema, erosion and burning pain, which can cause ulcer and necrosis in severe cases. Pay attention to protect the surrounding skin mucosa, wash it off with soap after the first application for 2-4 hours, and wash it off after repeated application for 6-8 hours to avoid burning the skin. It has teratogenic effect and is prohibited for pregnant women. Pay attention to protect the surrounding normal skin when taking medicine, and apply vaseline on the normal skin as a preventive measure in advance. This method is more painful after use and often requires painkillers. Can cause systemic toxic reaction, dizziness, lethargy, coma, vomiting, etc. And taking too much is dangerous, which may cause recurrent neuritis, paresthesia, fever, leukopenia and thrombocytopenia, coma and even death. Pregnant women are not allowed to use it.
(7) Apply the mixture of Orthophoto-mycin and Pingyangmycin with normal saline to the affected area, 2-3 times a week.
(8) Acyclic guanosine ointment
(9) Keep the affected area clean and dry, and clean it with 3% hydrogen peroxide solution or 1: 5000 potassium permanganate solution.
(10) 1-5% fluorouracil cream or 2% fluorouracil solution is applied externally, once a day 1 time, and only a few lesions are applied each time, so as to avoid erosion reaction of scrotum and mucosa.
(1 1)0.25% herpes cream twice a day. Two weeks in a row is a course of treatment.
(12) gram wart. At present, it is a good external medicine. Low toxicity, thorough treatment and few scars. (anzhen hospital Urology Department can be consulted) Follow-up for 3 months after cure to prevent recurrence.
The application of (12) 1% butylamine ointment, three times a day for six weeks, is expected to be cured.
Second, microwave therapy. This is a treatment method that rose after entering the 1990s. Its principle is to use the high-frequency vibration of microwave to evaporate the water inside the wart. The characteristic of microwave therapy is that the wart is completely destroyed and it is not easy to recur, but the wound surface recovers slowly and is easy to be infected. Therefore, microwave therapy is especially suitable for the treatment of condyloma acuminatum with large wart and isolated dispersion, and it should be kept away from the foreskin frenum to prevent it from damaging the foreskin frenum and affecting male sexual function.
3. Cryotherapy: Cryotherapy with liquid nitrogen or carbon dioxide dry ice will cause the wart tissue (that is, the damaged part of the skin) to be necrotic. Condyloma acuminatum is caused by condyloma acuminatum virus infection, which leads to benign hyperplasia of skin mucosa. It has a large number of small blood vessels and proliferates rapidly. By freezing, condyloma acuminatum can be frozen to form local high edema, thus destroying the wart body. The biggest advantage of cryotherapy is that it leaves no trace locally, and the cure rate is about 70%. In the course of treatment, there is generally no obvious sequelae except local redness, pain and blister reaction. Spray method or direct contact method can be used, which is suitable for verruca plana and verruca minor. Generally, it is frozen once a week 1 time, 2 ~ 3 times in a row. General post-menstrual treatment.
Fourth, laser treatment: suitable for superficial condyloma such as vulva and anus; It is characterized by quick response, and the wart can fall off during treatment. Commonly used is carbon dioxide laser, which cauterizes warts. Generally, 1 time can make warts fall off. However, because the laser beam is too concentrated, laser treatment is only suitable for condyloma acuminatum with small warts. If the wart is large, laser treatment is easy to recur. The cure rate can reach 80%.
Five, electrocautery treatment: electrocautery is an ancient treatment. In the past, dermatologists often used high-frequency electrotome or soldering iron to burn warts, pigmented nevus and other skin vegetation. Its characteristics are simple operation and quick response. High-frequency electrotome can directly remove and dry wart, and the treatment is thorough, but the healing of sore surface by electrocautery is slow. To sum up, electrocautery can be used for the treatment of any condyloma acuminatum, but it has high technical requirements for the performer, and it is harmful to burn too much or not. At the same time, attention should be paid to aseptic operation to prevent infection. High-frequency electrotome or electroacupuncture is more suitable for the treatment of tiny lesions of cervix or vagina. Larger warts require batch electrocautery.
Surgical excision: surgical excision can be considered for large isolated pedicled warts. Surgical resection of condyloma acuminatum is generally not recommended, because condyloma acuminatum is easy to relapse after surgical treatment, which makes the treatment fail. However, for large pedicled warts or warts suspected of malignant transformation, surgical resection can be considered. Some patients with condyloma acuminatum grow too fast or are as big as cauliflower, and other treatments are very difficult, so surgery can be considered. In order to prevent recurrence, other treatments were given after operation. According to the size and coverage area of wart, focus resection or vulvar resection is selected.
Seven, surgical curettage: during treatment, the left hand will tighten the skin or mucosa of the lesion, or hold a disinfection curette to scrape off the lesion tissue from the root; Thoroughly remove the pathological tissue left in the wound, and then apply it locally with 33% trichloroacetic acid solution or pure carbonic acid solution or 3% ferric chloride solution.
Eight, surgical ligation: suitable for a single small lesion with bangs, after local disinfection and local anesthesia; Lift the wart tissue with tweezers, clamp the root with hemostatic forceps, and then tie the base with 1 silk thread. Generally, warts can fall off 3-5 days after ligation.
Interferon: intramuscular injection 1 10,000 unit days, continuous treatment 10- 14 days, and then injection 3 times a week for about 4 weeks. 2. Local injection: Interferon is injected directly into the base of the lesion twice a week.
Polymorphonuclear cells (inducer): 20mg intramuscular injection once, twice a week. 2-4 weeks is a course of treatment.
They have their own indications, and the cure rate is between 50% and 80%. Follow the doctor's advice.