Case Of Cholesterol Granuloma Research Articles

A report on five cases of cholesterol granulomas in the thymus

BackgroundCholesterol granuloma (CG) is a benign entity characterized by the presence of cholesterol crystals and foreign body giant cells. This condition can be attributed to cholesterol crystals that are deposited in the tissues and react with foreign body giant cells, resulting in granuloma formation. Lesions commonly develop in the otolaryngeal region, such as the middle ear. However, crystals rarely form in the thymus, accounting for 1% of all mediastinal tumors. Herein, we present five cases of mediastinal CG.Case presentationThe patients were aged 49–61 (mean, 55.4) years. Among them, three were men and two women. One patient had fever, and four patients were asymptomatic. The patients’ lesions were detected during follow-up of other diseases or medical examinations showing the presence of abnormal chest shadows. The patients did not have a history of trauma or surgery. All lesions were located within the thymus gland. Three patients presented with multifocal lesions and two with a single lesion. Four patients had contrast effect on computed tomography scan. Four patients had abnormal fluorodeoxyglucose accumulation (mean maximum standardized uptake value, 4.67) on positron emission tomography-computed tomography. Four patients underwent complete surgical resection. The size of the resected lesions ranged from 1.8 to 5.1 (mean, 3.24) cm. Histologically, all patients presented with small nodules with cholesterol clefts and foreign body giant cells and histiocyte infiltration within the thymic tissue. The postoperative course was excellent. None of the patients who underwent complete resection presented with recurrence. Moreover, the patient who underwent partial resection did not have lesion enlargement.ConclusionsCG in the thymus is clinically challenging to differentiate from malignant lesions, and histologic diagnosis via surgical resection is required.

Vallecular Cholesterol Granuloma: Case Report

Introduction. Cholesterol granuloma is a rare benign cystic neoplasm characterised by a fibrous capsule, and a cystic fluid containing cholesterol crystals, multinucleated giant cells, erythrocytes and haemosiderin. Cholesterol granulomas are usually found in diverse parts of the temporal bone, most commonly – petrous apex. Very few cases of cholesterol granulomas in other organs have been reported, to our knowledge none are reported in the larynx. The main purpose of this case report is to highlight this extremely rare laryngeal lesion and its unique macroscopic appearance. Case report. A 55-year-old man is referred to the Ear, Nose and Throat Centre because of persistent hoarseness, globus sensation and complicated intubation due to a mass in the larynx. Videolaryngoscopy showed a large cyst-like mass in the vallecula, epiglottis was displaced towards the posterior pharyngeal wall and erythema of interarytenoid notch and arytenoid tubercle was present. A computerized tomography scan confirmed a cystic mass on the lingual surface of the epiglottis. On the basis of the examination and clinical symptoms, a diagnosis of chronic laryngitis, gastro-oesophageal reflux and an unspecified benign tumour of the respiratory system was made, surgical treatment was planned. The patient underwent microlaryngoscopy and surgical extirpation of the cyst using a CO2 laser, as the cyst was opened a yellowish, shiny, viscous fluid was observed. Two days later, laryngoscopy revealed fibrin plaque at the site of the cyst. Final diagnosis of cholesterol granuloma was formed based on histological examination of the mass. Conclusions. Cholesterol granulomas and masses in vallecula are extremly rare, but this case shows that cholesterol granuloma can be included in the differential diagnosis of cystic neoplasms of the larynx.

Cholesterol Granuloma of the Maxillary Sinus Misdiagnosed as Nasal Polyp or Mucocele: Four Cases.

Cholesterol granuloma is commonly found in the mastoid air cells but is rare in the paranasal sinuses. The most commonly affected sinuses are the frontal sinus, followed by the maxillary sinus. Cholesterol granuloma can be difficult to diagnose because clinical manifestations and radiologic findings are similar to those of other sinonasal disorders. The authors observed 4 cases of cholesterol granuloma that were preoperatively suspected to be nasal polyps or mucoceles. Here, the authors report on their clinical presentation and their successful treatment using the endoscopic sinus approach. These cases expand the current literature on cholesterol granuloma in the paranasal sinuses.

A Case of a Nonpetrous Cholesterol Granuloma Presenting as a Temporal Mass

Objective A case of a skull base cholesterol granuloma (CG) of the squamosal temporal bone. This is the first ever reported case of CG in a well-pneumatized squamous temporal bone. Design Case report and review of the literature. Discussion. CG is a cystic mass typically found in the petrous apex and occasionally in the paranasal sinuses and orbit. Experience with the treatment of these expansile and inflammatory processes has largely been garnered from those occurring in the petrous apex, where they are surgically drained, via a transtympanic, transmastoid, or middle fossa approach. We report a case of cholesterol granuloma situated in the temporal fossa presenting as a temporal mass. The accessible location of this particular lesion made it amenable to total excision, avoiding the need for surgical drainage and possibility for recurrence. Conclusion This case supports the theory of pathogenesis of such lesions typically occurring where pneumatized air spaces interface with bone marrow, in this case, where the reaches of pneumatized cells in the squamous portion of the temporal bone meet diploic bone.

