Cholesterol granuloma as a rare differential in bone erosion of the orbit: A case report

Objective@#We report a case of orbitofrontal cholesterol granuloma as a rare differential diagnosis of orbital erosion in the diploe of the frontal bone. @*Methods@#This is a case report. @*Results@#A 50-year-old man presented with right eye proptosis. Computed tomography (CT) scan of the orbit showed a fairly delineated homogeneous mass centered in the diploe of the right frontal bone with calcification and rugged erosion of the frontal bone and with expansion into the right superotemporal orbit. The patient was initially diagnosed with malignant lacrimal gland tumor on the right. He underwent orbitotomy with excision of the mass. Histopathologic studies of the excised mass revealed a cholesterol granuloma.@*Conclusion@#Cholesterol granulomas of the frontal bone in the superotemporal orbit are rare benign lesions that present with bone destruction and can be mistaken for lacrimal gland malignancies. Surgical excision has a high success rate with low incidence of recurrence.

Endoscopic-Assisted Infralabyrinthine Approach to Petrous Apex Cholesterol Granuloma / 대한이비인후과학회지

A cholesterol granuloma is the most common primary lesion of the petrous apex, and accounts for 40% of the pathologies that arise in this region. The primary treatment for symptomatic lesions is by surgery to decompress and drain or to completely remove the lesion. Here we describe the use of infralabyrinthine approach to access a lesion through the temporal bone and completely remove it with the assistance of a 0-degree endoscope. A 43-year-old man visited our clinic for diplopia. Magnetic resonance imaging revealed a 2.3-cm cholesterol granuloma located in the left petrous apex that caused deviation of the left abducens nerve. The tumor was completely removed using the endoscopic-assisted infralabyrinthine approach; the patient is currently being followed up, and there is no evidence of disease recurrence. This case report describes the successful completion of a petrous apex cholesterol granuloma that preserved the cochlear and vestibular systems.

A Case of Cholesterol Granuloma of Maxillary Sinus Misdiagnosed as Odontogenic Cyst

Cholesterol granuloma is a disease in which cholesterol crystals act as a foreign substance in the surrounding tissues and cause granulomatous reaction and fibrosis within the chamber. It is found in various locations of the body, but the most common location is the temporal bone associated with middle ear disease. Because the disease is associated with breathing disturbance, it may also occur in the paranasal sinus. However, it has been rarely reported since its first report by Graham and Michaels in 1978. Recently, we experienced a case of cholesterol granuloma of the right maxillary sinus of a 63-year-old female patient without any nasal symptoms. We successfully managed this case with Caldwell-Luc operation. Also, we summarized the cases of cholesterol granuloma of the sinonasal region reported in Korea.

Radiologically Unusual Presentation of Cholesterol Granuloma in the Sphenoid Sinus / 대한이비인후과학회지

Cholesterol granuloma is a histopathological diagnosis with features of cholesterol clefts, foreign body giant cells, and macrophages filled with hemosiderin. It is commonly found in the mastoid or petrous apex, but the involvement of paranasal sinuses is very rare. Radiologically, cholesterol granuloma show typical findings of hyperintense signals on both T1- and T2-weighted images on magnetic resonance imaging (MRI). We report two cases of cholesterol granuloma in the sphenoid sinus, which were first misinterpreted as mucoceles due to unusual MRI images.

Paediatric Primary Pachymeningeal Xanthogranuloma with Scattered Foci Displaying Reticulohistiocytoma-like Features

We report a unique case of a 4-year-old girl with an intriguing fibrohistiocytic tumour. Magnetic resonance imaging scans showed a dural mass of variegated intensity compressing the left occipital pole and apparently extending toward the superior sagittal sinus. Grossly, the cut surface of the surgical specimen was yellow, pale, and soft with reddish kernel-like crusts. Histologically, the yellow areas resembled cholesterol granulomas with widespread coagulative necrosis, cholesterol clefts, powdery calcification, foreign body-type giant cells, and foamy macrophages, while the scattered red spots contained numerous multinucleated giant cells of foreign-body and Touton types, the former with amphophilic to slightly eosinophilic cytoplasm. Immunoperoxidase reactions confirmed the expression of histiocytic markers and vimentin. As far as we know, no tumour displaying these peculiar morphological features has yet been described.

