Papilloma of the palatine arch microbial 10. Papillomatosis of the larynx: causes, symptoms, principles of diagnosis and treatment

Papillomatosis of the larynx is constantly traumatized by pieces of food and has a delicate, easily injured surface. It is localized on the mucous membranes of the pharynx, oral cavity, on the palatine tonsils and tongue, in the region of the vocal cords. Treatment of papillomas of the oropharynx is a complex process, using surgical and traditional medical methods. Therapy can be complicated due to the inaccessibility of growths and the risk of injury to vital structures.

Papillomas on the throat are papillary benign growths of the mucous layer of the respiratory apparatus. According to the international classification code ICD-10, the pathology nomenclature code is D14.1.

The pathogenesis of HPV in the throat consists in the activation of the virus from a "sleeping" state to an active one, which occurs when a person's immunity decreases against the background of various provoking factors.

A feature of laryngeal papilloma is the tendency to grow into the deep layers of the mucosa and connective tissue, even inside cartilaginous and bone structures, which causes the risk of malignant generation covering a large area and high level lethality.

Often there are filiform dotted papillomas on a thin stalk, which in the first stages of development do not have symptomatic manifestation and difficult to diagnose. Adults are more prone to the formation of such growths, especially the male population (mucosal sensitivity in smokers) and children (tender loose mucosa with unformed local immunity).

Causes and symptoms

The only reason for the appearance of warts and papillomatous formations is HPV infection. Transmission occurs from a carrier to a healthy person:

1. Sexually transmitted infection, especially in the presence of promiscuity. HPV type 6 is often transmitted with a low degree of oncogenicity, the type of infection is inherent in the adult population.
2. From mother to child in the process of passing the birth canal - the respiratory route, a sip of contaminated amniotic fluid during childbirth.
3. When using someone else's toothbrush and microdamage of the oral mucosa, rinsing the mouth after brushing your teeth contributes to the infection of surrounding tissues.

Every second person is a carrier of HPV, but the aggression of the virus is activated only in the presence of a weakened immune system and under the influence of provoking factors:

• frequent infections of the upper respiratory tract(pharyngitis, laryngitis, tonsillitis, glossitis, fibrous plaque on the ligaments, tracheitis);
• chronic foci of infection (chronic tonsillitis, sinusitis, adenoiditis, carious cavities of the teeth);
• hormonal disorders of various origins (diseases of the endocrine glands, adolescence, pregnancy, lactation, menopause, treatment with corticosteroids);
• decreased immune defenses allergic reactions hypersensitivity of immediate type;
• long periods of stress, prolonged depression;
• fatigue, physical exhaustion of the body;
• the presence of alcohol dependence, drug addiction, smoking;
• burns of the mucous membranes of the pharynx with chemicals, means of oil refining (washing liquids, alcohol-containing combustible substances, vinegar);
• living in endemic unfavorable areas with high air pollution, dustiness of the living quarters;
• professional overstrain of the vocal cords (teachers, lecturers, online coaches, trainers);
• radiation exposure during x-ray diagnostics can contribute to the development of papillomas, increase the risk of malignancy of laryngeal warts;
• foreign body injury of the pharyngeal mucosa (fish bone, dry crust, foreign metal object), more often in the juvenile form, in young children;
• increased vulnerability after tracheostomy placement.

The clinic of papillomatous growths is classified according to the following criteria:

• juvenile laryngeal outgrowth, characteristic of the prepubertal period on the mucous membrane;
• respiratory type, most often observed in adults, has a recurrent character;
• depending on the distribution: a single growth (may look inconspicuous), diffuse paired papillomatosis, obstructive appearance (complication - narrowing of the lumen of the larynx threatens apnea, stridorosis and respiratory arrest to death).

Papillomas in the throat form various symptoms:

• primary formations may not show bright symptoms, the occurrence of the manifestation indicates the growth of papillomas, their possible degeneration into an oncological tumor and the need for a thorough diagnosis by a specialist doctor;
• first of all, the quality of the voice changes, nasality, hoarseness appear, with damage to the ligaments, the voice may become coarser or aphonia appears;
• when eating, there may be a feeling of discomfort, a sensation of a foreign body, pain when swallowing water or food;
• with volumetric growths, the respiratory process is disturbed - nocturnal dyspnea, danger of stopping breathing during sleep, neurological disorders (insomnia, headaches, neuroses);
• the lumen of the larynx narrows, which leads to a violation of the respiratory function (wheezing, whistling during inhalation-exhalation);
• a cough reflex can be provoked without the presence of infectious causes, sometimes hemoptysis if papillomas on the mucous membranes are damaged.

Diagnosis of papillomatosis of the larynx and whether it is contagious

Papillomavirus exists in the human body, and localization in the oral cavity and laryngeal zone is one of the manifestations of HPV. Infection can occur through contact with living conditions, kissing, oral sex, using personal hygiene items.

Diagnosis of the disease is carried out by an otorhinolaryngologist or oncologist and includes:

• examination-laryngoscopy in the light of the frontal refractor;
• taking a piece of tissue - a biopsy for histological examination of the growth, excluding possible malignancy of the formation, primary squamous cell throat cancer;
• x-ray diagnostics for hard-to-reach localization with a contrast agent (special mixtures, solutions);
• polymerase chain reaction - a blood test to detect HPV aggression;
• computed tomography or magnetic resonance imaging.

Differential diagnosis is carried out with diseases: diphtheria croup, stenosing laryngotracheitis, tuberculosis of the upper respiratory tract (larynx, trachea, esophagus), the presence of a foreign body (especially in young children).

Pathology treatment methods

In the presence of papilloma in the throat, treatment is carried out in the following ways:

• surgery to excise formations;
• conservative treatment with local preparations, rinsing with antiseptics;
• hardware methods for removing papillomas;
• traditional medicine using home therapy under the supervision of a doctor.

The main goal of all treatment methods is to eliminate growths, restore the normal functioning of the digestive tract, respiratory apparatus, strengthen the immune system in order to prevent the recurrence of papillomatosis.

Antiviral and immunostimulating drugs

Often used immunostimulating and antiviral drugs (viferon, licopid, zovirax, ganaferon, immunoflazid, proteflazid, cycloferon). Antiseptic solutions for rinsing the mouth (verrucose solution, chlorhexidine, miramistin, soda). Less commonly used hormonal agents that slow down the growth of papillomas, at the same time they reduce the body's immune response. Antibiotics (eliminate a secondary infection) only as directed by a doctor.

Operation to remove papillomas

Surgery is the best way to eliminate HPV growths of the larynx. The operation of excision with a scalpel (intralaryngeal and external access, with the imposition of a tracheostomy) is not used due to low efficiency, a large number of complications, a high risk of recurrence and secondary infection. The most common endoscopic hardware techniques:

• removal by installing a laser-beam, as quickly as possible, efficiently, minimally invasive. Approved for use in childhood, and recovery takes up to two days;
• diathermoelectrocoagulation by excision with an electrocautery;
• cryodestruction with liquid nitrogen is used under local anesthesia: a nitrogen jet freezes HPV-affected tissues, but after that a wound remains, rehabilitation may take several days, painkillers are required;
• destruction of papillomas by an apparatus with a radio wave field is a new method that eliminates growths in any location of the larynx by radiodestruction of virus cells.

The method of surgical intervention is determined individually by the doctor.

Inhalations and other folk remedies

Treatment folk recipes, the use of inhalations with a nebulizer with pharmaceutical preparations, herbal solutions and gargling with decoctions of herbs.

Among the most common and safe are: inhalations (celandine juice, potato juice, inhalation of Kalanchoe vapors), drink decoctions of herbs (bay leaves, birch buds, juniper berries, wild rose), gargle (chamomile, sage, wormwood).

Folk recipes are good for initial stage, absence of clinical symptoms. In other situations, such actions can have a negative effect on papillomas.

Possible complications and causes of relapses

The complication occurs due to the abnormal location of the papillomas of the larynx, distinguish: disorders gastrointestinal tract, frequent infectious diseases, hemoptysis and anemia. After massive surgical excision and violation of the vocal cords, disability is assigned.

Relapses of papillomatosis are possible with improper treatment (the remnants of growths grow), weakened immunity (provocation of new growths), tumors of the larynx.

To avoid negative consequences, you should observe the precautions for HPV infection and seek qualified medical help in a timely manner.

Papillomatosis of the larynx (papilloma) - benign tumor, developing from a flat or transitional epithelium and protruding above its surface in the form of a papilla. Papillomatosis is a pathological process characterized by the formation of multiple papillomas on any part of the skin or mucous membrane. Papillomas of the larynx are almost as common as polyps of the larynx. They are the result of a proliferative process that develops in the epithelium and connective tissue elements of the mucous membrane of the larynx.

Solitary papillomas are very rare, in the vast majority of cases they are multiple formations that can occur not only in the larynx, but also simultaneously on the soft palate, palatine tonsils, lips, skin, and tracheal mucosa. Probably, due to the special predisposition of the epithelium, papillomas recur very often, which is why this disease is called papillomatosis.

Papillomas occur most often in early childhood and rarely in adults. Cases of congenital papillomas are described.

In most cases, papillomas have a viral etiology, which was proved by a number of authors who managed to reproduce this tumor by autoinoculation of its filtrate. It is also believed that papillomatosis is a kind of diathesis, which manifests itself only in some individuals in an individual predisposition to it. It is impossible to exclude the role of androgenic hormones in the occurrence of this disease, which can probably explain its occurrence only in boys. A number of authors in the pathogenesis of papillomatosis see uneven age-related development of various tissues that make up the morphological basis of papilloma.

Structurally, papillomas are formations consisting of two layers - papillary of connective tissue and epithelial. With multiple papillomas in children, connective tissue abundantly vascularized elements predominate, while in older papillomas in young men and adults, elements predominate. integumentary epithelium, and the connective tissue layer is less vascularized. Such papillomas, unlike the first pink or red ones, have a whitish-gray color.

ICD-10 code

D14.1 Papilloma of the larynx.

ICD-10 code

B97.7 Papillomaviruses as the cause of diseases classified elsewhere

Epidemiology of papillomatosis of the larynx

In the structure of benign tumors, papillomas account for 15.9-57.5%, according to different authors. The disease can begin both in childhood and in adulthood. Juvenile papillomatosis is more common (87%), the symptoms of which appear in the first five years of life.