Paratesticular cholesterol granuloma

We herein report a case of paratesticular cholesterol granuloma. A 5-year-old boy with a painless mass (10 mm in diameter) in the left scrotum. Although the mass shrank over the next eight months, it increased in size at six years of age. Surgical resection of the mass was performed. The mass originated from the tunica albuginea. The histological diagnosis was cholesterol granuloma. To our knowledge, this is the first case of cholesterol granuloma in the scrotum of a child.

A Case of Cholesterol Granuloma in the Maxillary Sinus

A Case of Cholesterol Granuloma in the Maxillary Sinus

A Case of Cholesterol Granuloma at the Petrous Apex with Improvement of Bone Conduction after Drainage Surgery

A Case of Cholesterol Granuloma at the Petrous Apex with Improvement of Bone Conduction after Drainage Surgery

A case of cholesterol granuloma probably caused by displaced ventilation tube in the tympanum

A case of cholesterol granuloma probably caused by displaced ventilation tube in the tympanum

経鼓室的に開窓した側頭下窩コレステリン肉芽腫例

経鼓室的に開窓した側頭下窩コレステリン肉芽腫例

A Case of Cholesterol Granuloma Extending to the Infratemporal Fossa Treated by Transtympanic Fenestration of the Cyst

A Case of Cholesterol Granuloma Extending to the Infratemporal Fossa Treated by Transtympanic Fenestration of the Cyst

A Case of Cholesterol Granuloma in the Nasal Septum

74세 여자 환자로 뇌경색의 경과 관찰 중 반복하는 두통이 지속되어 시행한 자기공명촬영에서 우연히 약 1×1 cm 크기의 비중격 종괴가 발견되어 본과로 의뢰되었다. 환자는 천식, 협 심증, 뇌경색의 과거력이 있었으나 부비강 수술, 방사선치료, 두부외상의 병력은 없었다. 또한, 비출혈, 콧물, 코막힘의 증상 은 없었다. 부비강 내시경 검사에서 왼쪽 중 비갑개 전방 내측 으로 비중격이 융기되었고 우측도 약간 돌출되어 있었다(Fig. 1A). 양측 비중격 점막 손상이나 궤양 소견은 없었다. 또한, 비 강 내 화농성 분비물도 관찰되지 않았다. 전산화단층촬영에서 비중격 내부에 약 1×1 cm 크기의 저 음영에 조영증강 되지 않으며 주변이 석회화되어 있는 결절형 병변이 관찰되었다(Fig. 2). 자기공명촬영에서는 같은 부위에 T1 강조영상에서는 고 신 호, T2 강조영상에서는 저신호 음영이 있었으며 gadolinium 조영증강은 없었다(Fig. 3). 병변은 전신마취하에 비내시경을 이용한 비중격 접근법으로 제거하였다. 왼쪽 비강에 Killian 절개를 가한 후 점막 연골막 피판과 점막 골막 피판을 차례로 박리하였다. 비중격 점막과 연골, 골 사이에 유착되어있는 노 란색의 부드러운 낭 모양의 종괴를 관찰하였으며(Fig. 4A) 종 괴 주위로 사골수직판과 서골의 일부 결손을 확인하였다. 종 Case Report Korean J Otorhinolaryngol-Head Neck Surg 2016;59(1):49-52 / pISSN 2092-5859 / eISSN 2092-6529 http://dx.doi.org/10.3342/kjorl-hns.2016.59.1.49

Radiologically Unusual Presentation of Cholesterol Granuloma in the Sphenoid Sinus

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. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(9):641-5

Endoscopic Transnasal Approach for Cholesterol Granuloma of the Petrous Apex.

Cholesterol granulomas are rare round or ovoid cysts. They contain cholesterol crystals surrounded by foreign bodies of giant cells and are characterized by chronic inflammation. Large cholesterol granuloma can compress surrounding tissue especially cranial nerves. There are several types of surgery for the resection of cholesterol granuloma. We describe 4 cases of cholesterol granuloma operated on via transnasal endoscopic approach. In this report, we describe radiologic and pathologic features of this lesion and explain the advantages and disadvantages of transsphenoidal endoscopic approach for these rare lesions.

