Cholesterol Granuloma Research Articles (Page 1)

A cholesterol granuloma (CG) is a mass of cholesterol crystals surrounded by large foreign-body cells and chronic inflammation. Tympanic CG is a rare disease; in contrast, petrous bone CG is a more common ailment. Surgery is an elective treatment option for the majority of CGs. CG can be treated with a variety of surgical techniques; however, no case of primary endoscopic ear surgery has been reported to date. In the context of posttraumatic bleeding of the temporal bones, CGs can also occur. Surgical therapy for cholesteatomas and persistent otitis media frequently results in their unintentional discovery. The middle ear, mastoid bone, or petrous apex could all be affected by a CG. Cerebral granuloma near the petrous apex is linked to symptoms of bone erosion, including tinnitus, vertigo, sensorineural hearing loss, and injury to the cranial nerve. This middle-aged woman presented with a mass in the right middle ear cavity that was diagnosed as CG following surgical removal and histopathological examination.

Aim and Objective: The objective of this study was to investigate the surgical outcomes in patients presenting with lateral rectus palsy at a tertiary care center. Study Design: This was a descriptive case series involving eight patients diagnosed with lateral rectus palsy. Interventions: Six (n = 6) patients underwent surgical intervention, one (n = 1) patient was managed conservatively, and one (n = 1) patient was deemed unfit for surgery. Outcome Measures: Recovery of lateral rectus function and resolution of diplopia. Results: The etiology of lateral rectus palsy varied among the cases, including otomastoiditis (n = 1), acute rhinosinusitis with orbital complications (n = 2), skull base osteomyelitis with petrositis (n = 1), petrositis only (n = 1), ophthalmoplegic migraine (n = 1), orbital apex syndrome (n = 1), and pediatric petrous cholesterol granuloma (n = 1). Appropriate surgical interventions were performed based on the underlying cause and site of abducens nerve involvement. Complete recovery was observed in seven out of eight patients. Conclusion: Early surgical intervention to decompress the abducens nerve resulted in complete recovery of lateral rectus palsy in the majority of cases, without the need for additional rehabilitation procedures. This study highlights the importance of timely and appropriate surgical management in cases of lateral rectus palsy with identifiable causes.

Cholesterol granuloma of the breast – A cause of concern

To evaluate the clinical features, surgical options, and prognosis of middle ear cholesterol granuloma involving the middle cranial fossa. Retrospective cohort study. Tertiary referral center. Medical records of three patients with giant skull base cholesterol granuloma from 2006 to 2017 were retrospectively analyzed. The symptoms, signs, radiological features, treatment options, and prognosis were summarized. All patients underwent radical mastoidectomy and resection of skull base lesions by means of a retroauricular approach. Postoperative pathological diagnosis showed cholesterol granuloma. All patients were followed for more than 1 year. The symptoms were relieved, and there was no recurrence. Postoperative imaging showed that the skull base lesions were cleared and the compressed brain tissue recovered. Patients with middle ear cholesterol granuloma involving the middle cranial fossa can be operated on by retroauricular approach. It can reduce the trauma of craniotomy and obtain good curative effect.

The patient was a 64-year-old man who was found to have an abnormal shadow in the anterior mediastinum on a chest computed tomography( CT) scan during a health check. He was admitted for diagnosis and treatment, and underwent thoracoscopic thymic and thymic tumor removal. The postoperative course was uneventful, and the patient was discharged on the 4th postoperative day. Histopathological examination revealed numerous foreign body giant cells and cholesterol crystals in the thymus tissue, and the patient was diagnosed with cholesterol granuloma. One cause of cholesterol granuloma is trauma. Trauma was suspected as the cause in this case because the patient had bruised his chest in a traffic accident eight years ago. It is difficult to diagnose cholesterol granuloma from image findings, and surgical resection is necessary for diagnosis and treatment to differentiate it from malignant diseases.

Accuracy of Dual-layer Detector Spectral CT in Localizing Cholesteatoma: An Advanced Imaging Perspective.

Cholesterol granuloma is a rare, benign lesion of the mastoid air cells, often associated with glue ear and typically presenting unilaterally. Histopathologically, it comprises of granulation tissue with cholesterol crystals, multinucleated giant cells, and hemosiderin deposits from erythrocyte breakdown. While commonly found in the petrous apex, tympanomastoid cholesterol granulomas are rare, with very few cases reported in literature. It can mimic other otological conditions, leading to diagnostic challenges. We report a rare case of cholesterol granuloma presenting as acute mastoiditis in a 24-year-old female with type 1 diabetes. She presented with postauricular swelling, pain, fever, and hearing loss. Imaging revealed a cystic lesion with bony erosion in the mastoid antrum. Surgical exploration uncovered a lobulated cyst containing thick fluid, which was managed via marsupialization and reconstruction. Histopathology confirmed the diagnosis of cholesterol granuloma. This case underscores the need for clinical suspicion of rare pathologies in chronic otitis media cases and highlights the importance of timely intervention to prevent complications.