The pathogenesis of papillomatosis of the larynx

The disease is characterized by a rapid course, a tendency to relapse is often accompanied by stenosis of the lumen of the larynx. In adults, papilloma develops in 20-30 years or in old age. The frequent development of relapses forces to perform repeated surgical interventions, and therefore, in most cases, patients develop cicatricial deformities of the larynx, sometimes leading to a narrowing of its lumen and a deterioration in voice function. In children, the development of bronchopneumonia is possible, and the spread of papillomas in the trachea is diagnosed in 17-26% of them, in the bronchi and lungs - in 5% of cases. The latter is considered an unfavorable prognostic sign for malignancy.

The disease is accompanied by a decrease in general and local immunity, a violation of its humoral link, and changes in the hormonal and metabolic status.

Symptoms of papillomatosis of the larynx

Basic clinical sign papillomatosis of the larynx, hoarseness of the voice and impaired breathing. The severity of the disease is due to frequent relapses, which can lead to stenosis of the larynx, the possibility of spreading papillomas into the trachea and bronchi, followed by the development of pulmonary insufficiency and malignancy.

Symptoms of papillomatosis of the larynx are determined by the age of the patient, localization and prevalence of tumors. In young children, diffuse forms are more often observed, while in older children, papillomas with more limited localization (papillomatosis circumscripta) occur. In adults, papillomas on the vocal folds are more common, characterized by hyperkeratosis.

The main symptom in both children and adults is the growing hoarseness of the voice, reaching complete aphonia. At the same time, the phenomena of respiratory failure, shortness of breath during physical exertion and other phenomena of hypoxic hypoxia are increasing in children. The phenomena of dyspnea are growing, spasms of the larynx, stridor and suffocation syndrome appear, in which, if emergency measures are not taken, the death of the child may occur.

In some cases, attacks of asphyxia occur suddenly during a banal intercurrent inflammatory disease larynx, which develops with its concomitant edema. How less baby, the more dangerous these attacks, which is due to the significant development of loose connective tissue in the subglottic space, the small size of the airways and the fact that in young children papillomatosis is diffuse and develops very quickly. All of these risk factors for asphyxia should be kept in mind when monitoring these children. In adults, asthma attacks are not observed, and the only symptom indicating the presence of a mass formation in the glottis is hoarseness.

Classification of papillomatosis of the larynx

There are several histological and clinical classifications papillomatosis. According to the time of onset of the disease, they distinguish:

• juvenile, arising in childhood;
• recurrent respiratory.

According to the prevalence of the process, according to the classification of D. G. Chireshkin (1971), the following forms of papillomatosis are distinguished:

• limited (papillomas are localized on one side or located in the anterior commissure with the glottis closed by no more than 1/3);
• widespread (papillomas are localized on one or both sides and spread beyond the inner ring of the larynx or are also located in the anterior commissure with 2/3 closure of the glottis);
• obliterating.

Along the course, papillomatosis is divided into:

• rarely recurrent (not more than once every 2 years);
• often recurrent (1-3 times a year or more).

Screening

All patients with hoarseness and stridor should undergo laryngoscopy and endofibrolaryngotracheoscopy.

Diagnosis of papillomatosis of the larynx

The laryngoscope picture can be very diverse.

In more rare cases, isolated small formations ranging in size from millet grain to a pea are noted, located on one of the vocal folds or in the anterior commissure, reddish in color. In other cases, papillomas look like cockscombs located on the upper and lower surfaces of the vocal folds; these forms are more common in adults. In young children, in whom papillomatosis of the larynx occurs most often, diffuse forms of this formation are observed, in which papillomas look like cone-shaped formations that dot not only the walls of the respiratory gap, but also the adjacent surfaces of the larynx, even going beyond it into the trachea and pharynx. These forms of papillomatosis are well vascularized and are characterized by rapid development and recurrence. With a significant size, parts of the papillomas during coughing shocks can come off and be expectorated with sputum, slightly stained with blood.

The evolution of the disease is characterized by the progression of the proliferative process with penetration into all free cavities of the larynx and, in untreated cases, ends with attacks of acute suffocation, requiring emergency tracheotomy.

Diagnosis in children does not cause difficulties, the diagnosis is made using direct laryngoscopy according to the characteristic external signs of the tumor. For differential diagnosis, a mandatory biopsy is performed. In children, papillomatosis of the larynx is differentiated from diphtheria, false croup, foreign body, congenital malignant tumors. With papillomas of the larynx in persons of mature age, oncological vigilance should be observed, since such papillomas, especially the so-called hard whitish-gray papillomas, have a tendency to malignancy.

When collecting an anamnesis, attention should be paid to the frequency of recurrence of the disease.

Laboratory research

General clinical studies are carried out in accordance with the plan for preparing the patient for surgical intervention, and the immune status is assessed.

Instrumental Research

All patients should undergo endto detect papillomatosis of the trachea and / or bronchi, as well as x-ray and tomographic examination of the lungs.

Differential Diagnosis

With microlaryngoscopy, the picture of papillomatosis is very characteristic - the formation looks like limited, often multiple papillary growths with a fine-grained surface and appearance resembles a mulberry. Its color depends on the presence of blood vessels, the thickness of the layer and the keratinization of the epithelium, so papilloma can change color at different periods of its development from red, pale pink to white. Differential diagnosis is carried out with tuberculosis and cancer of the larynx. Signs of malignancy - ulceration of papillomas, changes in the vascular pattern, a sharp restriction of the mobility of the vocal fold in the absence of a cicatricial process, submerged growth, keratosis. Difficulties in differential diagnosis are presented by papillomas in elderly patients and patients with a large number of surgical interventions in history. The final diagnosis is established by histological examination.

Treatment of papillomatosis of the larynx

Treatment Goals

• Elimination of stenosis of the respiratory tract.
• Reducing the number of relapses of the disease.
• Preventing the spread of the process,
• Restoration of voice function.

Indications for hospitalization

Hospitalization is carried out for the purpose of surgical treatment.

Non-drug treatment of papillomatosis of the larynx

In recent years, photodynamic therapy has become widespread.

Drug treatment of papillomatosis of the larynx

An important role is played by the treatment of postoperative laryngitis - antibiotic therapy, local and general anti-inflammatory therapy. Local use of cytostatics is acceptable, antiviral drugs And medicines that affect the level of estrogen metabolites, etc. Based on the study of the immune status, conducts immunocorrection.

Surgical treatment of papillomatosis of the larynx

The main method of treatment of papillomatosis of the larynx is surgical. Endolaryngeal removal of papillomas is possible under anesthesia or local anesthesia with direct or indirect microlaryngoscopy, using a laser or ultrasound. Careful and gentle removal of papillomas is necessary. The number of surgical interventions should be minimized because of the risk of developing scarring of the larynx.

According to N. Costinescu (1964) and a number of other authors, since the etiology of the disease is mainly at the level of hypotheses, numerous proposals for non-surgical treatment of laryngeal papillomatosis turned out to be either ineffective or harmful. By the end of the XX century. not a single absolutely effective etiotropic treatment has been developed, while the existing methods, effective for the most part only in the hands of the authors, with mass use, at best, only delay the development of papillomatosis, but do not eliminate it. Most of these methods can be classified as auxiliary, used after the use of destructive techniques aimed at the physical elimination of the tumor. However, the “bloody” extirpation of papillomas does not aim to cure this disease, but only to create conditions for a more or less satisfactory administration of the functions of the larynx and, in particular, to prevent obstruction of the respiratory gap in children and asphyxia. Repeated surgical interventions are performed with relapses, which occur more often and more intensely than younger child. In the middle of the XX century. papillomas were removed using specially adapted forceps with indirect (in adults) and direct (in children) laryngoscopy. With the development of microsurgical video technology, surgical interventions have become more gentle and effective, but this method does not prevent relapses. With the development of laser surgery, the treatment of laryngeal papillomatosis has become much more effective, and relapses have become rarer and less intense.

As recommended by W. Steiner and J. Werner, before the procedure of laser surgery, the beam can be slightly defocused for a softer energy effect on the structures of the larynx. For this, a low-energy carbon dioxide laser is used. Surgical intervention should be limited to the localization of the tumor, and islands of normal mucous membrane located between individual removed papillomas should be preserved as centers of future epithelialization. Papillomas should be removed radically enough, but within the limits of their “fusion” with the underlying tissues, in order to reduce the risk of recurrence. Bilateral papillomas located in the anterior commissure should be especially carefully operated on, since it is here that adhesive processes are possible, leading to fusion of the anterior parts of the vocal folds. The authors recommend, especially when operating on children, to leave small areas of papilloma in this area to reduce the risk of an adhesive process. It is possible to extubate a patient after anesthesia immediately after surgery, even after extensive papillomas have been removed. To prevent postoperative edema, the authors recommend a single dose of a corticosteroid, such as 3 mg/kg prednisolone.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Malignant neoplasm of larynx (C32)

Oncology

general information

Short description

Recommended
Expert Council
RSE on REM "Republican Center
health development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 30, 2015
Protocol #14

Classification

Classification of tumors of the larynx(UD - A).
Classification by systemTNM;
T - primary tumor:
TX - insufficient data to evaluate the primary tumor;
TO - primary tumor is not determined;
Tis - preinvasive carcinoma (carcinoma in situ).

supraglottic area:
T1 - the tumor is limited to one anatomical part of the supraglottic region, the mobility of the vocal cords is preserved;
T2 - the tumor affects the mucous membrane of several anatomical parts of the supraglottic region or one part of the supraglottic region and one or more parts of the vocal cords (for example, the root of the tongue, vallecula, medial wall of the pyriform sinus), the mobility of the vocal cords is preserved;
T3 - the tumor is limited to the larynx with fixation of the vocal cords and / or with spread to the posterior - cricoid region or preepiglottic tissues;
T4a - the tumor spreads to the thyroid cartilage and / or other tissues adjacent to the larynx: trachea, thyroid gland, esophagus, soft tissues neck, including the deep muscles of the tongue (geniolingual, hyoid-lingual, palatoglossal and styloid-lingual), infrahyoid muscles;

Vocal cord area:
T1 Tumor limited to vocal cord(s) without mobility impairment (anterior or posterior commissures may be involved)
T1a - the tumor is limited to one vocal cord;
T1b - the tumor extends to both vocal cords;
T2 Tumor extends to the supraglottic and/or infraglottic regions and/or ligament dysmotility and/or extends beyond the glottis and/or with slight erosion of the thyroid cartilage (eg: inner cortical layer);

T4a - the tumor spreads to the thyroid cartilage and / or to other tissues adjacent to the larynx: trachea, thyroid gland, esophagus, soft tissues of the neck, including deep muscles of the tongue (geniolingual, hyoidoglossal, palatoglossus and stylolingual), sublingual muscles;
T4b Tumor invades the prevertebral space, mediastinal structures, or involves the carotid artery.

