犬足乳头状瘤的诊断和治疗：44例回顾性分析

王帆

Canine pedal papilloma identification and management: a retrospective series of 44 cases

犬足乳头状瘤的诊断和治疗：44例回顾性分析

作者：Alexandra P. Gould, Kimberly S. Coyner, Ann M. Trimmer, Kathy Tater and Mark Rishniw

翻译：王羽迪

Background – Papillomavirus infections in dogs have a variety of manifestations and involve multiple viral genera. Canine pedal papillomas have been infrequently studied and reported in the literature.

Objective – To report the signalment, history, treatment and outcome of biopsy-confirmed cases of canine pedal papillomatosis, collected from veterinarians across the United States and Canada

Animals – Medical records from 44 dogs were submitted by North American veterinarians.

Methods and materials – Surveys were submitted through the Veterinary Information Network for biopsy-confirmed cases of canine pedal papillomatosis. Submissions included information on patient signalment, history, biopsy report, treatment and outcome.

Results – Forty-four cases were reviewed. The median age of presentation was four years old. Dogs most commonly presented with lameness and/or paw licking/chewing. Only one paw was affected in 35 cases, and front paws were more often affected than back paws. Twenty-eight dogs presented with one mass. Histopathological evaluation documented 33 cases of non-inverted papillomas and 11 cases of inverted papillomas. Thirty-four papillomas resolved in total; 25 resolved within three weeks after biopsy collection. Twenty-one dogs received no additional treatment and 15 of those cases resolved. Azithromycin was the most commonly reported treatment initiated after biopsy was collected.

Conclusions and clinical importance – The biological behaviour of canine pedal papillomas in this case series was similar to oral papillomas, and most lesions resolved with or without additional treatment. Further research is needed to better characterise the causative papillomavirus types and genera involved in the development of canine pedal papillomas.

背景-犬乳头状瘤病毒感染有多种表现，涉及多个病毒属。犬足乳头状瘤的研究和报道文献较少。

目标-报告从美国和加拿大兽医收集的活检确诊犬足乳头状瘤病例的特征、病史、治疗和结果。

动物-北美兽医提交的44只犬的医疗记录。

方法和材料-调查通过兽医信息网络提交了活检确诊的犬足乳头状瘤病病例。提交的信息包括患病动物特征、病史、活检结果、治疗和结果。

结果-回顾了44例病例。发病中位年龄为4岁。犬最常见的表现是跛行和/或舔爪/啃爪。35例中只有一只爪部感染，前爪比后爪更容易感染。28只犬出现一个肿块。组织病理学评估记录了33例非内翻性乳头状瘤和11例内翻性乳头状瘤。34例乳头状瘤全部治愈。25例在活检采集后三周内痊愈。21只犬没有进行额外治疗，其中15只消退。阿奇霉素是报道在活检后最常见使用的治疗药物。

结论和临床意义-在这个病例系列中，犬足乳头状瘤的生物学特点与口腔乳头状瘤相似，并且大多数病变在接受或不接受额外治疗后均得到解决。需要进一步的研究来更好地确定与犬足乳头瘤发展有关的致病乳头瘤病毒的类型和属。

Introduction

引言

Papillomaviruses are nonenveloped, double-stranded DNA viruses that most often spread through direct contact.Canine papillomavirus (CPV) infections have been associated with six syndromes: oral papillomas, venereal papillomas, exophytic cutaneous papillomas, cutaneous inverted papillomas, footpad papillomas and pigmented viral plaques. CPV infections also have been associated with the development of squamous cell carcinoma. Papillomas of the paw have been infrequently studied and most reports involve single cases. However, clinical experience has shown that papillomas of the paw are more commonly encountered than a literature search would suggest. In an informal records survey by a veterinary pathologist, pedal and digital papillomas were found to comprise 21.8% (513 of 2,355) of the total known anatomical site papillomas identified within a five year period from2015 to 2020 (D. Gardiner, personal communication).Therefore, the goal of this retrospective case series was to report the signalment, history, treatment and outcome of biopsy-confirmed cases of canine pedal papillomatosis, collected from veterinarians across North America.

