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Paraffin
Paraffin, being a mineral oil, is not hydrolyzed by tissue lipases and is treated by the body as a foreign substance. Augmentation of body contour by local injection of paraffin, although banned in most countries, is still performed in some regions of the world and is mostly done by non-medical personnel. Accidental paraffinoma of the orbit and palpebra has been reported following intraoperative placement of paraffin-impregnated gauze packs within the nasal cavity.
Clinical features
In those cases due to injected paraffin, the genitalia, buttocks, and breast are the most common sites of involvement. Penile paraffinomas, also referred to as sclerosing lipogranulomas of the penis, can lead to significant deformity (Fig. 94.9A). Clinically, non-tender firm nodules and indurated plaques are seen, sometimes with ulceration or abscess formation and involvement of subcutaneous tissue (see Ch. 100). The interval between the time of injection and the development of lesions varies from weeks to decades.
Pathology
The dermis shows a characteristic โSwiss cheeseโ appearance due to the presence of numerous ovoid or round cavities where the paraffin resided prior to processing (Fig. 94.9B). Between the cavities, there is fibrotic connective tissue and a cellular infiltrate composed of macrophages, variable numbers of multinucleated foreign body giant cells, and lymphocytes. Some of the macrophages have foamy cytoplasm. In specially processed tissue, the foreign material stains with fat stains, although less intensely than neutral fats, helping to differentiate paraffinoma from reactions to silicone, which also have numerous cavities but negative fat stains.
Treatment
Excision with appropriate tissue reconstruction is the only means of therapy.