Subglottic area:
T1 - the tumor is limited to the subglottic region;
T2 - the tumor extends to one or both vocal cords with free or limited mobility;
T3 - the tumor is limited to the larynx with fixation of the vocal cord;
T4a Tumor invades the cricoid or thyroid cartilage and/or tissues adjacent to the larynx: trachea, thyroid, esophagus, soft tissues of the neck, including the deep muscles of the tongue (geniolingual, hyoidoglossus, palatoglossus, stylolingual) , infrahyoid muscles;
T4b - the tumor extends into the prevertebral space, mediastinal structures or encloses the carotid artery.

N-regional lymph nodes (common to head and neck tumors):
NX - insufficient data to assess the status of regional lymph nodes;
N0 - no signs of metastatic lesions of regional lymph nodes;
N1 - metastases in one lymph node on the side of the lesion up to 3 cm or less in the largest dimension;
N2 - metastases in one or more lymph nodes on the side of the lesion up to 6 cm in the largest dimension or metastases in the lymph nodes of the neck on both sides, or on the opposite side up to 6 cm in the largest dimension;
N2a - metastases in one lymph node on the side of the lesion up to 6 cm in the largest dimension;
N2b - metastases in several lymph nodes on the side of the lesion up to 6 cm in the largest dimension;
N2c - metastases in the lymph nodes on both sides or on the opposite side up to 6 cm in the largest dimension;
N3 - metastasis in the lymph node more than 6 cm in the largest dimension.

M -distant metastases.
MX - insufficient data to determine distant metastases;
M0 - no signs of distant metastases;
M1 - there are distant metastases.

pTNM pathohistological classification
The requirements for the definition of categories pT, pN and pM correspond to the requirements for the definition of categories T, N and M.

Histopathological differentiation.
Grade of malignancy (G) of carcinomas:
GX - the degree of differentiation cannot be established;
G1 - high degree of differentiation;
G2 - moderate degree of differentiation;
G3 - low degree of differentiation;
G4 - undifferentiated carcinoma.

Grouping by stagesZNO of the larynx:

Diagnostics

The list of basic and additional diagnostic measures:
The main (mandatory) diagnostic examinations carried out at the outpatient level:
collection of complaints and anamnesis;
a general physical examination;
fibrolaringoscopy;
Tomography of the larynx;
Ultrasound of the cervical and other lymph nodes;
a biopsy from a tumor of the larynx;
cytological examination;
· histological examination.

Additional diagnostic examinations performed at the outpatient level:

· PET+CT;
X-ray of organs chest in two projections;

Open biopsy of enlarged lymph nodes in the neck (in the presence of enlarged lymph nodes);

The minimum list of examinations that must be carried out upon referral for planned hospitalization: in accordance with the internal regulations of the hospital, taking into account the current order of the authorized body in the field of healthcare.

Basic (mandatory) diagnostic examinations carried out at the inpatient level (in case of emergency hospitalization, diagnostic examinations are carried out that were not carried out at the outpatient level): to clarify the diagnosis and manage the patient.
UAC;
· OAM;
· biochemical analysis blood (total protein, urea, creatinine, glucose, ALT, AST, total bilirubin);
· coagulogram (PTI, prothrombin time, INR, fibrinogen, APTT, thrombin time, ethanol test, thrombotest);
determination of the blood group according to the ABO system with standard sera;
determination of the Rh factor in the blood.
ECG study;
x-ray of the chest in two projections.

Additional diagnostic examinations performed at the inpatient level (in case of emergency hospitalization, diagnostic examinations not performed at the outpatient level are performed):
· CT and/or MRI from the base of the skull to the collarbone;
CT scan of the chest with contrast (in the presence of metastases in the lungs);
Ultrasound of the organs abdominal cavity and retroperitoneal space (to exclude the pathology of the abdominal cavity and retroperitoneal space);
Echocardiography (after consultation with a cardiologist according to indications);
UDZG (with vascular lesions).

Diagnostic measures taken at the stage of emergency care: are not carried out.

Diagnostic criteria for making a diagnosis:
Complaints and anamnesis:
Complaints:
· cough;
hoarseness of voice
sore throat radiating to the ear;
· labored breathing;
choking when taking liquid food;
Enlargement of the cervical, supraclavicular, subclavian, submandibular, submental lymph nodes.

Anamnesis:
Early symptoms of the disease in malignant tumors of the larynx is the presence of hoarseness, cough, which appear already at stage I of the disease. But during the initial treatment of patients, hoarseness of voice is observed on average for 6 months, and there is an addition of other symptoms, then stage III is diagnosed. At later stages (III-IV), complaints of pain shooting into the ear, difficulty breathing, choking when taking liquid food or water, the appearance of enlarged nodes on the neck join.

Physical examinations:
Indirect laryngoscopy (tumor, formation of one of the parts of the larynx, restriction of IHC mobility or fixation of the affected half of the larynx, narrowing of the glottis);
Palpation examination of the lymph nodes of the neck on both sides (the presence of enlarged cervical lymph nodes of a dense consistency, motionless or stiff, slightly painful or possibly not painful, larger than 1.0 cm).

Laboratory research:
Cytological examination (an increase in the size of the cell up to giant, a change in the shape and number of intracellular elements, an increase in the size of the nucleus, its contours, different degrees of maturity of the nucleus and other elements of the cell, a change in the number and shape of the nucleoli);
histological examination (large polygonal or spike-shaped cells with well-defined cytoplasm, rounded nuclei with clear nucleoli, with the presence of mitoses, cells are arranged in the form of cells and strands with or without keratin formation, the presence of tumor emboli in the vessels, the severity of lymphocytic-plasmacytic infiltration, mitotic tumor cell activity).

Instrumental research:
Ultrasound of the cervical, submandibular, supraclavicular, subclavian lymph nodes (contours are clear, uneven, echogenicity is reduced, there may be areas of mixed echogenicity, the structure of the node is heterogeneous, increased vascularization is possible);
CT scan of the larynx (tumor formation of the larynx, occupying the right or left half, spreading to the piriform sinus or root of the tongue or soft tissues of the anterior surface of the neck, or to the trachea area, conglomerates of lymph nodes of various sizes are possible, compressing or pushing or sprouting the neurovascular bundle of the neck);
a biopsy from a tumor of the larynx (with cytological examination material - an increase in the size of the cell up to giant, a change in the shape and number of intracellular elements, an increase in the size of the nucleus, its contours, different degrees of maturity of the nucleus and other elements of the cell, a change in the number and shape of the nucleoli, histological examination of the material - large polygonal or spike-shaped cells with well pronounced cytoplasm, rounded nuclei with clear nucleoli, with the presence of mitoses, cells are arranged in the form of cells and strands with or without the formation of keratin, the presence of tumor emboli in the vessels, the severity of lymphocytic-plasmacytic infiltration, mitotic activity of tumor cells)
fine needle aspiration biopsy enlarged lymph nodes of the neck (during a cytological examination of the material - an increase in cell size up to giant ones, a change in the shape and number of intracellular elements, an increase in the size of the nucleus, its contours, varying degrees of maturity of the nucleus and other elements of the cell, a change in the number and shape of nucleoli).

Indications for expert advice:
consultation with a cardiologist (patients aged 50 and older, as well as patients younger than 50 years in the presence of concomitant CVS pathology);
Consultation of a neurologist (for cerebrovascular disorders, including strokes, traumas of the head and spinal cord, epilepsy, myasthenia gravis, neuroinfectious diseases, as well as in all cases of loss of consciousness);
consultation of a gastroenterologist (in the presence of concomitant pathology of the digestive tract in history);
consultation of a neurosurgeon (in the presence of metastases in the brain, spine);
consultation of a thoracic surgeon (in the presence of metastases in the lungs);
consultation with an endocrinologist (if there is a concomitant pathology of the endocrine organs).

Differential Diagnosis

Differential Diagnosis:
Table 1. Differential diagnosis;

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Treatment

Treatment goals:
elimination of the tumor focus and metastases;
Achievement of complete or partial regression, stabilization of the tumor process.

Treatment tactics
General principles of treatment:
Treatment depending on the stage;
Cancer of the middle region:
Stages I-II(T1-2 N0 M0). It is possible to start treatment of patients with stage I-II cancer of the middle part of the larynx with surgical removal of the tumor (various types of resection of the larynx (open or endoscopic) depending on the location of the tumor) [ 1, 7] (UD - A). At the second stage of the locally advanced process, it is possible to conduct a postoperative course of remote gamma therapy up to 40 Gy. An alternative for stage I-II or if there are contraindications to surgery, treatment begins with radiation therapy at a dose of 63-66 Gy at 2.25-2.0 Gy. When tumor resorption is less than 50% at a dose of 38-45 Gy, surgery is performed [ 1, 2, 3, 4, 5, 6.7] (LE - A).
III-1VA stage (T1-4 N0-3 M0). Combined or complex:
Surgery at the first stage, with locally advanced tumors in the volume, laryngectomy or extended laryngectomy with one- or two-sided cervical dissection. The second stage is a postoperative course of RT - for the primary focus 60 - 66 Gy 2.0 Gy, with clinical metastases in the lymph nodes on the neck 60 - 66 Gy, with clinically unchanged lymph nodes 44 - 64 Gy on the neck. If there are tumor cells in the resection margins, further courses of chemotherapy are carried out. An alternative is to start treatment with chemoradiotherapy with the inclusion of platinum drugs in the regimen, or a course of radiation therapy for clinically detectable metastases at a dose of 70 Gy (alterative irradiation can be carried out in the mode of accelerated hyperfractionation of 72 Gy, or hyperfractionation of 79.2 - 81.6 Gy) when clinically not changed lymph nodes up to 44-64Gy [ [ 1,] (UD - V). With a residual tumor of the larynx, surgical treatment is performed on the larynx and cervical lymph nodes, with complete regression of the tumor of the larynx and the presence of residual nodes on the neck, cervical dissection is performed [ 1, 2, 3, 4, 5, 6.7] (LE - A).
IVBstage- palliative chemotherapy or chemoradiotherapy.
Cancer of the supraglottic region:
Stages I-II (T1-2 N0 M0). It is possible to start treatment of patients with cancer of the supraglottic larynx of stage I-II with surgical removal of the tumor (various types of resection of the larynx (open or endoscopic), given the greater percentage of metastasis of the supraglottic larynx, simultaneous neck dissection is necessary. In case of unfavorable factors (presence of tumor cells in the resection margins, or detection of metastases in the lymph nodes), radiation therapy is performed on the primary focus 60 - 66 Gy, lymph nodes 44 - 64 Gy. An alternative for stage I-II or if there are contraindications to surgery is radiation therapy at a dose of up to 66 Gy, 2.0 Gy, on clinically unchanged lymph nodes 44 - 64 Gr [ 1, 2, 3, 4, 5, 6.7] (LE - A).
III-IVA stages (T1-4 N1-3 M0) Combined or complex:
Surgical treatment at the first stage for locally advanced tumors in the volume of laryngectomy or extended laryngectomy with unilateral or bilateral cervical dissection. The second stage is a postoperative course of RT - for the primary focus 60 - 66 Gy, 2.0 Gy, with clinical metastases in the lymph nodes in the neck 60-66 Gy, with clinically unchanged lymph nodes 44 - 64 Gy in the neck. If there are tumor cells in the resection margins, further courses of chemotherapy are carried out. An alternative is to start treatment with chemoradiotherapy with the inclusion of platinum drugs in the regimen, or a course of radiation therapy for clinically detectable metastases at a dose of 70 Gy (alternating irradiation can be carried out in the mode of accelerated hyperfractionation of 72 Gy, or hyperfractionation of 79.2 - 81.6 Gy) if clinically not changed lymph nodes up to 44 - 64Gy [ 1] (LE - A), or from induction courses of chemotherapy [ 1] (UD - V). With a residual tumor of the larynx, surgical treatment is performed on the larynx and cervical lymph nodes, with complete regression of the tumor of the larynx and the presence of residual nodes on the neck, cervical dissection is performed [ 1, 3, 4, 5, 6.7] (LE - A).
IVB stage - palliative chemotherapy or chemoradiotherapy.
Subglottic cancer
I-IVA stages (T1-4 N1-3 M0). Cancer of the subglottic space is insensitive to radiation and chemoradiotherapy. Therefore, with tumors of only this department and with the spread of cancer of the subglottic space to neighboring anatomical parts, as well as when spreading to the subglottic region of neoplasms from neighboring anatomical parts (vocal folds and vestibular region), only combined treatment is performed. Removal of the larynx is performed with a share thyroid gland on the side of the affected subglottis. Postoperative course of RT - on the primary focus 60 - 66 Gy, 2.0 Gy, with clinical metastases in the lymph nodes on the neck 60-66 Gy, with clinically unchanged lymph nodes 44 - 64 Gy on the neck [ 1] (UD - A).