Cholesterol Granuloma of Nasal Septum

Cholesterol granulomas are inflammatory deposits commonly found in the mastoid antrum and air cells of temporal bone. They rarely occur in the nose. Here, we report an extremely rare case of cholesterol granuloma in the nasal septum, and include a short literature review. The clinical characteristics, pathology, and surgical treatment are also discussed.

Cholesterol granuloma of the orbit: An atypical presentation.

Cholesterol granuloma is a rare, well-defined lesion of the orbit. In the orbit, diploe of the frontal bone is involved almost exclusively. We report an atypical case of cholesterol granuloma involving superomedial quadrant of orbit. A 42-year-old male presented with progressive, painless, proptosis with inferotemporal displacement of left eye. A large mass was felt beneath the bony orbital margin in the superomedial quadrant of the left orbit. Computerized tomography (CT) scan revealed an extraconal superomedial, heterogeneous enhancing mass which was isodense with brain and pushing the globe inferolaterally and anteriorly. Excision biopsy of the tumor revealed the typical features of a cholesterol granuloma without any epithelial elements. Cholesterol granuloma of the orbit is a rare entity, but it can be diagnosed and differentiated from other lesions of the superior orbit by its characteristic clinical, radiological and histopathological features. An appropriate intervention in time carries a good prognosis with almost no recurrence.

Middle Ear Cholesterol Granuloma without Tympanic Membrane Perforation / 대한이비인후과학회지

Cholesterol granuloma is a histopathologic term used to describe the giant cell reaction to cholesterol deposits that occurs in sequestered, fluid-filled air cells that are normally pneumatized compartments of the temporal bone. It is a benign lesion which is known to be found in the middle ear cavity, mastoid air cells and petrous apex. Although cholesterol granuloma is a pathologic term describing a tissue response to cholesterol crystals, it is now recognized as a clinical disease entity especially in cases of unilateral blue eardrum without tympanic membrane perforation. Three factors are considered to play an important role in the development of cholesterol granulomas: obstruction of ventilation, microhemorrhage, and impaired drainage. Cholesterol granulomas are often found as pathologic lesions like granulation tissue in the middle ear and mastoid cavities during middle ear surgeries in patients with chronic otitis media or cholesteatoma. Cholesterol granulomas of the middle ear typically present as conductive hearing loss and a blue eardrum, whereas those at the petrous apex are incidentally identified or manifest as bony erosion with sensorineural hearing loss, tinnitus, vertigo, or cranial nerve impairment. Cholesterol granulomas in middle ear cavity and mastoid air cells are related with Eustachian tube dysfunction, so initial treatment of cholesterol granuloma is the insertion of ventilation tube in many cases. However, it is often necessary for the complete cure to do excision of the lesion through tympanomastoidectomy surgery.

A Case of a Cholesterol Granuloma Occluding the External Auditory Canal in a 12-Year-Old Girl

Cholesterol granulomas are benign granulomatous lesions caused by tissue reaction to a foreign body such as cholesterol crystals. These crystals have been are associated with pathological conditions of pneumatized spaces, including those causing inadequate aeration, obstruction of drainage, and hemorrhage in pneumatized spaces, and where materials trapping materials, such as hemosiderin or cholesterol become trapped, and then forming a cholesterol granuloma. Cholesterol granulomas are frequently found in the temporal bones, with the middle ear, mastoid caverna, and petrous apex being the most commonly affected sites. As there have been few reported cases of cholesterol granulomas presenting as a mass in the external acoustic canal (EAC), a cholesterol granuloma occluding the entire EAC in a pediatric patient is considered quite rare. We encountered a large cholesterol granuloma occupying the entire EAC, resulting in total EAC occlusion in a 12-year-old girl. The granuloma was diagnosed via medical imaging and surgically excised.

The Unusual Ultrasound Features of a Breast Cholesterol Granuloma Manifesting as an Intracystic Mass: Case Report and Literature Review

Cholesterol granuloma of the breast is a rare, benign disease. Here, we present the unique ultrasonographic findings of breast cholesterol granuloma manifesting as an intracystic mass. The findings of this case report may help expand existing knowledge regarding differential diagnosis of intracystic breast masses, which are found on ultrasonographic examination.