乳头瘤病毒是无包膜的双链DNA病毒，最常通过直接接触传播。犬乳头瘤病毒(CPV)感染有六种综合征:口腔乳头状瘤、性病乳头状瘤、外生型皮肤乳头状瘤、皮肤内翻性乳头状瘤、爪垫乳头状瘤和色素性病毒斑块。CPV感染也与鳞状细胞癌的发展有关。爪部乳头状瘤很少被研究，大多数报告涉及单个病例。然而，临床经验表明，爪部乳头状瘤比文献搜索显示的更常见。在一项由兽医病理学家进行的非正式记录调查中，从2015年到2020年的五年间，足和趾部乳头状瘤占已知解剖部位乳头状瘤总数的21.8%(2355个中有513个)(D. Gardiner，个人通信)。因此，本回顾性病例分析的目的是报告从北美各地兽医收集的经活检确诊的犬足乳头状瘤病例的特征、病史、治疗和结果。

Methods and materials

方法和材料

Case selection        

病例筛选

Members of the Veterinary Information Network (VIN) were invited by community-wide E-mail to submit biopsy-confirmed cases of canine pedal papillomatosis. The open submission period lasted for six weeks, from January to February 2020. Participants were asked to provide patient signalment, case history and examination findings, biopsy report, treatment and outcome via the online data submission system (Appendix S1). Cases without histopathological confirmation of papillomatosis were excluded.

兽医信息网络(VIN)的成员被社区范围的电子邮件邀请提交经活检确诊的犬足乳头状瘤病病例。公开提交期限为6周，从2020年1月到2月。参与者被要求通过在线数据提交系统提供患病动物特征、病史和检查结果、活检报告、治疗和结果(附录S1)。排除未经组织病理学确诊为乳头状瘤病的病例。

Histopathological evaluation

病理组织学检查

All biopsy reports were reviewed for specific diagnostic terminology and description of surgical margins.

我们回顾了所有的活检报告，以了解具体的诊断术语和手术边缘的描述。

Clinical management and prognosis

临床管理与预后

Data on signalment, history, clinical signs, treatment and outcome for each case were collected for analysis.

收集每个病例的特征、病史、临床表现、治疗和转归数据进行分析。

Statistical analysis

数据分析

The data were analysed and reported as descriptive statistics. No inferential analysis was performed.

对数据进行分析，并以描述性统计报告。未进行推理分析。

Results

结果

Forty-four cases were reviewed. Submitted cases spanned a 12 year period (2007–2019), and were submitted from both Canada (six cases) and the United States (38 cases). First-opinion veterinarians referred 12 of these cases to a specialist dermatologist; the remainder were diagnosed and treated by first-opinion veterinarians. Patient signalment and history Of the 30 breeds of dog represented in the submitted cases, four breeds (or types) accounted for 36% of the cases: pit bulls (six cases), Labrador retrievers (four cases), Labrador retriever mixes (three cases) and golden retrievers (three cases). Papillomas occurred in the remaining 26 breeds or mixed-breed dogs as single cases or pairs. The submitted cases included 18 males (two intact, 16 neutered) and 26 females (four intact, 22 spayed). Dogs were reported to have developed papillomas at a median age of four years old (range: ≤1 to 15 years,Table 1); 12 of 44 cases were one year old or less.

回顾了44例病例。已提交的案件跨度为12年(2007-2019年)，分别来自加拿大(6例)和美国(38例)。首诊兽医将其中12例转诊给皮肤专科医生;其余的由首诊兽医进行诊断和治疗。在提交的30个犬种中，4个品种(或类型)占36%:比特犬(6例)、拉布拉多寻回犬(4例)、拉布拉多混血犬(3例)和金毛寻回犬(3例)。乳头状瘤在其余26个犬种或混血犬中以单例或成对出现。提交的病例包括18例雄性(2例未去势，16例已去势)和26例雌性(4例未绝育，22例已绝育)。据报道，犬在中位年龄4岁时出现乳头状瘤(范围:≤1至15岁，表1);44例中12例为1岁或以下。

Of the 24 cases for which dog daycare or boarding history was known, five dogs attended a facility one week before presentation, five dogs attended one month before presentation, and six dogs attended two to three months before presentation. The remainder either did not attend a facility or had attended a facility more than seven months before presentation.