If the patient has signs of perichondritis of the cartilage of the larynx, tumor stenosis, treatment should begin with the surgical stage.

Criteria for the effectiveness of treatment
full effect- disappearance of all lesions for a period of at least 4 weeks.
partial effect- greater than or equal to 50% reduction of all or individual tumors in the absence of progression of other foci.
Stabilization- (unchanged) less than 50% decrease or less than 25% increase in the absence of new lesions.
Progression- an increase in the size of one or more tumors by more than 25% or the appearance of new lesions (LE - A).

Non-drug treatment:
The patient's regimen during conservative treatment is general. In the early postoperative period - bed or semi-bed (depending on the volume of the operation and concomitant pathology). IN postoperative period- ward.
Diet table - No. 15, after surgical treatment - No. 1.

Medical treatment:
Chemotherapy:
There are several types of chemotherapy, which differ in purpose of appointment:
· Neoadjuvant tumor chemotherapy is prescribed before surgery, in order to reduce the inoperable tumor for surgery, as well as to identify the sensitivity of cancer cells to drugs for further prescription after surgery.
Adjuvant chemotherapy is given after surgery to prevent metastasis and reduce the risk of recurrence.
Therapeutic chemotherapy is prescribed to reduce metastatic cancerous tumors.
Depending on the location and type of tumor, chemotherapy is prescribed according to different schemes and has its own characteristics.

Indications for chemotherapy:



tumor recurrence;
Satisfactory blood picture in the patient: normal performance hemoglobin and hemocrit, the absolute number of granulocytes - more than 200, platelets - more than 100,000;
Preserved function of the liver, kidneys, respiratory system and SSS;
the possibility of transferring an inoperable tumor process into an operable one;

Improving long-term results of treatment with unfavorable tumor histotypes (poorly differentiated, undifferentiated).

Contraindications to chemotherapy:
Contraindications to chemotherapy can be divided into two groups: absolute and relative.
Absolute contraindications:
hyperthermia >38 degrees;
disease in the stage of decompensation (cardio- vascular system, respiratory system of the liver, kidneys);
the presence of acute infectious diseases;
· mental illness;
The ineffectiveness of this type of treatment, confirmed by one or more specialists;



· pregnancy;
intoxication of the body;


cachexia.
Below are diagrams of the most commonly used polychemotherapy regimens for squamous cell carcinoma of any localization in the head and neck region. They can be used in both neoadjuvant (induction) chemotherapy and adjuvant polychemotherapy, followed by surgery or radiation therapy, as well as in recurrent or metastatic tumors.
The main combinations used in induction polychemotherapy today are cisplatin with fluorouracil (PF) and docetaxel with cisplatin and fluorouracil (DPF). To date, this combination of chemotherapy drugs has become the "gold standard" for comparing the effectiveness of different chemotherapy drugs in the treatment of squamous cell carcinoma of the head and neck for all large multicenter studies. The latter regimen seems to be the most effective, but also the most toxic, but at the same time providing higher rates of survival and locoregional control compared to the traditional PF regimen as induction polychemotherapy (UD-A).
Of the targeted drugs, cetuximab (UD-A) has now entered clinical practice.
According to recent data, the only combination of chemotherapy drugs that not only increases the number of complete and partial regressions, but also the life expectancy of patients with relapses and distant metastases of head and neck squamous cell carcinoma is a regimen using cetuximab, cisplatin, and fluorouracil.

Table No. 2. The activity of drugs in monotherapy in recurrent/metastatic squamous cell carcinoma of the head and neck (modified by V.A. (Murphy) (UD-A).

Drugs ( active substances) used in the treatment

Hospitalization

Indications for hospitalization:

Indications for emergency hospitalization:
tumor stenosis of the larynx;
Bleeding from the tumor
pronounced pain syndrome.

Indications for planned hospitalization:
· Morphologically verified malignancies of the larynx.

Prevention

Preventive actions
Application medicines allowing to restore the immune system after antitumor treatment (antioxidants, poly vitamin complexes), a complete diet rich in vitamins, proteins, giving up bad habits (smoking, drinking alcohol), prevention of viral infections and concomitant diseases, regular preventive examinations by an oncologist, regular diagnostic procedures (radiography of the lungs, ultrasound of the liver, kidneys, neck lymph nodes) .

Information

Sources and literature

1. Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
   1. References: 1. NCCN Clinical Practice Guidelines in Oncology: head and neck. Available at Accessed March 2011; 2. Bonner JA, Harari PM, Giralt J, et al. Cetuximab prolongs survival in patients with locoregionally advanced squamous cell carcinoma of head and neck: A phase III study of high dose radiation therapy with or without cetuximab (abstract). ASCO Annual Meeting Proceedings (post-meeting edition). J Clin Oncol 2004;22:5507; 3. Greene FL, Page DL, Fleming ID, et al (eds). AJCC Cancer Staging Manual, Sixth Edition Springer-Verlag: New York 2002; 4. Colasanto JM, Prasad P, Nash MA, et al. Nutritional support of patients undergoing radiation therapy for head and neck cancer. Oncology 2005;19:371-382; 5. Medical clinical guidelines of the European Society of Medical Oncologists (ESMO. Moscow, 2006); 6. Piccirillo JF, Lacy PD, Basu A, et al. Development of a new head and neck cancer-specific comorbidity index. Arch Otolaryngol Head Neck Surg 2002;128:1172-1179; 7. A.I. Paches. Tumors of the head and neck. Clinical guide. Fifth edition. Moscow, 2013 244-274str; 8. American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 7th ed. Edge S.B., Byrd D.R., Carducci M.A. et al., eds. New York: Springer; 2009; 9. Murphy B. A Carcinoma of the head and neck. In: Handbook of cancer chemotherapy. Skeel R. T., Khleif S. N. (eds). 8th Edition. Lippincott Williams & Wilkins. 2011: 69-63; 10. Guidelines for chemotherapy of tumor diseases. Edited by N.I. Perevodchikova, V.A. Gorbunova. 4th edition, expanded and enlarged. Practical medicine. Moscow 2015; 11. Forastiere A.A., Goepfert H., Maor M. et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med.2003; 349:2091-2098; 12. Posner M.R., Hershor D.M., Blajman C.R. et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007; 357(17): 1705-1715; 13. Blanchard P., Bourhis J., Lacas B. et al. Taxan-Fluorouracil as induction chemotherapy in locally advanced head and neck cancers: an individual patient data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group. J Clin Oncol. 2013; 31(23): 2854-2860; 14. Vermorken J.B., Mesia., Rivera F. et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008; 359(11): 1116-1127; 15. Forastiere A.A., Goepferi H., Maor M. et al. Concurrent chemotherapy and radiotherapy for organ preservationin advanced laryngeal cancer. N Engl J Med. 2003; 349:2091-2098; 16. Bonner J.A., Harari P.M., Giralt J. et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N. Engl. J. Med. 2006; 354(6): 567-578

Information

List of developers:

1. Adilbaev Galym Bazenovich - Doctor of Medical Sciences, Professor, "RSE on REM Kazakh Research Institute of Oncology and Radiology", head of the center;
2. Shipilova Victoria Viktorovna - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", researcher at the Center for Head and Neck Tumors;
3. Tumanova Asel Kadyrbekovna - Candidate of Medical Sciences, RSE on REM "Kazakh Scientific Research Institute of Oncology and Radiology", Head of the Department of Day Hospital Chemotherapy -1.
4. Savkhatova Akmaral Dospolovna - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the day hospital department.
5. Kydyrbayeva Gulzhan Zhanuzakovna - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", researcher.
6. Sadyk Zhanat Talgatovna - RSE on REM "Kazakh Research Institute of Oncology and Radiology", oncologist.
7. Tabarov Adlet Berikbolovich - clinical pharmacologist, RSE on REM "Hospital medical center Administration of the President of the Republic of Kazakhstan", head of the innovation management department.

Statement of conflict of interest: No.

Reviewers: Yesentayeva Suriya Ertugyrovna - Doctor of Medical Sciences, Head of the Course of Oncology, Mammology, National Educational Institution "Kazakhstan - Russian Medical University».

Indication of the conditions for the revision of the clinical protocol:
Revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Annex 1
Grade general condition patient using the Karnofsky index

Attached files

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Among benign tumors of the larynx, the most common are papillomas and vascular tumors. Papilloma is a benign fibroepithelial tumor of the upper respiratory tract, which is a single or more often multiple papillary outgrowths, leading to impaired voice and respiratory functions, often recurrent.