Cholesterol granuloma of the petrous apex is an uncommon benign lesion characterized by a foreign body reaction to cholesterol crystals within an air cell tract of the temporal bone. It is often mistaken for other petrous apex lesions such as cholesteatoma or petrous apex effusion. We present the MRI findings in a 16-year-old female with a history of left-sided cholesteatoma surgery at age 7, presenting 9 years later with suspected recurrence on CT. MRI revealed a non-enhancing, T1 and T2 hyperintense lesion with restricted diffusion at the left epitympanum and mastoid, consistent with a cholesterol granuloma associated with recurrent cholesteatoma. This article highlights the imaging hallmarks, diagnostic challenges, differential diagnoses, and current literature on petrous apex cholesterol granulomas, with a focus on MRI.

ведение. Поражения височной кости образованиями в виде кист различной этиологии встречаются редко. Причины развития данных новообразований могут иметь как врожденный характер, так и приобретенный. Дермоидные кисты являются врожденной патологией, образованы кожей и ее придатками, характеризуются медленным ростом и латентным течением. Холестериновые гранулемы в свою очередь развиваются на фоне дефицита кислорода, что приводит к анаэробному расщеплению эритроцитов с образованием гранул холестерина. Для диагностики данных патологий используются отоскопические данные, результаты аудиологических и рентгенологических методов обследования. Лечение пациентов заключается в хирургическом удалении новообразований с последующей гистологической верификацией. Цель. Сравнительный анализ пациентов с дермоидными кистами и холестериновыми гранулемами среднего уха. Материалы и методы. В период с января 2022 по декабрь 2023 г. проведено хи- рургическое лечение 8 детей: 4 пациентов с диагнозом «дермоидная киста среднего уха» и 4 пациентов с диагнозом «холестериновая гранулема среднего уха». Всем пациентам выполнено стандартное оториноларингологическое обследование, исследование слуха, МСКТ и МРТ височных костей. Хирургическое лечение у пациентов выполнялось ретроаурикулярно-трансмеатальным доступом с расширением области хирургического вмешательства при необходимости. Для лечения пациентов с дермоидными кистами среднего уха интраоперационно использовалась система электромагнитной хирургической навигации Collin Digipointeur 6200, 6200V, 6200VR, анализирующей предоперационные МСКТ- и МРТ-данные пациента. Окончательный диагноз устанавливался по результатам патогистологического исследования интраоперационного материала. Результаты. Среди исследуемой выборки пациентов 6 госпитализированы впервые, а 2 пациентам с дермоидной кистой среднего уха ранее были выполнены санирующие операции. Жалоба на снижение слуха отмечена у всех пациентов. Отоскопическая картина характеризовалась интактной барабанной перепонкой (n=3), перфорацией тимпанальной мембраны (n=3) и наличием послеоперационной полости (n=2). Были определены характерные рентгенологические признаки новообразований. У всех пациентов применялся заушный доступ, трансканальный подход использовался в 6 случаях, а трансмастоидальный подход – у 2 пациентов. В случае поражения среднего уха дермоидной кистой применялись модифицированный нами трансканальный доступ и навигационная система. Для профилактики рецидива заболеваний выполнялась ревизия и санация пораженных отделов среднего уха под контролем эндоскопа. Проводилась оссикулопластика аутоматериалом или титановыми протезами при необходимости. Контрольный осмотр пациентов спустя 3, 6 и 12 месяцев во всех случаях показал состоятельность неотимпанальной мембраны, улучшение слуха. Заключение. Своевременная диагностика и выбор оптимальных способов хирургического лечения таких патологий, как дермоидные кисты и холестериновые гранулемы среднего уха, приводят к успешным анатомическим и функциональным результатам оперативного вмешательства, улучшают социализацию и качество жизни пациентов. Introduction. The lesions of the temporal bone caused by cysts of various etiologies are rare. The causes of these neoplasms can be both congenital and acquired. Dermoid cysts are a congenital pathology formed by skin and its appendages, characterized by slow growth and a latent course. Cholesterol granulomas, in turn, develop due to oxygen deficiency, which leads to the anaerobic breakdown of red blood cells with the formation of cholesterol granules. Otoscopic data, the results of audiological and radiological examinations are used to diagnose these pathologies. Patient treatment involves the surgical removal of neoplasms followed by histological verification. Purpose. Comparative analysis of patients with dermoid cysts and cholesterol granulomas of the middle ear. Materials and methods. From January 2022 to December 2023, surgical treatment was performed on 8 children: 4 with a diagnosis of dermoid cyst of the middle ear and 4 with a diagnosis of cholesterol granuloma of the middle ear. All patients underwent a standard otorhinolaryngological examination, hearing tests, and CT and MRI scans of the temporal bones. Surgical treatment was performed using a retroauricular-transmeatal approach, with expansion of the surgical field as needed. For patients with dermoid cysts of the middle ear, intraoperative electromagnetic surgical navigation system Collin Digipointeur 6200, 6200V, or 6200VR was used to analyze the pre-operative CT and MRI data. A definitive diagnosis was made based on the results of the pathohistological examination of the intraoperative specimen. Results. Among the studied sample of patients, 6 patients were hospitalized for the first time, while two patients with a dermoid cyst of the middle ear had undergone previous operations. All patients reported hearing loss. Otoscopic findings were characterized by an intact tympanic membrane (n=3), perforation of the tympanic membrane (n=3), and the presence of a postoperative cavity (n=2). Characteristic radiological signs of the neoplasms were identified. All patients underwent a postauricular approach; a transcanal approach was used in 6 cases, and a transmastoid approach was used in 2 patients. In cases of middle ear dermoid cysts, a modified transcanal approach was used, combined with a navigation system. To prevent disease recurrence, revision and sanitation of the affected parts of the middle ear were performed under endoscopic control. Ossiculoplasty with autologous material or titanium prostheses was performed when necessary. Follow-up examinations of the patients after 3, 6, and 12 months showed the integrity of the neotympanic membrane and improvement in hearing in all cases. Conclusion. Timely diagnosis and the selection of optimal surgical treatment methods for pathologies such as dermoid cysts and cholesterol granulomas of the middle ear lead to successful anatomical and functional outcomes of surgical intervention, improving socialization and quality of life for patients.