据了解，24例病例有白天托管或寄养史，有5只犬在就诊前一星期被送到托管机构，5只犬在就诊前一个月被送到托管机构，6只犬在就诊前2-3个月被送到托管机构。其余的犬要么没有去过托管机构，要么在就诊前去过托管机构时间超过7个月。

Thirty-four dogs had received no immunosuppressive medications within one month of presentation, four had received oclacitinib, two had received an unknown immunosuppressive medication, and one dog each had received corticosteroids, cyclosporine, trimeprazine tartrate with prednisolone, or a combination of both corticosteroids and oclacitinib. Of the 42 dogs with a reported medical history, 41 had no reported immunosuppressive conditions; one patient was diagnosed with epitheliotropic lymphoma concurrent with the papillomavirus diagnosis.

34只犬在就诊后一个月内没有使用过免疫抑制药物治疗，4只犬使用奥拉替尼，其中两只接受了未知的免疫抑制药物治疗，各一只犬分别使用了皮质类固醇、环孢素、异丁嗪和泼尼松龙，或是糖皮质激素和奥拉替尼联用。42只犬有用药，其中41只没有免疫抑制疾病;一只犬被诊断为趋上皮淋巴瘤并发乳头状瘤。

Clinical signs and examination

临床症状及检查

Dogs presented with a variety of clinical signs (Table 2) at initial examination. In nine dogs, masses were noted on examination without the owners describing signs at home. Of the 35 cases for which initial clinical signs were seen, 24 cases presented with at least two signs simultaneously, the most frequent of which were lameness and paw licking (12 cases).

犬初诊时表现出多种临床症状(表2)。在9只犬中，在检查时发现了肿块，而主人在家没有发现。35例有初步临床症状的病例中，24例同时出现至少两种症状，最常见跛行和舔爪(12例)。

Thirty-five dogs developed papillomas on only one paw; front paws were affected more often than hind paws (26 masses on the front paws, nine masses on the hind paws). In the remainder of cases, at least two paws were reported affected. Papillomas were distributed across multiple areas on the paw (Table 3), and almost always occurred on haired skin (43 cases). Ten dogs developed papillomas on the paw pads and two developed papillomas on the claw beds.

35只犬在一只爪子上长出了乳头状瘤，前爪比后爪更易患病(26个肿块在前爪，9个肿块在后爪)。在其余的病例中，至少有两只爪部患病。乳头状瘤分布在爪部的多个区域(表3)，几乎总是发生在有毛发的皮肤上(43例)。10只犬在爪垫上出现了乳头状瘤，2只在爪床上出现了乳头状瘤。

Twenty-eight dogs had only one pedal papilloma, two dogs had two papillomas, four dogs had three papillomas, one dog had five papillomas and seven dogs had more than five papillomas identified.

28只犬只有一个足部乳头状瘤，2只犬有2个乳头状瘤，4只犬有3个乳头状瘤，1只犬有5个乳头状瘤，7只犬有超过5个乳头状瘤。

Six dogs were reported to have suspected papillomas at sites distant from the feet; one mass inside the mouth and one mass on the right hip were confirmed as papillomas by biopsy evaluation. The remaining four distant suspected papillomas were not biopsied.