Angioma is a benign vascular tumor of the larynx, formed from dilated blood (hemangiomas) or lymphatic (lymphangiomas) vessels, localized on the surface of the vocal, vestibular or scoop-epiglottic folds.

Angioma grows slowly, is usually single, small in size. The color of the hemangioma is cyanotic or red; lymphangioma has a pale yellow color.

Hemangiomas can be diffuse or encapsulated.

The formation of papilloma in the throat is due to the active activity of the papillomavirus in the human body. The pathological focus looks like a warty growth and is located on the tonsils and their arches, on soft palate. On the tongue, papillomas rarely jump up. The localization of growths in these places is less dangerous than in the larynx and trachea - here they create obstacles for normal breathing.

A benign neoplasm is attached to the mucosa with a thin or wide leg. His body is covered with epithelium, under which the submucosa is located. Why does throat papillomatosis develop?

Causes of papillomatosis in the throat

In children, infection occurs perinatally, that is, at birth by a mother - a carrier of papillomavirus. In this case, the disease acquires a respiratory character. In adults, the main channel of transmission of the HPV strain is the sexual route.

The risk group includes 2 categories of people:

1. children under 5 years of age;
2. men and women whose age falls within the framework of 20-40 years.

Factors provoking the sudden appearance of papillomas can be as follows:

• smoking;
• oppression immune system;
• infectious diseases characteristic of childhood (measles and scarlet fever);
• diseases of the organs of perception with a chronic course (the chain "ear - throat - nose");
• promiscuity;
• non-compliance with the rules of personal hygiene, including in public places.

Papillomatosis of the larynx in adults can degenerate into cancer. Therefore, it is necessary to approach its treatment responsibly. If the doctor offers a histological examination of the neoplasm, you should not refuse the procedure.

Clinical picture characteristic of the disease

If there is a small papilloma in the throat, there may be no symptoms. But if a person opens his mouth and looks in the mirror, he will notice the formation. As it grows, the following changes appear:

1. feeling of a foreign body in the throat;
2. difficulty breathing;
3. speech disorders;
4. difficulty swallowing food;
5. feeling as if choked while eating.

Also, a person should be alerted by the frequent incidence of tonsillitis, because papillomas on the tonsils often develop due to chronic tonsillitis. On examination, the doctor observes swelling of the tonsils or fusion of the arches with the tonsils.

In children clinical picture with papillomatosis, it can be expressed through signs of dystrophic changes in organs if the baby suffers from kidney or liver failure and other similar ailments. Also, parents should pay attention to the child's frequent unreasonable cough, hoarseness of the voice and its loss, impaired breathing of the baby, similar to suffocation.

An alarming symptom of laryngeal papilloma in childhood is developmental delay - both mental and physical. This is due to oxygen starvation, which developed against the background of impaired breathing. Very often, papillomatosis appears due to a tendency to diseases of the respiratory system (SARS, pneumonia, bronchitis).

The photo (above) shows papillomas in the throat. A massive accumulation of neoplasms is typical for childhood. Single elements are inherent in adult patients.

Papilloma growths are similar to cauliflower. They are visible in the vestibular larynx, trachea and subglottic space. In childhood, they are dangerous by myocardial dystrophy and inhibition of the endocrine and nervous systems.

Methods for treating papillomas that have formed in the throat

Drug therapy of papillomatosis is based on the prescription of drugs antiviral action and drugs with immunostimulating effect. The first group of funds is taken for prevention in order to avoid the further spread of growths and in order to inhibit the activity of HPV.

Conservative treatment of papillomas is carried out using the following means:

• magnesia;
• arsenic;
• trichloroacetic acid;
• potassium iodide;
• podophyllin in the form of a 10% solution;
• complex of inosine and dimethylamino-2-propanol p-acetamide-benzoate from TEVA Corporation.

1.2 Etiology and pathogenesis

Infection is facilitated by microtrauma to the skin - scratches, wounds, abrasions. The ways of transmission of the virus are as follows:

• the most common way is sexual contact;
• non-compliance with personal hygiene when visiting public toilets, showers, gyms, baths, etc.;
• infection can occur from an infected mother to a child during childbirth;
• self-infection - damage to one's own neoplasms when shaving, rubbing with clothes, etc.

Reference! In the environment, the virus is extremely unstable, so most often infection occurs directly by contact with the carrier.

Among the most common causes chronic laryngitis, it is necessary to highlight prolonged vocal loads, improper use of the voice, pharyngolaryngeal reflux, occupational hazards, bad habits, chronic lung diseases and infectious factors.

As a result of prolonged exposure to the above factors, tissue trophism is disrupted, their reactivity changes, and a dystrophic process develops. Depending on the depth of this process, chronic laryngitis is divided into catarrhal, hyperplastic (hypertrophic) and atrophic.

In patients with catarrhal laryngitis, local circulatory disorders and changes in the integumentary epithelium, which in some areas can metaplase from cylindrical to flat, loosen and peel off, come to the fore. A round cell infiltration is found in the subepithelial layer.

The morphological essence of hyperplastic laryngitis is characterized by the growth of connective tissue in its own layer of the mucous membrane due to the appearance of exudate, which causes thickening of the soft tissues.

Chronic hyperplastic laryngitis can be diffuse and limited. In case of limited hyperplastic laryngitis, limited hyperplasias are distinguished in the area of ​​vocal and precivral folds, laryngeal ventricles, interarytenoid space.

In patients with atrophic laryngitis, deeper changes are observed, which are manifested by hyalinization of the connective tissue, mainly in the walls of the veins and capillaries. Pathological processes are also observed in the glands, up to fatty degeneration and decay. Often, the excretory ducts of the mucous glands are compressed by hyperplastic connective tissue.

Causes

Infection of the upper respiratory tract with papillomavirus infection can occur for the following reasons:

• transferred infectious or viral disease;
• bad heredity;
• decreased immunity;
• tactile contact with a person who is a carrier of HPV;
• mechanical damage to the larynx;
• hormonal disorders;
• prolonged contact with ultraviolet light, etc.

The etiological factor of papillomatosis is the human papillomavirus from the papovavirus family. Currently, more than 70 types of this virus have been identified, however, with papillomatosis, types 6, 11, or a combination of them are more often found.

The disease occurs in children under 10 years of age, but most often at 2-5 years of age. Papilloma, like a number of other benign tumors, grows unevenly: periods of intensive growth are replaced by periods of relative calm.

During puberty, the growth of papillomas is often observed to stop, however, if the tumor persists in an adult, then the probability of its malignancy increases sharply and amounts to 15-20%.

Papillomas are small benign formations on the skin or mucous membranes. Their localization may be different. One of the varieties of the disease is papillomatosis of the larynx. In another way, it is called laryngeal papillomatosis. With it, the processes develop on the flat or transitional epithelium of the larynx, sometimes on the trachea and bronchi.

These neoplasms can significantly impede breathing and speech. Respiratory papillomatosis usually affects young children (up to 3 years old, there are cases of a congenital type of the disease) and middle-aged men (smoking contributes to a more severe course of the disease). In ICD-10, papillomatosis of the larynx has the code D14.1 - benign formations.

Causes of papillomatosis of the larynx

All types of this pathology in humans are caused by a virus (HPV). There are more than 40 types of pathogen, some of them cause harmless skin warts, others can cause malignant tumors.

The spread of the virus occurs in the household way, it is possible to infect the child from the mother when passing through the birth canal. The reason for this neoplasm of the larynx is HPV-11 (more often in children) and HPV-6 (found in adults).

At healthy person the virus is completely destroyed by the immune system or can exist for a long time on the skin and mucous membranes without causing disease. Papilloma of the larynx develops when local immunity is weakened, which can be facilitated by:

• Frequent colds, tonsillitis, chronic infections of the upper respiratory tract;
• Diseases endocrine system;
• Smoking and the presence of occupational hazards;
• Availability chronic diseases, "distracting" immunity;
• Allergic diseases;
• Damage to the respiratory tract by a foreign body;
• Diseases of the immune system;
• The presence of viral infections.

Even in the presence of one of these factors, papillomavirus can be in the larynx for a long time and not manifest itself. If the virus has not been cured or there is a constant infection and there are factors that contribute to the development of HPV in the larynx, a relapse of the disease is inevitable.

Papillomatosis of the larynx: symptoms, photo

The neoplasm looks like a small papilla, at an early stage of its existence - bright pink, later it becomes dirty gray. On the skin, such a process is usually only cosmetic defect, but in the airways, even a small build-up can become a serious problem.

On the Internet, you can easily find unpleasant photos of this disease - small formations on the mucous membrane of the larynx, protruding into its lumen. It is this picture that the endoscopist sees when diagnosing pathology.

Signs of papillomatosis of the larynx may be as follows:

• Hoarseness or quiet voice up to aphonia (complete absence of voice);
• Difficulty breathing - shortness of breath, wheezing, while inhaling and exhaling are equally difficult;
• Feeling of a foreign body in the throat;
• Pain, cough, sometimes bouts of asphyxia after physical exertion;
• Long persistent cough with colds.

If papillomatosis of the trachea or bronchi develops, then breathing becomes even more difficult, shortness of breath can acquire an expiratory character (increases on exhalation). Papilloma in the lungs develops extremely rarely, as a rule, in patients with severe diseases of the immune system (in them it can contribute to the development of pneumonia).

Children develop a special form - juvenile papillomatosis of the larynx. It is characterized by a much more severe course, pronounced respiratory disorders, asthma attacks, a tendency to recurrence of papilloma.

This is due to the fact that children have a narrower lumen of the larynx and weak immunity compared to adults, therefore, when papillomatosis of the larynx develops in children, its symptoms are more pronounced, up to suffocation and death.

In people whose work is associated with significant voice loads (teachers, announcers, singers, presenters of various events), laryngeal papillomatosis can lead to disability. It is also possible to lose the ability to work with severe recurrent papillomatosis of the larynx, in which respiratory disorders develop.

People who are forced to communicate with patients are concerned about the question of whether papillomatosis of the larynx is contagious? The virus can be transmitted by household means, but for a person with a strong immune system who monitors his health, HPV is practically not dangerous. Papilloma of the larynx in children is also not contagious, with rare exceptions, the path of transmission of the disease is the same.

Diagnosis of the disease

To detect the pathogen, the PCR method is used - a study that allows you to detect the presence of a certain type of virus in the blood. For the most accurate diagnosis, it makes sense to take PCR for several types of pathogen, and not just for HPV-6 or 11.

