Recurrent orbitofrontal cholesterol granuloma in pediatric patient: Case report and review of the literature

Department of Neurosurgery, Arad Hospital, Somayeh St., Tehran, Iran.
Child s Nervous System (Impact Factor: 1.11). 02/2012; 28(2):291-6. DOI: 10.1007/s00381-011-1611-x
Source: PubMed


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.

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    • "An intraventricular cholesterol granuloma near the septum pellucidum thought to be secondary to remote head trauma from a motor vehicle collision was previously reported.2 Orbitofrontal cholesterol granulomas have been associated with trauma as miniscule as a bee sting,3 and have been shown to recur after incomplete excision.3–5 Some of these have been reported to exhibitc evidence of dysplasia of the adjacent bone, suggesting a pre-existing bony or vascular anomaly as a possible etiology.6 "
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    ABSTRACT: Cholesterol granuloma is a well-characterized entity comprised of a foreign-body giant cell-reaction that forms in response to the presence of cholesterol crystals. It is usually found in the middle-ear or mastoid process in patients with diseases associated with chronic inflammation such as cholesteatoma and otitis media. They are rarely seen in the mediastinum. Osseous metaplasia is an exceedingly rare feature of cholesterol granulomas only reported twice in the literature. We report a case of a cholesterol granuloma of the anterior mediastinum with osseous metaplasia in a 75 year-old man that was found incidentally during urgent coronary artery bypass graft surgery.
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    ABSTRACT: A 40-year-old woman presented with a 1-year history of left proptosis and hypoglobus. Eight years ago, she had undergone the surgical removal of left orbital cholesterol granuloma by Krönlein lateral orbitotomy. MRI showed a lesion of high T1-signal intensity and heterogeneous T2-signal intensity, which did not demonstrate gadolinium enhancement. The lesion was excised via a sub-brow skin incision, and careful drilling and curettage of the affected bony surface of the superolateral orbit were also performed. The diagnosis of orbital cholesterol granuloma was made by histopathologic examination. There was no evidence of tumor recurrence after 2 years of follow up. The authors present a rare case of recurrent cholesterol granuloma of the orbit and its successful surgical treatment with complete excision of the tumor and the surrounding bony base.
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    ABSTRACT: The aim of this study was to present image findings, clinical and histopathologic features, and surgical management of orbital cholesterol granuloma (CG), a rare orbital entity. Findings from 2 patients with orbitofrontal CG are presented along with a review of the literature on CG of the orbit. Both patients were 40-year-old men. The common symptoms of this condition in the present cases were proptosis and inferomedial displacement of the globe. Computed tomography scan in patient 1 revealed the presence of a cystic lesion without bone erosion in the superolateral orbital roof. Magnetic resonance imaging in patient 2 revealed a non-contrast-enhancing lesion with moderate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. For both cases, anterior orbitotomy through subbrow incision by drainage and curettage resulted in a curative outcome. No lesion recurrence was observed by 5 years after surgery in 1 case and 3 years in the other. Histopathologic evaluation revealed numerous inflammatory cells, blood degradation products, and cholesterol clefts. The absence of epithelial elements led to the diagnosis of CG. Orbital CG is a rare expansive cystic condition and nearly always occurs in the lateral region of the superior orbital ridge within the frontal diploic space. This condition shows a marked preponderance in middle-aged males. The findings that computed tomography scan did not reveal bone erosion in patient 1, and magnetic resonance imaging examination showed moderate signal intensity, rather than high signal intensity, on T1-weighted images in patient 2 indicated that these represented unusual presentations. Surgical excision has a high success rate with a low incidence of recurrence.
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