据报道，6只犬疑似在远离足部的部位长有乳头状瘤;一个肿块在口腔内，一个肿块在右髋关节经活检确诊为乳头状瘤。其余4例远处疑似乳头状瘤未行活检。

Biopsy evaluation

活检评估

Biopsies were collected less than one week after the mass was noted in 25 cases and between one and three weeks after mass identification in 13 cases. Five biopsies were taken between four and 12 weeks after mass identification. The timing of one biopsy collection was not reported. Twenty-seven dogs were receiving medication at the time of biopsy collection (Table 4)

25例在发现肿块后不到一周进行活检，13例在发现肿块后1-3周进行了活检。在肿块确定后的4至12周内进行了5次活组织检查。一次活检采集的时间未被报道。27只犬在活检采样时接受药物治疗(表4)。

Twenty-five biopsies were reported to be excisional, defined as the entire mass being removed. Nineteen biopsies were reported as incisional, defined as only part of the mass being removed. On histopathological reports, 21 cases were completely excised and 13 cases were incompletely excised. Of the cases with complete excision, 15 cases were a single papilloma, two cases were two papillomas and four cases had more than five papillomas. Two cases received additional surgery after the biopsy report was received. The extent of excision in the remaining 10 cases was either not reported or determined to be unclear by a pathologist.

据报道，25例切除活检，定义为整个肿块被切除。19例切开活检，即仅部分切除肿块。在组织病理学报告中，21例完全切除，13例不完全切除。在完全切除的病例中，15例为单发乳头状瘤，2例为两个乳头状瘤，4例为超过5个乳头状瘤。2例在收到活检报告后接受了二次手术。其余10例的切除范围要么没有报告，要么病理学家无法确定。

The terminology of biopsy diagnosis was variable, with masses being identified as viral papilloma (19 cases), inverted papilloma (10 cases), viral squamous papilloma (eight cases), papilloma (four cases), exophytic viral papilloma (two cases), and inverted viral papilloma (one case). Inverted papillomas are classically defined as being umbilicated and lined with hyperplastic squamous epithelium, while exophytic papillomas contain multiple projections of thickened, heavily keratinised squamous epithelium. Biopsy descriptions all were consistent with exophytic or inverted papillomas when these terms were used in the dermatopathological diagnosis. Pathologists also reported koilocytes in 37 reports, intranuclear inclusion bodies in 29 reports and giant keratohyalin granules in 13 reports.

活检诊断的术语各不相同，包括肿块被鉴定为病毒性乳头状瘤(19例)、内翻性乳头状瘤(10例)、病毒性鳞状乳头状瘤(8例)、乳头状瘤(4例)、外生性病毒性乳头状瘤(2例)和内翻性病毒性乳头状瘤(1例)。内翻性乳头状瘤的典型定义是呈脐状，内衬增生性鳞状上皮，而外生性乳头状瘤包含多个增厚的、高度角化的鳞状上皮突起。当皮肤病理诊断包括这些术语时，活检描述均与外生性或内翻性乳头状瘤一致。病理学家在37例中描述了挖空细胞，29例中描述了核内包涵体，13例描述了巨大的透明角质颗粒。

Papilloma treatment

乳头状瘤治疗

Twenty-one patients received no additional treatment besides the confirmatory biopsy. Ten of these cases were reported completely excised, eight were incompletely excised and three were unknown. Of the remaining 23 cases that received treatment (Table 4), 11 cases were reported completely excised, five were incompletely excised and seven were unknown. No revision surgeries were reported for incompletely excised cases. Ten dogs began treatment before biopsy collection and less than one week after the mass was observed, six began treatment at the time of biopsy collection, and four began treatment after biopsy results were obtained. Two dogs started treatment one to three weeks after the mass was observed and before biopsy collection, and one dog began treatment four to six weeks after the mass was observed and before biopsy collection. Of the 19 dogs receiving treatment before receipt of biopsy results, three dogs’ treatments were altered after biopsy results were received.

