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Case 3

Altered Breast: Paraffin Injection with Development of Paraffinomas

Numerous dense nodules (granulomata), some of which contain are calcifications, involve the entire right breast (Fig. 3A,3B,3C,3D). Questioning revealed that the patient had received injections in Vietnam as a teenager. She had asymmetric breast development, and an "oily substance" had been injected in the right breast for cosmetic balance.

View larger version (61K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —39-year-old asymptomatic Asian—American woman. Mediolateral oblique mammograms of right (A) and left (B) breasts and craniocaudal mammograms of right (C) and left (D) breasts show multiple dense nodules (arrows, A and C) with numerous arc and ring calcifications (arrowheads, A and C) in right breast.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —39-year-old asymptomatic Asian—American woman. Mediolateral oblique mammograms of right (A) and left (B) breasts and craniocaudal mammograms of right (C) and left (D) breasts show multiple dense nodules (arrows, A and C) with numerous arc and ring calcifications (arrowheads, A and C) in right breast.

View larger version (47K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C. —39-year-old asymptomatic Asian—American woman. Mediolateral oblique mammograms of right (A) and left (B) breasts and craniocaudal mammograms of right (C) and left (D) breasts show multiple dense nodules (arrows, A and C) with numerous arc and ring calcifications (arrowheads, A and C) in right breast.

View larger version (42K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D. —39-year-old asymptomatic Asian—American woman. Mediolateral oblique mammograms of right (A) and left (B) breasts and craniocaudal mammograms of right (C) and left (D) breasts show multiple dense nodules (arrows, A and C) with numerous arc and ring calcifications (arrowheads, A and C) in right breast.

Paraffin oil breast injections were performed until the early 1900s in the West and until the 1970s in Asia. These "free" injections may still be available from unqualified practitioners in the Far East [1, 2]. The paraffin converts into a semisolid state in the breast and causes a foreign body granulomatous reaction with fibrosis. Women may present decades after the injection with hard, nodular breast masses. The paraffin may infiltrate along lymphatic channels into the axilla and anterior mediastinum. Its complications include formation of paraffinomas, tissue necrosis, and development of skin ulceration with sinus tracts [2].

Mammographically, paraffinomas appear as dense, rounded, and streaky opacities. They frequently form amorphous rim calcifications. The whole breast is typically involved, but dense fibrosis in the retroglandular mid breast region suggests the diagnosis [2]. Bizarre architectural distortion and dense masses will obscure the underlying fibroglandular tissue. Conglomerate calcification may be seen in the axilla, chest wall, and mediastinum because the paraffin migrates to these areas. Sonography reveals marked acoustic shadowing associated with the paraffinomas and fibrotic changes. Attempts have recently been made to better evaluate paraffinomas and the surrounding fibroglandular tissue with MR imaging [3].

The feature distinguishing this entity from inflammatory carcinoma is that the overlying skin is often normal without associated nipple retraction or peau d'orange changes [2]. The patient was asymptomatic and presented for baseline examination, which excluded the choice of radiation edema. The presence of numerous nodules and calcifications excludes the possibility of asymmetric tissue as a diagnosis.

References

1. Raven RW. Paraffinoma of the breast. Clin Oncol 1981;7:157 -161[Medline]
2. Yang WT, Suen M, Ho WS, Metreweli C. Paraffinomas of the breast: mammographic, ultrasonographic, and radiographic appearances with clinical and histopathologic correlation. Clin Radiol 1996;51:130 -133[Medline]
3. Khong PL, Ho LWC, Chan JHM, Leong LLY. MR imaging of breast paraffinomas. AJR 1999;173:929 -932[Abstract/Free Full Text]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sinclair, D. S. Articles by Spigos, D. G. Search for Related Content PubMed Articles by Sinclair, D. S. Articles by Spigos, D. G. Social Bookmarking                      What's this?