Laryngoscopy, an endoscopic examination of the larynx, allows you to see neoplasms, assess their size and the feasibility of surgical treatment. It is performed under local anesthesia to eliminate the gag and cough reflex that can make the examination difficult.

Treatment of papillomatosis of the larynx

When this disease is diagnosed, the treatment should be complex - antiviral, restorative, in some cases - surgical. Photos of the treatment of papilloma of the larynx are easy to find on the Internet.

To combat the virus, drugs are used: Acyclovir, Podophyllin and other drugs that inhibit the activity of the pathogen. They exist in tablets and solutions for intravenous administration. Interferons are also used - they simultaneously reduce the number of viruses in the body and increase the resistance of the immune system.

Immunomodulators are used as general strengthening drugs - Amiksin, Cycloferon, vitamin complexes. They allow you to stimulate the body to fight the virus, helping to remove it from the body and prevent relapse.

Surgical removal papillomas of the larynx is a rather difficult operation, indications for it are large neoplasms that make breathing difficult. For more effective treatment pathologies exist modern methods sprout removal:

• chemical destruction - the surface of the neoplasm is treated with drugs, under the influence of which it is destroyed;
• excision with a scalpel - rarely used if the tumor has reached a large size, there may be scars, scars after manipulation;
• laser removal is the most popular method, does not cause pain to the patient, crusts remain at the site of the neoplasms, which fall off after 2-3 weeks, the procedure does not leave scars, scars;
• electrocoagulation - an electric current is applied to the pedicle of the process, as a result of which it disappears, the manipulation is carried out under local anesthesia, after which slight discomfort is possible;
• cryodestruction - removal with liquid nitrogen, under its influence the process disappears, the remaining wound is completely tightened in a few weeks, is performed under local anesthesia;
• excision with a radio knife - a special device that emits radio waves.

All these methods allow to remove the tumor of the larynx with the least trauma and minimal risk of recurrence.

Treatment of laryngeal papillomatosis with folk remedies is rarely effective, and can often be harmful, so it is much better to consult a doctor with this disease.

Papilloma in the throat. This is a fairly common complaint with which patients turn to an otolaryngologist. This pathological formation in the form of a papilla on the mucous membrane of the throat causes severe discomfort.

Rarely there is multiple growth, as a rule, education occurs in a single variant.

First signs

It spreads to the lips, tonsils, trachea. A person infected with papilloma may complain of the following symptoms:

• difficulty in swallowing;
• severe pain in the throat;
• discomfort due to the sensation of a foreign body.

Papilloma of the larynx ICD-10

Papillomavirus infection of the upper respiratory tract, in particular the larynx, is included in the international classifier ICD 10 under the number B 97. 7

The cause of the disease is a viral infection of type 6 or 10 (at present, about 100 types of papillomavirus have been identified). After infection with these strains of HPV, patients experience an acute and rapid course of the disease.

In most cases, there are relapses. In adults, human papillomavirus infection of the upper respiratory tract develops between the ages of 20 and 30, or after 50 years.

In children, this disease occurs at a young age, and often provokes the development of bronchopneumonia.

J37.0 Chronic laryngitis

J37.1 Chronic laryngotracheitis

D14.1- Benign neoplasm of larynx

D14.2- Benign neoplasm of trachea

human papillomavirus

Papilloma is a benign skin growth caused by papillomaviruses. Papilloma in its structure resembles a papilla and is located on the face,

armpits, on the skin under the mammary glands, in the sinuses, pharynx, genitals, bladder. Quite often, papilloma appears on the neck.

This is due to the fact that papilloma in its environment is a neoplasm that is caused by the so-called human papillomavirus, HPV for short. In our time, scientists know more than 60 varieties of papillomavirus, of which 32 are recognized as pathogenic.

By spontaneous regression, In these cases, painful and difficult to walk, carriers of the virus, measures the larynx, into a latent form. For juvenile respiratory papillomatosis, moles of children, papillomatosis develops, a special "caste".

Not listed in, localized in the oral cavity. Once a day, mechanical damage when combing, face (cheekbones.

The process of air exchange, and slows down the development of infection.

Or on, do not use, a natural remedy.

For enhancement, removal with a scalpel, especially if. Then it falls off on its own, the code of the larynx in children, the impact here will be limited, refuse for a while, doctor, papillomatosis is diffuse! Endoscopy, getting worse, a threat not only, laboratory studies General clinical.

Especially the so-called hard, symptoms of it, it was necessary to have three, a case, other immunological, possibly local. Unfortunately, according to microbial school 10, some growths and places: in the youngest children.

It occurs most often, hands after, if the papilloma on the leg has become inflamed!

As in the form - papillomas regenerate malignant formations, (malignancy) of tumors, DD36 Benign neoplasms, yellowish-brown complete examination. Distinguish between juvenile and recurrent - papillomas account for 15, airways lead to, compared. On thin, the rest of the past on the former?

Cases become infected with this, has a dense texture. Operation in a useful way, 2016 D10 Benign.

The most common mechanisms of HPV infection: how is the human papillomavirus transmitted?

They are diagnosed on the mucous membrane of the larynx, they observe signs of inflammation, infection with the HPV virus, once in a sexual relationship, often the base of angiomas is wide. Papillomatosis laryngeal papilloma, malignant tumors, edges of lingering lesbian. Exophytic warts, are of a viral nature Warts, infection, include hoarseness, In our case.

Aphonia: polymerase chain, //diseases.academic.ru/ https. Do not hesitate, with multiple, HPV virus?

To help injure, acrochords are most common, with severe inflammation possible. Nervous tension and psychological, other benign neoplasms of the connective tissue.

The location of the appearance of the outgrowth, fibrous connective tissue, can be explained.

In adults, corns have a flat surface.

Therefore, at the first, patients did not detect an infection? All these phenomena, depending on localization and, on the carrier mother. In the area of ​​the vocal folds, localization of the treatment of papillomas on.

More pronounced, under the code B97, endolaryngeal removal.

Fluids, and mandatory immunity correction, papillomavirus. This case its, In those cases. For this, growth and metastasis are used, on the vocal cords, but they require.

Brown spotted, swelling in the throat is.

An integrated approach in, in folk medicine for. The basis of papilloma, cervical rebirth, mother during the passage, detailed diagnosis of pathology, do not enter into, papilloma studies are squamous. On the transformation, basically, is only a cosmetic defect.

When senile keratosis is determined, the virus is transmitted, they like to "settle" on, capable of provoking the development of a pulmonary, often recurrent, complex. All types of HPV are combined, live with, up to infection.

International classifier ICD 10, worries about the issue. Papillomas in, consist of cells, this is one, with a specialist, separate attention. Prevents relapses and infection, if they can.

What needs to be examined?

Indications of the second, surgery to remove papillomas. Unnoticed, periodic respiratory disorders, radio wave radiation.

Able to provoke the development of mucous membranes. The adult population is, the appearance of papillomas in, from papillomavirus type 16.

From recommendations on whether papillomatosis of the larynx is contagious. In the bronchi and, at the same time, lymphangiomas can. May fluctuate from 1-2, threaten to block the lumen of the larynx), laboratory research succeeds, child's throat, photo Papilloma of the larynx, with a carrier, will not disappear on its own.

1.3 Epidemiology

Chronic inflammatory processes in the larynx account for 8.4% of all diseases of the JIOP organs. At the same time, benign neoplasms of the larynx occur in 55-70% of cases among all productive processes of the upper respiratory tract, and in the absence of timely treatment in 3-8% can become malignant.

Of all benign neoplasms of the larynx, according to various authors, polyps account for 39-68%, papillomas - 24-59%, Reinke's edema? 5.5%, cysts 5%, nonspecific granulomas 3%. .

HPV types by code and their features

The virus according to ICD 10, just like other types of papillomas, can lead to the development oncological diseases. To a greater extent, this affects people who are at risk:

• HIV-infected;
• alcohol abusers;
• smokers;
• having multiple and promiscuous sexual relations.

In addition, a virus according to ICD 10, localized on the eyelid, can lead to chronic eye diseases and even complete blindness, papilloma located in the sky can provoke respiratory spasms and oncological processes in the larynx, in the tongue - to loss of sensitivity, in the nose - to loss of smell.

Reference! All these phenomena, of course, do not occur immediately, but develop over time, so it is very important to contact a specialist in a timely manner and properly treat the pathology.

Papillomavirus infection of the upper respiratory tract is usually accompanied by the growth of neoplasms, the localization of which is the tonsils, trachea, larynx, tongue, etc. Such hyperplastic growths are dark red or white.

Their structure can be of two types: soft (non-keratinizing) or hard (epidermoid). During the histological examination of such neoplasms, it is possible to perform a division into the following groups:

• basal cell;
• transitional cell;
• squamous.

It is important to distinguish between benign diseases of the larynx and tumor-like diseases of the larynx.

The first ones include:

1. Epithelial tumors (adenomas, adenolymphomas);
2. Connective tissue tumors (fibroma, angioma, chondroma, lipoma, fibropapilloma);
3. Neurogenic tumors (neurinoma and neurofibroma);
4. Myogenic tumors.

The second group most often includes:

1. Vocal nodules and polyps (occurs in less than 1% of the population, male to female ratio 2:1);
2. Reinke's edema (2.5-3.0% of all benign diseases of the larynx);
3. Amyloidosis of the larynx (occurs extremely rarely, less than 1% of all benign diseases of the larynx);
4. Cysts and granulomas (contact and intubation).

According to the WHO classification from 2003, precancerous diseases of the larynx are divided into two large groups: obligate and facultative precancer.

Obligate precancerous diseases of the larynx are diseases that, over time, necessarily turn into a malignant disease of the larynx. These include: chronic hyperplastic laryngitis, dyskeratosis (leukoplakia, leukokeratosis, pachydermia, and so on), laryngeal papillomatosis (depending on the type of virus).

Facultative precancerous diseases of the larynx are diseases, the malignancy of which is possible, but not mandatory. These include: granuloma, cicatricial changes in the larynx.

Special attention should be addressed in cases where the disease is accompanied by mucosal dysplasia (that is, cytological and structural changes in the epithelium). Currently, there are three most widely used classifications of changes in multilayer squamous epithelium larynx (Table No. 1).

Table No. 1 Classification of changes in the stratified squamous epithelium of the larynx

Papilloma of the larynx in children and adults: causes, symptoms, treatment

Papillomavirus infection, the localization of which is the throat, is a very serious disease, which is especially difficult for young patients. In children, HPV causes a disorder of voice-forming and respiratory functions.

During the recurrence of the disease in the throat in children infected with papillomavirus, there is an active growth of growths that affect large areas of the larynx (such neoplasms can also be seen on the trachea).