21例患病动物除接受活检确诊外，未接受其他治疗。其中10例完全切除，8例不完全切除，3例未知。在其余23例接受治疗的病例中(表4)，11例被报道完全切除，5例被报道不完全切除，7例未知。未完全切除的病例均未进行二次手术。10只犬在活检前观察到肿块后不到一周开始治疗，6只在活检时开始治疗，4只在活检结果出来后开始治疗。2只犬在观察到肿块1-3周后活检采样前开始治疗，1只犬在观察到肿块4 -6周后活检采样前开始治疗。在得到活检结果前接受治疗的19只犬中，有3只犬在得到活检结果后改变了治疗方法。

Outcome

结果

Thirty-four papillomas resolved (19 with medical therapy, 15 with no treatment beyond biopsy collection). Of these 34 cases, histopathologically 18 were considered completely excised, nine were incompletely excised, and seven were unknown. Of the nine resolved cases where excision was incomplete, four patients received additional medical treatment. Three received azithromycin and one received a topical antibiotic/steroid combination along with oral antibiotics and a nonsteroidal anti-inflammatory.

34例乳头状瘤痊愈(19例经药物治疗，15例经活检后未治疗)。在这34例病例中，组织病理学检查认为18例完全切除，9例不完全切除，7例未知。在已消退的9例切除不完全的病例中，有4名患病动物接受了额外的药物治疗。其中三只接受阿奇霉素治疗，一只接受外用抗生素/类固醇联合治疗，同时口服抗生素和非类甾体抗炎药。

The majority of all cases that resolved (25 cases), did so within three weeks following biopsy collection (Figure 1). Of the cases that resolved within three weeks, 15 were completely excised, eight were incompletely excised and two were unknown. Because the majority of dogs had only one papilloma, it was not possible to determine whether the number of papillomas affected the speed of resolution. Seven papillomas were reported at the time of data submission to have failed to resolve at any point and three papillomas had unknown outcomes.Follow-up contact was attempted for the clinicians with the unresolved cases and six veterinarians responded to report that the papillomas resolved after complete surgical excision.

大多数病例(25例)在活检采样后三周内治愈(图1)。在三周内治愈的病例中，15例完全切除，8例不完全切除，2例未知。因为大多数犬只有一个乳头状瘤，所以不可能确定乳头状瘤的数量是否影响消退的速度。在提交数据时，有7例乳头状瘤在任何时候都未能治愈，3例乳头状瘤的预后未知。对未消退病例的临床医生进行了随访，6名兽医回应称乳头状瘤在完全手术切除后痊愈。

Recurrence was reported in five cases (three at the same site only, one at the same and distant sites, and one at a distant site only), yet a confirmatory biopsy was collected in only one case. Two of the same-site recurrences originally were reported to be completely excised, as was the recurrence at the distant site. The recurrence at both the same and distant sites originally was reported as incompletely excised. Suspected same-site recurrence occurred within four months in all four cases.

有5例报告复发(3例仅在同一部位，1例在相同的位置和远处，1例仅在远处)，然而，只有一个病例获得了确诊性活检。据报道，同一部位的两例复发最初被完全切除，远处的复发也是如此。同一部位和远处的复发最初报告为未完全切除。四例患者均在四个月内发生疑似同一部位复发。

Veterinarians treated three of the suspected recurrent cases. Topical imiquimod was used alone in one case, in combination with azithromycin and interferon alpha in another case, and the third case was treated with surgical excision via electrosurgery. Four of these suspected recurrent cases were reported resolved, and the outcome of one was unknown. Resolution took less than one week in one case, one to three weeks in two cases and >12 weeks in one case.

兽医治疗了其中三例疑似复发病例。1例单外用咪喹莫特，1例联合阿奇霉素和α干扰素治疗，3例电外科手术切除。其中4例疑似复发病例报告已解决，1例结果未知。解决时间:1例不到1周，2例1-3周，1例大于12周。

Discussion

讨论

This study provides comprehensive information on a relatively large cohort of dogs with pedal papillomas. Data suggest that these papillomas may be more common than the literature would indicate, and that they often resolve relatively quickly with or without medical therapy.