Challenging diagnosis of a resected pancreatic pseudocyst accompanied by cholesterol granuloma

ObjectiveTo report a patient who was misdiagnosed and operated on for cerebrospinal fluid (CSF) otorrhea and to demonstrate that cholesterol granulomas mimic CSF leakage by secreting beta-trace protein (BTP).PatientsEleven consecutive patients undergoing ear surgery in whom cholesterol granulomas were discovered intraoperatively.InterventionBiochemical and histologic analysis of liquid and solid fractions of cholesterol granulomas.Main Outcome MeasuresBTP and beta-2-transferrin concentrations and BTP mRNA levels in surgical specimens.ResultsCholesterol granulomas produce BTP and express high levels of BTP mRNA, but do not produce beta-2-transferrin.ConclusionsBeta-2 transferrin analysis is preferable to BTP analysis for the detection of CSF otorrhea because BTP may be false positive in the presence of cholesterol granulomas.

Transpromontorial approaches require obliteration of the surgical cavity and the eustachian tube, along with cul-de-sac external auditory canal closure, without obliteration of the mastoid air cells. This study aims to evaluate the clinical and radiological implications of tympanic cavity obliteration when the mastoid air cell system is preserved. Retrospective observational study. Tertiary referral center. Thirty-one adult patients with unilateral vestibular schwannoma. Patients underwent resection of a vestibular schwannoma through either an exclusive endoscopic transcanal transpromontorial approach (endoTTA) or an expanded transcanal transpromontorial approach (expTTA). Postoperative radiologic mastoid and surgical cavity content and clinical outcomes. Thirty-one patients met the inclusion criteria. The mean radiological follow-up was 54 months. Regarding mastoid content, air was present in 13 patients (42%) and trapped fluid in 18 patients (58%). Surgical cavity content revealed air in 14 patients (45%), trapped fluid in 8 patients (26%), total fat obliteration in 5 patients (16%), and partial fat obliteration in 4 patients (13%). No cases of mucocele, cholesterol granuloma, or iatrogenic cholesteatoma were observed. Three main radiological patterns were identified by combining mastoid and surgical cavity findings. EndoTTA was found to be significantly associated with postoperative radiological air content in the mastoid cavity ( p value = 0.013), while no association was found between the type of radiological pattern and the development of complications or symptoms at the last follow-up. EndoTTA and expTTA are safe and effective procedures, with no increased risk of meningitis or CSF leak, even in cases where obliteration tissue is reabsorbed.

Difficult preoperative diagnosis of multiple mediastinal cholesterol granulomas: a case report

Our experience in petroclival lesions using a contralateral transmaxillary approach.

Cholesterol granuloma is known to be a disease formed by hemosiderin and cholesterol crystals when bleeding occurs while ventilation and drainage are not well performed by inflammatory tissue. It is known to occur mainly inside the temporal bone that has been undergone pneumatization, and occurrences in the paranasal sinuses have been rarely reported. A 72-year-old female patient visited to our institution, complaining of a sensation that pus had been coming out of her upper right extraction sockets for the past few months ago. She underwent the extraction of her upper right first and second molars a year ago. In the CBCT image, a well-circumscribed and expansile cystic lesion was located in the right maxillary sinus, bulging posterolateral wall of the maxillary sinus, with amorphous internal calcification and sclerotic border. After surgical excision, the lesion was confirmed as cholesterol granuloma with massive ossification by the histopathological interpretation postoperatively.

