Papillomatosis

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A papilloma is a benign* neoplasm of the skin, oral cavity, digestive tractor cloaca. The condition is associated with the herpes virus. However, if internal papilloma(s), those that are operable, are not surgically removed, there is great danger of severe haemorrhage or cancer of the liver and/or bilary duct. Papillomas have an extensive blood supply and may bleed very easily and copiously when traumatised. Unfortunately, papillomatosis is a recurring condition.

Skin (cutaneous) papillomas may occur virtually anywhere on the body: neck, wings, feet, legs, eyelids, or uropygial area. They can be seen at the beak margins of budgerigars and cockatiels.

Cutaneous papillomas vary in appearance. They may appear as hard, white or grey horny growths on the feet. They can appear as crusty sores or reddish, cauliflower like growths. Papillomas of the skin are not associated with those of the oral cavity or cloaca (Turrel, 1987).

Cloacal papillomas when aggravated appear as tissue extrusions from the vent, being moist, red in colour, and warty or cauliflower like in appearance. They are easily misdiagnosed as cloacal prolapses (Cambell, 1986).

Oral papillomas resemble those of the cloaca in appearance. They may be confined to the mouth, being often seen in the choanal slit, or they may extend to the larynx, oesophagus, crop, and proventriculus. Papillomas of the oral cavity are often associated with cloacal papillomas and visa versa.

Laboratory work

Diagnosis is usually made by physical examination. Radiographs may be used to confirm the presence of papillomas in the digestive tract. Examination of the diseased tissue under microscope is the only way to confirm positively that it is papillomatous and not of different origin, such as a malignancy.

Treatment

Various surgical techniques improve and evolve with time. Treatment will depend on the vet's preferred procedure. Electrosurgery and cryosurgery are two well-known forms of treatment. Some success in preventing recurrence of papilloma post surgery has been reported using autogenous vaccines (Cribb, 1984; Turrel, 1987)

Unfortunately, cloacal papillomas are unlikely to be detected in the early stages of development because the tissue changes are confined to cellular levels. Only as they enlarge within the cloaca do they become apparent, finally protruding through the vent. Prior to this, straining around the vent feathers, sometimes described as "vent glean", and an unpleasant odour associated with the droppings may be suggestive of the condition. The parrot can also encounter difficulty in defecating because of the growing obstruction within the cloaca. Ref: "New Treatment for Cloacal Papillomatosis" by David Alderton.

Our vet has successfully treated papillomatosis on a rescued African Grey, Pressy. Pressy had three separate operations to remove a large percentage of the diseased tissue using chemical cautery, which is where caustic material (silver nitrate) is used gently to cauterise the papilloma cells away in layers.

Pressy had suffered years of ill health under the ignorant care of his owner. He never saw a vet, let alone an avian vet. Symptoms consisted of muscle weakness, lassitude, vomiting, diarrhoea, excessive thirst, laboured breathing, bacterial infection and occasional haemorrhage with regular small amounts of blood in his droppings. He was also suffering from malnutrition: hypovitaminosis A, hypocalcemia (calcium deficiency), deficient in minerals, trace elements, and amino acids. All of which culminated in an extremely weak immune system (immunodepression).

Pressy

Unfortunately, the first three avian vets that we took him to failed to give a correct diagnosis. It was only by chance that I finally encountered a vet that we could confidently hand over the veterinary responsibility to.

The then charity’s avian vet, Jonathan Newman MA VetMB MRCVS of Broadway Veterinary Hospital, Peterborough, used endoscopy procedure and took a cloacal biopsy, from which confirmed cloacal papillomotosis. Although surgery was successful, not all of the papilloma could be removed because it is extremely difficult to remove all of the neoplastic tissue.

Unfortunately, the papilloma recurred and pressy was again passing blood in his droppings so we started him on Bee Propolis and he has been on and off it for over a year now. He is finally enjoying excellent health. The papilloma seems to have disappeared and he hasn’t passed any blood in his droppings for the duration.
Please note: *benign neoplasm is a medical term for non-producing secondary tumours.  Papillomatosis is most definitely not a 'benign' condidition as there is a high risk of the condition causing cancer of the biliary duct if left untreated.

Most of the information presented here and in the right block was collated from "Parrots in Health and Illness" by Bonnie Munro Doane and modified with available current data by Julie Hamilton.