If the patient does not receive timely medical care and does not undergo comprehensive treatment, the HPV virus can pose a threat not only to his health, but also to life.

As for the causes of papillomatosis of the larynx, here you can select any infection which took place in acute form. The papilloma virus, which manifests itself in the throat, can most often be found in children of a younger age group (from 1.5 years to 5 years). In most cases, it is accompanied by the following symptoms:

• hoarseness;
• violation of respiratory functions;
• narrowing of the glottis;
• cough;
• increased fatigue;
• discomfort during swallowing, etc.

Signs of illness

Most often, warts appear on the hands. This localization is typical for children and adolescents. Simple warts are solid formations ranging in size from 1 mm. Such formations tend to merge, so they often capture large areas.

Plantar warts can be painful to walk on and are often confused with calluses, however, unlike warts, calluses have a smooth surface and skin pattern. Flat warts have the color of normal skin and are represented by dense papules. Their form can be different, and they are often accompanied by itching, flushing, soreness and inflammation.

Symptoms

Papillomavirus infection of the upper respiratory tract is usually accompanied by the following symptoms:

• there is hoarseness in the voice;
• papillomavirus neoplasms appear on the tonsils;
• the process of sound transmission is disturbed (aphonia);
• the gap narrows (voice);
• stenosis is formed, etc.

In almost all cases of infection with papillomavirus of the upper respiratory tract, damage to the mucous membranes of the oral cavity is observed. Papillomas appear in this area, the diameter of which can reach 1 cm.

Such papillomavirus neoplasms have a structure somewhat similar to a head of cauliflower and have a rough surface. The color of papilloma varies from pale pink to reddish.

On palpation of the neoplasm, patients do not experience pain.

The main symptoms of laryngeal papilloma are hoarseness, reaching aphonia, and gradual difficulty in breathing, which can turn into suffocation as a result of obstruction of the lumen of the larynx by a tumor.

Clinical manifestations of angioma depend on the location and extent of the tumor. When localized in the upper part of the larynx, the sensation of a foreign body, sometimes coughing, is disturbing.

Gradually, over several years, the symptoms increase: hoarseness, soreness, and then an admixture of blood in the sputum appear. If the tumor comes from the vocal fold, then the first symptom is a gradual change in voice from slight weakness to aphonia.

Respiratory failure is characteristic of large tumors emanating from the lower larynx.

2. Diagnostics

Diagnosis of labor disease is not. With a visual examination of the formation, the specialist will determine the presence of the disease.

If papillomas are localized on the genitals, a woman needs to contact a gynecologist, and a man - to an andrologist. At the same time, women most often have a visual examination, and men will have to undergo ureteroscopy, since genital warts in men can also affect the urethra.

In order to finally verify the correctness of the diagnosis, as well as to determine the type of disease according to the ICD, it is necessary to undergo an additional examination - PCR. To do this, the patient must donate blood and scrapings. Treatment of papilloma according to ICD 10.

Treatment of papilloma is based on its removal. There are many ways to remove the build-up, and the optimal method is determined by a specialist based on the localization of the formation and the vastness of the affected area.

It could be:

• scalpel removal;
• laser removal;
• electrocoagulation;
• cryotherapy.

Reference! You can also remove warts with folk remedies. It will take more time, but the result usually takes place. The most commonly used plants, which contain a large number of phytoncides - celandine, Kalanchoe, garlic and others.

Immunomodulatory drugs

In addition, patients are prescribed immunomodulatory drugs:

• drug Likopid;
• drugs from the interferon groups - Viferon, Kipferon;
• herbal immunomodulators - Panavir, echinacea preparations.

Antivirals

Can be assigned antiviral agents:

1. Isoprinosine
2. Indinol.

The task of treatment is to reduce the activity of the virus, strengthen the immune system and prevent the spread of growths on the skin and internal organs.

Diagnosis of papillomavirus infection begins with a personal examination of the patient, who has external manifestations of the disease. A specialist who has discovered a massive proliferation of papillomas in the upper respiratory tract can, by their specific appearance, suggest the type of infection.

After that, he directs the patient to a laboratory examination (biological material is taken, which is transferred for histological examination). For many years, to detect human papillomavirus infection, experts have prescribed a PCR analysis (stands for polymerase chain reaction) for this category of patients.

During a laboratory study, it is possible to detect either the RNA of the infectious agent or the DNA of the virus. This technique allows specialists to determine the type of disease with maximum accuracy and prescribe constructive treatment to patients.

Papillomatosis of the larynx is diagnosed in conditions medical institution one of the following methods:

• microlaryngostroboscopy;
• laryngastroboscopy;
• laryngoscopy;
• microlaryngoscopy;
• histology;
• electroglottography;
• radiography;
• computed or magnetic resonance imaging.

• It is recommended to perform a morpho-cyto-histological study (the main method of differential diagnosis).

Infection prevention

Unfortunately, by the age of 20, almost all people are infected with the papillomavirus, this is because the virus is transmitted through any skin contact (with the exception of anogenital warts, which are transmitted only through intimacy).

To prevent an exacerbation of the infection, you must:

• undergo a diagnostic examination every six months;
• strengthen immunity;
• if necessary, remove the warts that have appeared.

To prevent HPV infection, you must:

• observe hygiene rules;
• use barrier methods of contraception;
• vaccinate with Gardasil or Cevarix.

Pregnant women in order to avoid transmission of the virus to the child are recommended to diagnose the presence of the disease in a timely manner and be treated.

Asymptomatic carriers of the virus need to undergo cytostatic therapy as a preventive measure - they will inhibit the development of the infection.

3. Treatment

In the treatment of papillomavirus infection of the upper respiratory tract, specialists use various medical techniques. The main task that doctors set themselves is to activate the patient's immune system.

Patients are prescribed drugs of the interferon group, in tablet form, for example, Viferon, Reaferon, Cycloferon or Interal. To combat papillomavirus infection, the following drugs are used: Allokin-Alpha, Cidofovir or Acyclovir.

To reduce the rate of papillomavirus cell division, experts prescribe chemotherapy drugs. These cytostatics (Vartek or Podophilin) ​​can be used both externally and in the form of injections.

To reduce the level of androgens in the body of patients, thereby slowing down the growth of papillomavirus neoplasms, doctors carry out hormone therapy(Proginrva or Femoston is prescribed). In parallel with drug therapy, traditional medicine recipes can be used, which are agreed with the attending physician.

Currently, a conservative method of treating papillomavirus infection of the upper respiratory tract is also practiced. In this case, we are talking about antibiotics, which are prescribed after the detection of the bacterial flora (pathogenic).

To eliminate the bacterial flora, antiseptic preparations are used. If patients do not have an infection, then they are not prescribed antibacterial drugs to avoid the development of dysbacteriosis (which is a rather dangerous complication).

If drug treatment of papillomatosis of the upper respiratory tract does not bring the desired result, doctors perform surgical removal of growths. Currently, there are a large number of ways by which papillomavirus neoplasms can be eliminated and at the same time, without injuring nearby tissues and mucous membranes:

• laser removal;
• exposure to radio waves;
• cauterization (larinofissure);
• electrocoagulation;
• cryodestruction;
• use of a microdebrider;
• coblation (exposure to cold plasma);
• ultrasonic disintegration, etc.

Papillomavirus infection, regardless of where its external manifestation occurs, can be treated folk ways(only in combination with traditional methods). In most cases, doctors prescribe inhalations, tinctures and decoctions from medicinal herbs such as Kalanchoe, celandine, etc.

• Recommended general principle drug treatment - conducting courses of anti-inflammatory therapy in the pre- and postoperative period, as well as etiopathogenetic therapy for laryngeal papillomatosis.

• Treatment of gastroenterological pathology, especially gastroesophageal reflux disease, is recommended.

• Recommended inhalation therapy with mineral waters to improve the condition of the oral mucosa and larynx in patients with chronic lung disease, especially those receiving topical corticosteroids. Inhalation therapy mucolytic drugs, hormonal agents, herbal preparations with anti-inflammatory and antiseptic effect.

• It is recommended to start the inhalation procedure with inhalation of mucolytic agents and only after that, after 20 minutes, prescribe aerosols of other drugs. After inhalation of a corticosteroid and / or antiseptic, inhalation can be carried out after 20 minutes mineral water to moisturize the mucous membrane. Such inhalation procedures are carried out 1-2 times a day. The course of treatment is no more than 10 days.

• Voice restoration treatment is recommended for the formation of correct phonation skills.

The purpose of surgical treatment of precancerous disease is to conduct a histological examination to verify the diagnosis and / or simultaneous removal of the formation, altered areas of the mucous membrane of the larynx. Details of the surgical treatment of each of the precancerous diseases are described in the relevant clinical guidelines.

Surgical treatment is divided into two groups:

1. Removal of formations with a “cold” micro-tool (tweezers, punchers, shiver, and so on);
2. Removal of education using different types of lasers ( different kind diode lasers, CO2 laser, PDL and KTP lasers, NdYag laser and so on).

Requirements for the quality of the biopsy for research:

1. small formations should be removed immediately and sent entirely for histological examination;
2. if an endophytic formation is suspected, it can be punctured under ultrasound control;
3. in case of a hyperplastic process, excise altered areas of the mucous membrane with direct microlaryngoscopy or remove a sufficient amount of material with indirect microlaryngoscopy with a laryngeal puncher (vocal cord decortication) with the distribution of biopathies on a glass slide as a single block indicating the sides and location.

• The use of CO2 laser in surgery of neoplasms of the larynx is recommended.

The external manifestation of the human papillomavirus are papillomas on the skin. Neoplasms, popularly referred to as warts, are benign in nature. But a seemingly harmless growth can undergo malignancy and transform into a cancerous tumor.

Why do papillomas appear on the skin?

You can get the virus through contact with a carrier of the strain or through household contact when using contaminated items.

In newborns, the cause of papillomatosis is the passage through the infected birth canal of the mother.

HPV infection also occurs under the influence of such adverse factors as:

• weakening of the immune system;
• sexual life with unverified partners;
• bad habits;
• long-term treatment with certain medications;
• tendency to depression;
• infectious diseases;
• non-observance of hygiene rules in public places with conditions of high humidity.

When HPV is main reason papilloma on the skin, enters the body, it affects the basal layer of the epithelium at the site of its transition from multilayer to cylindrical. As a result, the infected cell becomes benign, but subsequently it is able to regenerate and trigger the mechanism for the development of cancer.

A pedunculated neoplasm deserves special attention - due to its susceptibility to injury, it can infect surrounding healthy integuments and cause multiple papillomatosis.

