Unilateral exophthalmos due to orbitofrontal cholesterol granuloma

Abstract

1. 1. The clinical and pathologic features of nine cases of orbitofrontal cholesterol granuloma have been summarized. 2. 2. All lesions were solitary and occurred in young or middle-aged adult males. 3. 3. There was a definite history of trauma in two cases. 4. 4. Unilateral exophthalmos and diplopia were the most common symptoms. 5. 5. Forward, inferior and medial displacement of the eye with restriction of upward gaze were the most constant findings. In six cases there was a visible or palpable abnormality of the lateral portion of one supraorbital ridge. 6. 6. There was radiographic evidence of an osteolytic lesion in the lateral portion of one supraorbital ridge with involvement of the adjacent frontal squama, orbital roof and zygomatic process of the frontal bone in all eight cases in which x-rays were taken. 7. 7. All patients were operated upon, disclosing a cavity in the bone filled with a soft, yellowish-brown, amorphous, gritty substance. There was compression of the orbital fascia in each instance. No invasion was demonstrated through the orbital fascia or frontal dura. 8. 8. The microscopic appearance in all cases was that of a granuloma containing large numbers of cholesterol crystal clefts, foreign body giant cells, foam cells, histiocytes with eosinophilic cytoplasm, inflammatory cells, blood pigment and collagenous connective tissue. 9. 9. Local excision has resulted in prompt recovery and there has been no evidence of recurrence. A conservative operative approach and curettage has been recommended. 10. 10. The etiology and pathogenesis remain unknown. It is suggested that these lesions may be related to the histiocytic granulomas of the Schüller-Christian type, but conclusive proof is lacking.