Multiple Cholesterol Granuloma Involving the Paranasal Sinus: A Case Report

ABSTRACT

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.