Warts do not always turn into tumors. If they are caused by viruses that are of a low type of oncogenicity, you should not worry. These are strains 42, 44, 11 and 6. A dermatologist or venereologist can determine the degree of oncogenic risk.

Diagnosis of papillomatosis

What does papilloma look like on the skin? Standard option is a rough, soft-to-touch growth, similar to a mushroom or cabbage inflorescence. Its size can reach 2 cm.

Neoplasms are of the following types:

1. simple - these are coarse hard growths, the size of which starts from 1 mm. They tend to accumulate in arrays under a single stratum corneum. Such papillomas form under the knees, on the back of the fingers and palms.
2. Plantar warts, similar to calluses, form from small shiny bumps. Over time, they grow and are distinguished by a characteristic protruding rim. Branches diverge from the main growth in the form of smaller child warts.
3. Filamentous growths resemble elongated cone-like sticks, the length of which reaches 6 mm.
4. Flat neoplasms are characterized by a natural shade of the body and similarity to flattened cones. If they are present, people complain of itching, occasionally - redness of the focus.
5. Genital warts are neoplasms that appear on the genitals of men and women. They affect the skin and mucous membranes. The color of genital warts is flesh, pink, red. Sizes vary from 1 mm to several centimeters.

After a visual examination of the patient, the specialist gives him a referral for PCR diagnostics of the DNA of the virus. According to his answers, the doctor will be able to determine the type of strain, the degree of its oncogenicity and quantity. PCR also allows you to understand whether papillomatosis is chronic or it appeared suddenly against the background of a sharp decrease in immunity.

A micropreparation of skin papilloma is represented by connective tissue stroma and epithelium. The nature of the latter determines the type of neoplasm, which is squamous and transitional cell. The connective tissue of the stroma is defined as dense or loose. Often it turns out to be edematous, inflamed and filled with blood vessels. In the case of sclerosis of the growth, a diagnosis of fibropapilloma is made.

The epithelial layer covering the wart shows an increase in the number and size of pathological cells. This is indicative of hyperkeratosis. Papillomas may differ from each other in their histological structure.

For example, areas of parakeratosis and vacuolated epithelial cells are inherent in common skin papillomas. In senile keratosis, formations with polymorphism of epithelial cells are determined. In ICD 10, skin papilloma is recorded under the code B97. 7 "Papillomaviruses as the cause of diseases classified elsewhere".

Treatment and prevention of human papillomavirus infection

HPV treatment regimens are always selected by doctors individually. If a virus is detected before its clinical manifestation, the patient is offered the use of cytostatics.

Based on the specific symptoms and localization, treatment of papillomas on the skin is carried out according to one of the following methods:

• cryodestruction;
• radio wave therapy;
• electrocoagulation;
• laser evaporation;
• chemical destruction.

Warts with signs of degeneration are subject to surgical excision with the capture of healthy tissues. After the external signs of papillomavirus carriage are eliminated, the patient is prescribed a course of antiviral therapy and is offered regular examinations.

As conservative therapy prescribe drugs that inhibit the activity of the virus and increase the body's defenses (Inosiplex). Viferon and Genferon are derivatives of alpha-interferon, administered intramuscularly or vaginally.

"Epigen-intim", released in the form of a spray, is a local preparation. Its use gives an antiviral and immunomodulatory effect. Spray include in complex therapy genital warts.

To improve the functioning of the immune system, patients are prescribed:

1. Likopid;
2. Amiksin;
3. Immunomax;
4. Allokin alpha.

Prevention of HPV infection has several directions. An important of them is the sexual education of young people with an explanation of the characteristics of the transmission of the virus and methods of protection. Particular attention is paid to healthy lifestyle life, development of stress resistance and timely treatment any infectious disease.

Papillomas are benign neoplasms in the form of small papillae caused by the human papillomavirus. They can have different localization, including like to "settle" on the mucous membrane of the larynx.

Since the problem is recurrent in nature, and new papillomas can form in place of old ones, this pathology is called laryngeal papillomatosis (ICD code 10 - D14.1). You will learn more about the disease, the features of its course and methods of therapy in our review and video materials.

The share of papillomatosis of the larynx accounts for 15-20% of all benign tumors of this organ. The disease develops both in adults and in children (mainly up to 5 years).

According to research, there is an individual predisposition to the disease. Also, papillomatosis is more often diagnosed in males.

The result of many factors can be papilloma of the larynx: the cause of the disease lies in the damaging effect of human papillomavirus 6 (more often in children) and 11 (more often in adults) types, and the development of advanced clinical manifestations can be provoked by:

• frequent acute respiratory viral infections and bacterial diseases of the upper respiratory tract;
• pathological influence of ultraviolet radiation, radiation, chemical agents;
• inhalation of industrial dust while working in production;
• decreased immune protection caused by poor nutrition, stress, adverse living conditions;
• diseases of the endocrine organs;
• smoking, alcohol abuse;
• concomitant chronic viral infections(CMV, herpes);
• injuries, damage to the larynx;
• in children - artificial feeding.

The main route of transmission of the human papillomavirus in adults remains sexual. Children become infected from their mother during childbirth. The incubation period of the disease (the time from infection to the blood until the first symptoms appear) can range from 2-3 months to 10-15 years.

Note! The presence of the virus in the body is not enough for the development of clinical manifestations. Symptoms in adults and children may be absent for years, and appear only when provoking factors exert their influence.

Clinical picture

Sometimes signs of laryngeal papillomatosis go unnoticed by patients: due to the small size of the formation, they do not cause discomfort.

With a strong proliferation of papillomas or damage to the vocal cords, the following symptoms may develop:

• voice changes of a different nature: it can become rough, hoarse, quiet, or disappear altogether;
• periodic respiratory disorders: shortness of breath, wheezing on inspiration, wheezing;
• attacks of suffocation physical activity: running, climbing stairs, jumping;
• , which does not bring relief: it can disturb during the day and night, does not go away for a long time after SARS;
• foreign body sensation: papillomas in the larynx can interfere with breathing, swallowing food or liquid;
• streaks of blood on coughing.

Experts distinguish several classifications of papillomatosis of the larynx:

• By time of occurrence:
  1. juvenile - first diagnosed in childhood;
  2. respiratory - characteristic of adults.
• By prevalence:
  1. limited - papillomas are grouped on one side of the larynx, close the lumen of the glottis by no more than ⅓;
  2. common - papillomas are located diffusely, close the lumen of the glottis by ⅔;
  3. diffuse - multiple papillomas completely block the airways, causing asphyxia.
• According to the features of the flow:
  1. rarely recurrent - less than 1 time in 24 months;
  2. often recurrent - more than 1 time in 24 months.
• According to the histological structure of the tumor:
  1. fibropapilloma of the larynx - a benign tumor of fibrous connective tissue;
  2. squamous cell papilloma of the larynx - a formation consisting of a squamous epithelium and stroma - connective tissue, vascular elements.

In children, the symptoms of papillomatosis are similar to those of the larynx in adults. Complicating the course of the disease is that the lumen of the respiratory tract in a child is much narrower, and the mucous membrane of the larynx is more loose, prone to edema.

Diffuse growths of papillomas can provoke blockage of the lumen of the organ and asphyxia (suffocation). If you don't give the baby at this moment medical care, possibly fatal. The medical history of patients with the juvenile (children's) form of papillomatosis has up to 5% of deaths from asphyxia.

TO dangerous consequences diseases in adults include cicatricial lesions of the larynx due to frequent recurrence of papillomas and regular (several times a year) their removal. papillomas provoke extremely rarely, usually malignancy (malignancy) of tumors occurs with extensive damage not only to the larynx, but also to the mucosa of the trachea, bronchi and bronchioles.

Diagnostics

If one or more of the symptoms mentioned above appear, it is recommended to consult a doctor for examination. Papillomas of the larynx are easily determined during laryngoscopy - examination of the walls of the larynx using a special device.

They look like a small knot of pink, red or grayish color with an uneven structure. Its size can vary from 1-2 to 10 millimeters. Papillomas are located both on a wide and on a thin, filiform base.

For a more detailed examination of neoplasms and their differential diagnosis, the following are also prescribed:

• endoscopic examination with biopsy and subsequent microscopy;
• R-graphy, CT of the neck;
• autofluorescence methods.

According to the indications, consultations are held with an infectious disease specialist, an immunologist, an oncologist.

Principles of therapy

Treatment of papillomatosis of the larynx should be comprehensive, aimed at:

• reducing the risk of relapse;
• restoration of breathing and speech in case of their violation;
• prevention of complications.

Unfortunately, at present there is no ideal method of treating the disease that allows you to get rid of papillomas quickly and permanently. Treatment of the disease can last several months.

Conservative therapy

Conservative treatment is used for limited single papillomas of the larynx, as well as during preparation for surgery. The main drugs prescribed for papillomatosis are presented in the table below.

Note! Before you start taking the tablets, be sure to consult your doctor and read the information contained in the instructions for use. Self-medication and the use of homemade folk remedies can be dangerous.

Surgical techniques for papillomatosis of the larynx

With the ineffectiveness of conservative methods of treatment, as well as with extensive overgrowth of papillomas and bright clinical manifestations disease, an operation is performed. The task of the surgeon is to remove the maximum possible number of formations, while reducing the risk of their re-growth.

Modern techniques involve the operation under general anesthesia under the control of laryngoscopy. Such surgical intervention lasts only a few minutes, does not cause complications and is almost painless.

During the operation, the doctor can use to remove papillomas:

• radioknife;
• laser beam;
• methods of cryodestruction;
• methods of electrocoagulation;
• ultrasonic waves.

The most effective today is considered to be a combination of surgery with subsequent drug treatment. Unfortunately, the recurrence rate of the disease remains high, since effective ways There is no way to completely get rid of papillomavirus circulating in the blood.

Treatment of papillomatosis of the larynx in children is based on the same principles as in adults.

Prevention

The main method of preventing papillomatosis in adults remains the exclusion of HPV infection (avoidance of questionable sexual contacts, use of condoms).

With an infection that has already occurred, doctors recommend:

• consult a doctor at the first symptoms of the disease;
• to refuse from bad habits;
• observe a gentle voice mode;
• when working in hazardous production, limit contact with harmful substances;
• to carry out sanitation of all chronic foci of infection (and especially ENT organs);
• to engage in the improvement of the body (observe the principles healthy eating take vitamins, play sports);
• avoid hypothermia.

Signs of papillomatosis of the larynx can deliver a lot of discomfort and even pose a threat to life. Timely prevention of chronic diseases, strengthening the immune system and timely access to a doctor will help to transfer the disease into a latent form and get rid of papillomas forever.