Cholesterol Granuloma in a Post-mastoidectomy for Cholesteatoma

Cholesterol granuloma is a histological term used to describe the foreign body reaction towards cholesterol crystals causing granuloma. We report a case of cholesterol granuloma in a patient who presented with a mass in her ear after 6 years of mastoidectomy. The diagnosis has been confirmed by MRI and postoperative findings. The difference between cholesterol granuloma and the other entities especially cholesteatoma and meningoencephalic herniation must be made in view of its implications and surgical management of each lesion.

A Case of Cholesterol Granuloma in Pancreas / 대한소화기학회지

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. Cholesterol granuloma is histologically characterized as fibrous granulation tissue containing cholesterol crystals within surrounding giant cells. Cases of cholesterol granuloma of the pancreas are very rare. We report a case of a 47-year old male who had a cholesterol granuloma of the pancreas. Abdominal CT showed 24 mm-sized cyst in the pancreas and peri-pancreatic regional mass infiltrating to the stomach. PET-CT revealed increased 18F-FDG uptake at the cyst and peri-pancreatic mass. Thus, Whipple's operation was done. The disease was confirmed by surgical pathologic examination of the tissue. Pathologic examination of resected specimen showed numerous cholesterol crystals surrounded by multinucleated foreign body giant cells. We report on this case and give a brief review of the literature.

A Case of Intracranial and Extradural Cholesterol Granuloma / 대한이비인후과학회지

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. The pathogenesis of cholesterol granuloma is controversial. But three factors are thought to have an important role in its development: obstruction of ventilation, impaired drainage, and hemorrhage. It may arise from any portion of the pneumatized temporal bone. But huge cholesterol granuloma with intracranial and extradural extension has been rarely reported. Recently, we experienced a case of huge cholesterol granuloma with intracranial and extradural extension. The patient has never experienced chronic otitis media before. The cholesterol granuloma was successfully removed by transmastoid approach. So we report this case along with a literature review.

Cholesterol Granuloma of the Tympanic Membrane Presenting as a Blue Eardrum

Intramembranous tympanic membrane cholesterol granuloma (CG) occurs infrequently. Here, the authors report a case of CG in the tympanic membrane presenting as a blue eardrum in the right ear. In addition, a pinhole perforation noted in the anterosuperior area revealed a brown discharge. High-resolution temporal bone CT showed a bulging mass shadow in the middle ear and a soft tissue dense lesion that filled both the epitympanum and mastoid cavity. Tympanomastoidectomy was performed under general anesthesia. New bone formation was confirmed in the mastoid antrum and epitympanum, and the epitympanum was blocked by new bone. The tympanic membrane revealed a round, brownish mass with a glistening surface and a severely thickened pars tensa. We herein report this case and review pertinent medical literature.

Clinical Analysis of Cholesterol Granuloma in the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Cholesterol granuloma is often observed in middle ear surgeries. In the clinic, it can be found in a normal ear, but also as a recurrent serous otitis media in non-responding medical therapy. The purpose of this study is to analyze the clinical characteristics of cholesterol granuloma with or without cholesteatoma. SUBJECTS AND METHOD: We performed a retrospective study of 40 patients who underwent tympanomastoidectomy between January, 2000 and January, 2009 for cholesterol granuloma. We divided patients into a non-cholesteatoma group and a cholesteatoma group and observed the following clinical manifestations: initial symptom findings, ear drum findings, preoperative audiogram, postoperative audiogram, operative technique and operative findings. RESULTS: Cholesterol granuloma was found in 10.2% of 393 cases (40 cases) who underwent chronic otitis media surgery. Of these, 5.3% (21 cases) was diagnosed with non-cholesteatoma group and 4.8% (19 cases) was diagnosed in the cholesteatoma group. Chief complaints were the difficulty of hearing in the non-cholesteatoma group and otorrhea in the cholesteatoma group. Ear drums were nearly retracted and perforated in both groups, although the cholesteatoma group had more damaged ear drum. Distinctive features of hearing were the conductive type with a moderate degree and ossicular destruction showed missing or eroded incus. Major sites of cholesterol granuloma were antrum, air cells and epitympanum. CONCLUSION: Although ear drum was relatively preserved in the non-cholesteatoma group of cholesterol granuloma, the hearing level and the degree of ossicular destruction were not so much different between the two groups. Therefore, a complete removal of cholesterol granuloma and ossiculoplasty should be considered for better hearing restoration.

