Recurrent orbitofrontal cholesterol granuloma in pediatric patient: case report and review of the literature.
ABSTRACT Orbitofrontal cholesterol granuloma is a rare entity which typically involves the lateral part of the supraorbital ridge. It causes progressive expansion and erosion of the inner and outer tables of the frontal bone. We describe a case of recurrent orbitofrontal cholesterol granuloma in a 17-year-old girl. In June 2002 this patient had originally presented to an eye clinic with a small palpable mass in the right superolateral orbit, limitation on upgaze, and progressive proptosis. MRI of the orbit revealed an intraorbital extraconal mass with smooth border, high signal on both T1- and T2-weighted magnetic resonance images. She underwent an anterior orbitotomy via a subbrow incision. The lesion was removed completely, and histopathological examination confirmed a cholesterol granuloma. She remained asymptomatic until her presentation in August 2005. On second admission (3 years later), she complained of a tender palpable mass in the superolateral aspect of the right orbit. Her right eye was 4 mm proptosed and 4 mm inferomedially displaced with limited elevation. The rest of the examination was normal. MRI of the orbit showed a large intraorbital but extraconal mass with smooth border, high signal on both T1- and T2-weighted images without enhancement after gadolinium injection. She underwent complete surgical excision by means of a bicoronal approach. Histopathological diagnosis revealed cholesterol granuloma. No recurrence of the lesion has been observed during the last 6 years following the second operation.
Article: Orbitofrontal cholesterol granuloma.[show abstract] [hide abstract]
ABSTRACT: Cholesterol granuloma of the orbital bones is a rare but readily recognizable clinical and radiologic entity usually affecting men. Twenty-seven patients are reported, and in all except one, the frontal bone in the region of the lacrimal fossa was involved. These lesions produced an area of osteolysis in the frontal bone with expansion into the extraperiosteal space of the lacrimal fossa, causing fullness of the upper lid and proptosis. The granuloma always remained extraperiosteal and was composed of a granulomatous reaction surrounding cholesterol crystals and altered blood. It is postulated that cholesterol granuloma occurs because of hemorrhage into the diploe of the bone. Extraperiosteal surgical removal cured all patients. Some previous reports have failed to identify the true nature of this lesion and confused its nomenclature.Ophthalmology 02/1990; 97(1):28-32. · 5.56 Impact Factor
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ABSTRACT: Cholesteatoma and cholesterol granuloma are relatively rare lesions of the orbit. Both may involve the superior orbit and present with globe ptosis, proptosis, and double vision developing over weeks to years. In addition to their etiology being unknown, the nomenclature regarding these tumors historically has been confusing, with a variety of names being used to describe them. Their histopathology shares numerous similarities but has one key distinguishing feature: The cholesterol granulomas lack an epithelial lining, whereas the cholesteatomas have an epithelial lining. Surgical removal is the treatment of choice for both tumors. It is important to differentiate the two as the prognosis with recurrence differs. Cholesteatoma may recur with the possibility of malignancy found at the time of re-exploration. We present a case of each tumor type, illustrating their similarities and highlighting the histopathologic findings and treatment recommendations.Ophthalmic Plastic and Reconstructive Surgery 01/2007; 23(5):415-7. · 0.67 Impact Factor
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ABSTRACT: Orbital cholesterol granuloma in a 51-year-old man is described. Computed tomography (CT) and magnetic resonance imaging (MRI) were done. Both studies showed a mass in the left orbit, with evidence of orbital roof destruction in the CT scan. On the basis of clinical and imaging findings, a diagnosis was made of malignant orbital tumor with destruction of the lateral orbital roof. Surgical exploration revealed a thickly encapsulated mass densely adherent to the left superior orbital bone and periosteum. Although the dura mater was intact, bone destruction in the lateral orbital roof was seen. The entire mass was successfully excised and histopathological evaluation was performed. Histopathology showed numerous inflammatory cells, blood degradation products, and cholesterol clefts. The absence of epithelial elements led to the diagnosis of cholesterol granuloma. Care must be taken to differentiate cholesterol granuloma from malignant orbital tumor. CT scan and MRI imaging seem well-suited to detecting the characteristic findings of cholesterol granuloma.Japanese Journal of Ophthalmology 01/2000; 44(2):179-82. · 1.27 Impact Factor