PMC4582499_01
(A) Photograph of the patient's bulky lips at the time of first attendance. (B) Deformity of the lips during lip movements caused by paraffin deposits. (C) Dystrophic areas of the integument are visible at the site of paraffin deposits. (D) Incision line for debulking of the augmented lips. (E) Whitish and firm tissues constitute the prominent lip masses adhering to the local connective tissues. (F) Sample of excised lip tissue. (D) Post-operative photographs demonstrate moderate reduction in lip volume.
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Finally, she had decided to ask for surgical help both to remove these indurations and to restore her distorted lip shape (Figure 1A (Fig. 1)). On admission, the patient showed very prominent and wide lips (Figure 1A (Fig. 1)). However, during speaking the assumed regions of injection became visible as stationary glossy protrusions (Figure 1B (Fig. 1)). These regions were painful on palpation (Figure 1C (Fig. 1)). In general anaesthesia, a w-shaped incision was performed in the labial mucosa of both lips lateral to the margins of the palpable masses (Figure 1D (Fig. 1)). The masses extended completely through the oral orbicularis muscle, with focal thickenings matching the palpable and visible lip masses (Figures 1E and 1F (Fig. 1)). After the first postsurgical follow-up (Figure 1G (Fig. 1)), she terminated further appointments.
Paraffinoma (microscopic findings). (A) Under low-power magnification, numerous oil cysts and cellular infiltrations of soft tissue between the muscle fibres are apparent (haematoxylin and eosin; original magnification 100X). Under higher-power magnification, multinucleated giant cells, foamy macrophages, a few lymphocytes and eosinophilic leucocytes along with mast cells can be recognized within the interstitial infiltrate. The conventional histology findings were proven by immunohistochemistry for (B) CD163, (C) mast cell tryptase (D) CD3, and (E) CD20 (magnification (B-E) 200X).
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The microscopic analysis of the tissue showed skeletal muscle fibres (Figure 2A (Fig. 2)) surrounded by numerous oil cysts rimmed by foamy macrophages and multinucleated giant cells as well. The dominant cell type within the interstitial tissues was the mature M2 macrophage, which showed characteristic expression of the CD163 antigen (Figure 2B (Fig. 2)). The low intra-lesional occurrence of the mast cells was proven by immunohistochemistry using the specific antibody against mast cell tryptase (Figure 2C (Fig. 2)). Furthermore, immunohistochemical analysis showed a slight dominance of CD3-positive T-lymphocytes (Figure 2D (Fig. 2)) over B-lymphocytes, which showed positive reaction to CD20 antibodies (Figure 2E (Fig. 2)). 