Petrous Apex Cholesterol Granuloma Presenting as Endolymphatic Hydrops: A Case Report

A petrous apex cholesterol granuloma (PACG) is the most common lesion of the petrous apex mass. Affected patients present with various symptoms such as hearing loss, vertigo, headache, tinnitus, facial spasms, and diplopia. We report the case of a 32-yr-old man with a PACG, who was first misdiagnosed with Meniere's disease. He was placed on a low-salt diet, and prescribed medication from another hospital, for several months, but the symptoms persisted and worsened. The patient presented to the emergency room complaining of left facial twitching and numbness. To rule out a central neurological lesion, temporal bone magnetic resonance imaging was carried out and a 2.5 cm mass with high signal intensity on T1- and T2-weighted imaging, without gadolinium enhancement, was found. Because of the hearing and facial problems, we drained cholesterol-bearing material via an infralabyrinthine approach using a computer aided image-guided surgical device, the BrainLAB(R). After the operation, the vertigo and hearing loss were no longer present. It is likely that the patent's Meniere's disease-like symptoms were due to the compression of the endolymphatic sac by a PACG.

Ovarian cholesteatoma in a bitch / Colesteatoma ovariano em uma cadela

O presente relato descreve um caso de colesteatoma ovariano em uma cadela Yorkshire de 15 anos de idade. O diagnóstico clínico foi de piometra e o animal foi submetido a ovariosalpingohisterectomia. O ovário esquerdo apresentava-se aumentado de volume (4 x 3 x 2cm), firme e esbranquiçado. Histologicamente havia grande número de cristais de colesterol, com acúmulo de macrófagos e algumas células gigantes multinucleadas. A lesão resultou em compressão do córtex ovariano adjacente que não continha nenhuma estrutura funcional, como folículos e corpo lúteo. O ovário contralateral não apresentava nenhuma alteração e continha múltiplos corpos lúteos.

Cholesterol Granuloma of the External Auditory Canal / 대한이비인후과학회지

Cholesterol granuloma (CG) has been known to be a pathologic condition that is associated with many kinds of middle ear diseases. Histopathologically, it is characterized by foreign body giant cells and numerous clefts consistent with prior cholesterol crystals. It can occur in any pneumatized bone and can cause expansile changes in surrounding structures. The temporal bone is the most common site of CG, but presenting in the ear canal is rare. We report a case of CG in the external auditory canal with a review of literature.

Huge Cholesterol Granuloma With Fungal Ball / 대한이비인후과학회지

Cholesterol granuloma is usually found in chronic middle ear disease. However, it rarely occurs in the sinonasal regions and only a few cases have been reported in the literature. The etiology of the sinonasal cholesterol granuloma is not known yet, and the clinical manifestations are variable. The 78-year-old man complained of facial pain and toothache at first visit. The PNS CT had a homogenous isodense mass occupying right spenoid sinus and extending to right pterygopalatine fossa, infratemporal fossa and masticator space. The PNS MRI had characteristically high signal lesion at both T1- and T2-weighted images. The tumor was completely excised via transantral approach. Pathological confirmation was the cholesterol granuloma with fungal infection consistent with Aspergillus species. This patient is followed up without recurrence.

Multiple Cholesterol Granuloma Involving the Paranasal Sinus: A Case Report

Cholesterol granuloma is a chronic inflammatory process associated with foreign body reaction to hemorrhage-related cholesterol crystal. It occurs most commonly in the middle ear cavity and the mastoid air cell complex. Sinonasal cholesterol granuloma is very rare, and there have been only 37 reported cases in the English literature so far. In this study, we examined a 61-year-old man suffering from bilateral orbital pain, headache and diplopia for 2 years. He had underwent a bilateral Caldwell-Luc operation 15 years ago. The brain MRI findings revealed 3 different cystic mass involving the bilateral sphenoid sinuses, and left ethmoid and maxillary sinuses. The patient was referred from the department of neurology, and the PNS CT findings were similar to the brain MRI. In the nasal endoscopic finding, there was a hard bilateral submucosal mass in the middle meatus. We planned an endoscopic sinus surgery for the mass, diagnosed as mucocele. The mass was accompanied by a greenish fluid and yellowish crystal in the left side of the lesion and dark reddish matter on the opposite site. Bone defects were observed in the left lamina papyracea and the intersinus septum of sphenoid sinus. The pathology was confirmed as a typical cholesterol granuloma. There is no recurrence during the last 18 months. We report this case of multiple cholesterol granuloma of the paranasal sinuses for the first time with literatures review.