这项研究提供了一个相对较大病例量的犬足乳头状瘤的综合信息。数据表明，这些乳头状瘤可能比文献显示的更常见，它们通常在药物治疗或不进行药物治疗时都消退得相对较快。

Previous case reports of pedal papillomas have included dogs ranging in age from nine months to 11 years, and have encompassed multiple breeds including two beagles, one golden retriever, one Jack Russell terrier and one French bulldog. The median age of onset reported in this study (four years) is older than that reported for canine oral papillomas, and is similar to reports of other forms of papillomatosis.Even though pit bull terriers and Labrador retrievers or Labrador retriever mixes were the most commonly recorded dog breed in this study, this information should be regarded with caution because it was not possible to determine whether those breeds generally are over-represented in the dog population in North America.

此前有关足乳头状瘤的病例报告包括9月龄至11岁的犬，包括两个比格犬、一个金毛寻回犬、一个杰克罗素㹴和一个法国斗牛犬。本研究报道的中位发病年龄(4岁)比报道的犬口腔乳头状瘤年龄大，与其他形式的乳头状瘤病的报道相似。虽然在这项研究中，比特犬和拉布拉多寻回犬或拉布拉多寻回杂交犬是最常见的犬品种，但这一信息应该谨慎对待，因为不可能确定这些品种在北美的犬种群中是否普遍存在过度代表。

Information on the patients’history at dog daycare and boarding facilities was requested because a previous case report suggested that oral papillomavirus spread through a daycare facility. No previous case reports of pedal papillomas have mentioned dog daycares or boarding in the patient history. Few dogs in this study were reported to have attended such a facility before diagnosis, so it is not possible to comment on community spread of pedal papillomas through boarding facilities.

由于之前的病例报告表明口腔乳头瘤病毒通过日托机构传播，因此要求提供患病动物在犬日托机构和寄养机构的病史信息。在既往的病例报告中没有提到足乳头状瘤提到患犬日托或寄养。据报道，在本研究中，少数患犬在确诊前去过托管设施，因此无法评估足乳头状瘤通过托管机构的传播。

Most of the dogs in this study were presented to their veterinarian with clinical signs that led to the discovery of the mass. Therefore, clinicians should examine the paws thoroughly for pedal masses in dogs that present with a history of lameness or paw licking.

在这项研究中，大多数犬都是在临床上发现有肿块去看兽医的。因此，临床医生应该彻底检查有跛行或舔爪病史的犬的爪部是否有肿块。

Previous investigators have linked the development of papillomaviral lesions to immune suppression in dogs, including in one case report of pedal papillomatosis.However, this study did not support a strong association between immunosuppressive medications or comorbidities and the development of pedal papillomatosis. A single case report of 17 dogs with X-linked severe combined immunodeficiency previously were reported to develop chronic cutaneous papillomavirus favouring the paws following bone marrow transplantation, and a subset of those cases transformed into squamous cell carcinomas.However, none of the papillomas in the present study were reported to undergo malignant transformation, suggesting that such a transformation appears to be uncommon.

以往的研究表明，乳头状瘤病毒病变的发展与犬的免疫抑制有关，包括一例足乳头状瘤病的报告。然而，这项研究并不支持免疫抑制药物或并发症与足乳头状瘤病的发展之间的强相关性。一例单独报道，17只患有X染色体并发重度免疫缺陷病的犬在骨髓移植后出现慢性皮肤乳头状瘤病毒，其中一部分病例转化为鳞状细胞癌。然而，本研究中没有一例乳头状瘤发生恶性转化，表明这种肿瘤化乎并不常见。

Pedal papillomas in this study most often affected the haired skin of front paws. It has been hypothesised that papillomavirus infection could be associated with trauma, which could explain why the front paws were the preferred location of masses in this study. Dogs bear more weight on the front paws and the front paws also have more contact time with the ground, both of which can increase the likelihood of trauma.