This study aimed to investigate the surgical efficacy of middle ear cholesterol granuloma using otoendoscopy. A total of 23 patients (9 males and 14 females) aged (38±18) years who were diagnosed with middle ear cholesterol granuloma at the Otology Medical Center, the First People's Hospital of Foshan from May 2020 to August 2023 were retrospectively analyzed. Based on clinical characteristics of the lesions, the patients were categorized into retention type and granulation type; the latter was further subdivided into localized and extensive types. Endoscopic intervention was performed on four patients with retention-type lesions. Nineteen cases presented as granulation type, among which eleven were classified as localized type and successfully treated via endoscopy. Among eight patients with extensive-type lesions, five adult patients underwent open endoscopic surgery for tympanic sinus and mastoid process reconstruction, and three children received endoscopic surgery along with microscopic closure techniques. During follow-up for at least one year, post-extubation fluid accumulation occurred in one patient, and no recurrence was observed in others. The current study suggests that endoscopic treatment for middle ear cholesterol granuloma yields favorable outcomes.

Indocyanine Green Angiography-Assisted Marsupialization of a Petrous Apex Cholesterol Granuloma: 2-Dimensional Operative Video.

Introduction: Pneumatization patterns in the temporal bone have been implicated in the prognostic outcomes of various pathological conditions, such as cholesterol granulomas, otitis media, and cholesteatomas. This study investigated how high-resolution computed tomography (HRCT) helps to classify pneumatization patterns in the temporal bone, exploring its impact on the pathogenesis, surgical outcomes of temporal bone diseases, and its association with age and gender. Methods: HRCT of temporal bone of fifty patients of age 13 years and more with normal findings were included. The petrous apex, mastoid, and infra-labyrinthine regions’ pneumatization patterns were categorized using previously published grading methods. Results: The dominant pattern of pneumatization in the petrous apex was classified as group 2, indicating that less than 50% of the pneumatization was located medially in the labyrinth. Conversely, in the mastoid, the prevailing pattern was group 4, which signifies hyper-pneumatization. In the infra-labyrinthine region, the prevailing pattern was categorized as type B, indicating limited pneumatization. It was found that patients who exhibited augmented pneumatization in one compartment of the temporal bone tended to display similar changes on the opposite side and in other compartments on the same side (P < 0.05). Importantly, it was observed that younger age (P < 0.001) and male gender (P = 0.001) were associated with increased pneumatization in the petrous apex and infra-labyrinthine compartments. Conclusion: Different compartments of temporal bone show varying degrees of pneumatization. The level of pneumatization of the temporal bone is highly associated with age and sex.

A 50-year-old male presented with complaints of gradually progressive prominence of the left eye associated with a diminution of vision. Magnetic resonance imaging showed a well-circumscribed extraconal mass arising from the intradiploic space with erosion and thinning of the orbital roof. Excision and complete curettage were performed. On the 11thpostoperative day, the patient presented with gross proptosis, ballooning of the conjunctiva, and exposure keratopathy following forceful nose blowing. An urgent computed tomography scan revealed an orbital emphysema, and a needle orbital decompression was performed. The patient improved clinically and radiologically with nil recurrence at follow-up. Orbital emphysema post-surgery, though rare, should be considered as a differential of acute-onset postoperative proptosis. Patients should be advised to avoid forceful blowing of nose or any Valsalva maneuver to prevent such a complication.

BackgroundCholesterol granuloma is not a common entity in the paranasal sinuses. It is a foreign body reaction to the cholesterol crystal deposition. Mostly associated with chronic middle ear diseases.Case presentationThis article reports a case of cholesterol granuloma in the maxillary sinus. A 23-year-old Asian man presented with cough, nasal obstruction, and postnasal discharge. On endoscopy, there was a mass protruding from the right maxillary ostium. On computed tomograpy imaging, there was a polypoidal mass in the right maxillary sinus. Endoscopic sinus surgery was performed, the cholesterol granuloma was removed from the right maxillary sinus, and the tissue was submitted for histopathological examination, which showed foreign body giant cell reaction to cholesterol crystals.ConclusionCholesterol granuloma of maxillary sinus is not common and often missed by clinicians. It is necessary to consider the cholesterol granuloma of maxillary sinus in the differential diagnosis sinonasal lesions. Histopathological analysis is required for confirmation and should be removed surgically. This case may help as a reference for clinician to approach these kinds of cases.