Paraffinoma

PARAFFINOMA, a tumor formed at the site of paraffin injected under the skin. The paraffin injected under the skin, after a more or less prolonged period, leads to the formation of lipomatous tissue surrounded by a connective tissue capsule. From this capsule, connective tissue layers extend inward in various directions, between which are enclosed lumps of paraffin; in the layers, rows of giant cells are located (see Paraffin, application in surgery). When hot paraffin is injected, the connective tissue layers necrotize, and the ingrowth of new strands of connective tissue into the remaining layers in the solidified paraffin occurs significantly later. Pokrovsky, in D'yakonov's clinic, observed further ingrowth of connective tissue into the paraffin depot in preparations taken 2^months after the injection of paraffin. The connective tissue surrounding the lobules of paraffin, as it approaches the center, contained increasingly young cells with figures of karyokinesis; in places, individual cells were completely penetrated by connective tissue, or the entire depot was penetrated by dense scar strands. Kirschner explains the penetration of dense paraffin by the penetration of connective tissue cells into the amorphous fine-meshed network formed by the coagulation of tissue juices that resulted from the paraffin injection. Following the cells, capillaries penetrate. Thus, the fragmentation and resorption of solid paraffin proceeds. Upon removal of a P. of 10 years or more, on the one hand, the described picture of complete penetration of the paraffin depot by connective tissue was observed [see separate table (st. 239-240), fig. 5] with paraffin lobules ranging from a small pea to a millet grain, each lobule being surrounded by a spherical capsule of dense consistency, and all of them being very tightly fused by a common scar capsule with the surrounding areolar tissue; on the other hand, cases were encountered where the paraffin depot, despite the prolonged period (10 years), had not changed but was surrounded on the outside by a dense connective tissue capsule, giving the injected paraffin a spherical or kidney-shaped form. In pre-revolutionary Russia, in France, and in Austria-Hungary, the injection of paraffin was widely used for simulating tumors with the aim of being released from military service, in military prisons (Algeria). According to Hess's material (183 cases), P. were observed in the area of the ankle joint, on the shin, in the area of the knee joint, elbow joint, and forearm, on the scrotum, and on the neck. For injection, paraffin is most often used, and only in rare cases is liquid paraffin used. One of the main differential-diagnostic signs of P. is their changeability of form under the influence of pressure and the application of heat. Over time, even soft P. harden, as they cause a reaction in the surrounding tissues, which leads to their penetration by connective tissue, and then by scar tissue, which easily ulcerates. Most often, P. have to be differentiated from tumors, tuberculous, and syphilitic lesions. The differential diagnosis is facilitated by the following signs: paraffinomas have a hard, cartilaginous consistency, much more rarely a soft consistency; sometimes they wrinkle under pressure and change shape with heat; if they are located on the scrotum, they usually have no relation to the testicle and its appendage; often they are not connected to the skin, which is usually completely normal; in cases of localization over a large area, they are almost always tightly fused to the skin and underlying tissues, immobile, multilobular, and send out processes to the sides; all P. are completely painless; in rare cases, there are traces of the puncture on the skin, from which a dense strand goes under the skin to the tumor. The longer the paraffin lies, the more difficult the diagnosis. An absolute proof of self-mutilation is biopsy, but such patients usually never agree to surgery, fearing to be exposed; sometimes, in suitable cases, patients state that the paraffin was injected into them by a doctor for therapeutic purposes. If in the imperial army cases of P. were far from rare, then under Soviet conditions one cannot expect a repetition of such cases. On the contrary, after the October Revolution, many of such patients, wishing to join the Red Army, turned to surgical aid with the aim of getting rid of the artificial P., which made them incapable of military service. Unfortunately, in chronic cases, cure by removal of P. is in most cases impossible. In cases of large ulcerations, it is sometimes even necessary to resort to amputation of the limb.