本研究中足乳头状瘤最常发生在前爪有毛的皮肤上。已有假设，乳头瘤病毒感染可能与创伤有关，这可以解释为什么前爪是本研究中肿块的首选位置。犬的前爪承受的重量更多，前爪与地面接触的时间也更多，这两种情况都会增加受伤的可能性。

The retrospective nature of this study and the widespread locations of submitting veterinarians resulted in multiple pathologists interpreting the biopsy samples.Because the method of reporting a papillomavirus diagnosis is not standardised, it was only possible to categorise the papillomas in this paper as either inverted (or endophytic) and noninverted (assumed to be exophytic) papillomas. The cases included in this study involved 11 inverted papillomas and 33 noninverted papillomas. Inverted papillomas on the feet have been reported previously in a low number of dogs.They also have been described elsewhere on the body, including on the abdomen and the ventral neck.Noninverted papillomas also have been reported previously on the feet.

这项研究的回顾性分析和提交兽医的区域广泛导致了多个病理学家解读活检样本。由于报告乳头瘤病毒诊断的方法没有标准化，本文只能将乳头瘤分为内翻性(或内生性）和非内翻性(假设为外生)乳头瘤。本研究包括11例内翻性乳头状瘤和33例非内翻性乳头状瘤。此前，足内翻性乳头状瘤的报告数量较少。它们也在身体的其他地方被描述过，包括腹部和颈腹侧。以前也有报道非内翻性乳头状瘤发生在足部。

All of the histopathological reports in this study included the basic descriptions and dermatopathological diagnoses consistent with exophytic or endophytic papillomas. Additional findings consistent with the diagnosis of papillomavirus infection include the presence of koilocytes, giant keratohyalin granules and intranuclear inclusion bodies. In 41 reports in this study, masses included characteristics specifically associated with papillomavirus infection. These findings contradict a prior claim that the viral origin of pedal papillomas has not been proven, yet further immunohistochemical analysis would be necessary to definitively confirm the presence of papillomavirus in the lesions.

本研究所有的组织病理学报告的基本描述和皮肤病理诊断相一致，包括外生性或内生性乳头状瘤。研究发现与乳头瘤病毒感染诊断一致的证据包括挖空细胞、巨大的透明角质颗粒和核内包涵体的存在。在本研究的41份报告中，肿块包括与乳头瘤病毒感染特异性相关的特征。这些发现与先前关于足乳头状瘤的病毒起源尚未被证实的说法相矛盾，但需要进一步的免疫组化分析来明确确认病变中存在乳头状瘤病毒。

Nearly half of the dogs in the study received no treatment for pedal papillomatosis after confirmatory biopsy was collected, and the lesions in most of these dogs resolved spontaneously. Spontaneous regression commonly is associated with multiple presentations of canine papillomavirus lesions. Regression in oral papillomavirus infections has been linked to the development of circulating antibodies against the L1 capsid protein of CPV1, so future research on pedal papillomas could include evaluation of resolving patients for similar antibodies.

在本研究中，近一半的犬在接受活检确诊后未接受任何治疗，这些犬的病变大多自行消退。自然消退通常与犬乳头瘤病毒病变的多重表现有关。口腔乳头状瘤病毒感染的消退与抗CPV1 L1衣壳蛋白的循环抗体的发展有关，因此对足乳头状瘤的未来研究可能包括评估患病动物是否有类似抗体。

Previously suggested treatments for papillomaviruses of varying body locations have included surgical excision, imiquimod, Type I interferons, azithromycin, cryotherapy, recombinant canine oral papillomavirus vaccines and autologous vaccination.

先前提出的针对不同部位乳头状瘤病毒的治疗方法包括手术切除、咪喹莫特、I型干扰素、阿奇霉素、冷冻疗法、重组犬口服乳头状瘤病毒疫苗和自体疫苗。

Of the treatments that have been recommended previously for papillomaviral lesions, azithromycin was most commonly used in this study. Complete surgical excision, as defined by the biopsy report, was reported in 21 dogs. Two recurrent papillomas were treated with topical imiquimod, although it was not prescribed for the initial lesions. It should be noted that, because many papillomas can resolve spontaneously, it is difficult to determine the efficacy of the antiviral treatments. Most papillomas resolved within three weeks following biopsy collection, which is consistent with the speed of resolution commonly reported for canine papillomatosis, including the two pedal papillomas reported previously.