Cholesterol granuloma of the breast suspected as breast carcinoma

Cholesterol granuloma of the breast is a rare benign condition which is difficult to differentiate from breast cancer. We herein report the case of a 56-year-old Japanese asymptomatic female who, on a computed tomography examination for sigmoid colon cancer, was found to have a palpable nodule in the upper external quadrant of the left breast. Breast carcinoma could not be ruled out on the basis of clinical and radiological findings, but excisional biopsy revealed cholesterol granuloma. A histological examination implied that this case of cholesterol granuloma might have been related with mammary duct ectasia. Although cholesterol granuloma is a rare disorder in the breast, this case indicated that a better awareness of this benign breast disease is important for avoiding misdiagnosis and unnecessary surgery.

Cholesterol Granuloma of the Frontal Sinus: A Case Report

Cholesterol granulomas are common in the mastoid antrum and air cells of the temporal bone. In the paranasal sinuses, especially in the frontal sinus, they have occasionally been mentioned in the literature. The pathogenesis is unknown, but the majority of the authors support the concept of airway obstruction in the cells well pneumatised of temporal bone and paranasal sinuses. The authors report a case of cholesterol granuloma of the frontal sinus treated with radical surgical techniques, and they also recommend an endoscopic approach to frontal sinus to restore or enlarge the nose-frontal canal and promote drainage and ventilation of the frontal sinus.

Sonographic appearance of a cholesterol granuloma within a renal epithelioid angiomyolipoma

We present the sonographic characteristics of a rare case of cholesterol granuloma within a renal epithelioid angiomyolipoma (AML) in a 57-year-old woman. Sonography showed acoustic shadowing distal to the central region of the AML behind a hyperechoic cholesterol, which was hypoattenuating on CT with no contrast enhancement. Microscopic examination confirmed that this central area was a cholesterol granuloma. The patient was treated successfully with radical nephrectomy.

Cholesterol granuloma of the posterior ethomoid sinus mimicking meningocele

Cholesterol granuloma is usually associated with chronic middle ear disease, less common in the orbit, and rare in the paranasal sinus. Cholesterol granuloma is thought to be initiated by hemorrhage, impaired drainage, and interruption of aeration. Here we report a case of cholesterol granuloma arising in the posterior ethmoid sinus mimicking meningocele. Magnetic resonance imaging is useful for differential diagnosis, and endoscopic surgery is effective for the management of cholesterol granuloma arising in the ethomoid sinus.

Cholesterol granuloma surrounding the endolymphatic sac

We report a unique case of cholesterol granuloma (CG) surrounding the endolymphatic sac (ES). A 49-year-old man presented with the left side of sensorineural hearing loss, tinnitus, and vertigo. Magnetic resonance and computed tomography imaging revealed a CG surrounding the left ES. The patient initially underwent left transmastoid surgical resection of the tumor. At the time of surgery, brown fluid was aspirated from the tumor, but no other tumors were found. Histopathological examination revealed that the tumor contained cholesterol crystals, confirming the diagnosis of CG. At his 12-month postoperative follow-up, there was no evidence of recurrence. We discuss the radiology, pathology, and surgical removal of CGs surrounding ES.

Cholesterol granuloma of the petrous apex

A case of cholesterol granuloma (giant chocolate cyst) of the petrous apex of the temporal bone is reported. The importance of correct pre-operative diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is discussed. This may allow, as in this case, less major surgical management by transmastoid drainage. A 44-year-old woman presented with a 4-year history of left-sided facial spasms, which had become progressively more frequent and severe. They occurred daily and were triggered by noise, cold air or abduction of the arm. Over a few seconds the left eye would close and the angle of the mouth would be drawn up, the facial muscles remaining in spasm for over half an hour. There was no associated pain or parasthesia, but she was aware of facial numbness. There had been associated left-sided hearing loss for the previous 2 years. General and neurological examination between attacks was unremarkable apart from reduction in light touch and pin-prick sensation over the left cheek. A mild conductive hearing loss was present on the affected side. Brain stem evoked potentials were bizarre and poorly seen, features suggesting a retrocochlear lesion involving the auditory pathways. Facial electromyogram during an episode was not consistent with hemifacial spasm or facial myokymia. Facial nerve conduction, blink reflex latency and cerebrospinal fluid analyses were normal. Computed tomography of the brain (WW75 WL45) was normal.

後部箭骨洞コレステロール肉芽腫の一例

A case of cholesterol granuloma in the ethmoidal sinus is reported. The patient was a 44-year-old male whose chief complaint was visual disturbance. Visual acuity improved transiently at the early postoperative day, but his visual impairment could not be healed completely. Although CT was one of the best method for diagnosis, conventional methods, tomography and Rhese's method, were also useful for early detection and diagnosis. The cholesterol granuloma was thought to be caused by hemorrhage. However, closed cavity was also an important facter for the development of cholesterol granuloma.