在以前推荐的治疗乳头状瘤病毒病变的方法中，阿奇霉素是本研究中最常用的。根据活检报告的定义，对21只犬进行了完全手术切除。2例复发性乳头状瘤外用咪喹莫特治疗，但不是在最初的病变处使用咪喹莫特。需要注意的是，由于许多乳头状瘤可以自行消退，因此很难确定抗病毒治疗的结果。大多数乳头状瘤在活检采样后三周内消失，这与通常报道的犬乳头状瘤病的消除速度一致，包括先前报道的两个足乳头状瘤。

A recent case report describes the repeated recurrence of pedal papillomas in a dog despite multiple excisions.10 This case series details the same-site recurrence of two pedal papillomas after complete surgical excision and one after incomplete excision, which is consistent with the recent case report. Although it is not possible to determine likelihood of recurrence from such a small sample size, the risk of same-site recurrence of pedal papillomas after excision should be considered when patients are treated for this condition.

最近的一个病例报告描述了在多次切除后的犬足乳头状瘤的反复复发。这个病例系列详细描述了两个足部乳头状瘤在完全手术切除后和一个不完全手术切除后的同部位复发，这与最近的病例报道一致。虽然不可能从如此小的样本量确定复发的可能性，但在对患者进行治疗时，应考虑足部乳头状瘤切除后同部位复发的风险。

This study has several shortcomings that should be noted. The paper was retrospective across multiple veterinary facilities and practitioners, so it was not possible to standardise the treatment regimen across dogs to determine which treatments would be most effective for pedal papillomas. The multiple-choice question format of the survey made it impossible to collect individualised descriptions of each papilloma, which could have contributed to understanding the general appearance of pedal papillomas in dogs. Additionally, as was noted previously, the fact that multiple pathologists read the included reports made it impossible to standardise the reporting criteria for the diagnosis of pedal papillomas. Recommendations for future studies would include a long-term prospective study designed to reach a statistically significant sample, conducted with specific criteria for treatment and ideally using a single pathologist or standardised histopathological descriptors, with confirmatory immunohistochemical stains. In addition, future investigation is needed to determine the types and genera of CPV associated with this form of papillomatosis in dogs.

本研究有几个不足之处，值得注意。这篇论文是对多个兽医机构和从业人员的回顾性研究，因此不可能对犬的治疗方案进行标准化，以确定哪种治疗方法对足乳头状瘤最有效。该调查的多项选择形式使其不可能收集每个乳头状瘤的个体描述，这可能有助于理解犬足状乳头状瘤的一般表现。此外，如前所述，由于多名病理学家阅读了纳入的报告，因此无法对足乳头状瘤的诊断报告标准进行标准化。对未来研究的建议将包括一项长期的前瞻性研究，旨在获得具有统计学意义的样本，在特定的治疗标准下进行，理想情况下使用单一的病理学家或标准化的组织病理学描述，以及确定的免疫组化染色。此外，还需要进一步的研究来确定与犬类乳头状瘤病相关的CPV的类型和属。

This paper documents a case series of pedal papillomas in dogs and provides further information to support the viral origin and spontaneous resolution of pedal papillomas. In addition, this case series describes common presentations and treatments of pedal papillomas in dogs. Further research is needed to better characterise the behaviour and best treatment practices for this papillomaviral presentation.

本文记录了一系列犬足乳头状瘤病例，并提供了进一步的信息来支持病毒起源和足乳头状瘤的自发消退。此外，本病例系列描述了犬常见的足乳头状瘤的表现和治疗。需要进一步的研究来更好地描述这种乳头瘤病毒表现的行为和最佳治疗方法。

Time of resolution（weeks）

消退时间（周）

Figure 1. Time to papilloma resolution following biopsy collection, distinguishing dogs receiving (dark bars) or not receiving (light bars) treatment after biopsy results

图1.活检采样后乳头状瘤消退的时间，分别为得到活检结果后接受治疗（暗条）或不接受治疗（亮条）的犬。

小宠医

学习学习

笼中红细胞

南海