A Case of Breast Cholesterol Granuloma Accompanied by Cancer

Multiple cholesterol granulomas of the breast: A case report and review of the literature

RATIONALE

Cholesterol granuloma of the breast is a rare disease defined as chronic reactive inflammation of cholesterol crystals and foreign body giant cells. This disease can mimic breast cancer in the clinic as painless palpable hard nodules, and imaging shows irregular hypoechoic nodules with unclear boundaries. Therefore, the uncommon lesions can be easily misdiagnosed as breast cancer. Meanwhile, it can be easily neglected by clinicians because of poor understanding.

PATIENT CONCERNS

In this report, we present a rare case of multiple cholesterol granulomas of the breast, which was analyzed retrospectively and combined with all 11 relevant available studies in the last 50 years.

INTERVENTIONS

The patient had undergone multiple breast imaging inspections for breast nodules and had the local resection of nodules.

DIAGNOSES

The patient was confirmed to have a final diagnosis of benign cholesterol granulomas but was initially considered as breast cancer.

OUTCOMES

The patient did not complain of discomfort after surgery, and ultrasound reexamination 5 months after surgery showed no recurrence.

LESSONS

By retrospective analysis, dynamic contrast-enhanced magnetic resonance imaging and core needle biopsy can synergistically help clinicians distinguish it from other breast disease. To raise awareness of such a rare disease and reduce related misdiagnoses, we summarize the characteristics of cholesterol granulomas and recommend appropriate novel diagnosis and treatment regimens for patients with cholesterol granulomas.

Cholesterol Granuloma of the Breast Mimicking Cancer: A Case Report and Review of the Literature

Cholesterol granuloma of the breast is an infrequent benign lesion with clinical and radiological findings suggestive of cancer. Herein, we present the case of a 52-year-old woman with no significant past medical history, who presented to the outpatient department for her routine breast screening. Physical examination revealed a painless palpable nodule in the upper external quadrant of the left breast, measuring 0.7 cm. On imaging, the mass met the criteria for Breast Imaging Reporting and Data System (BI-RADS) category 4B. Subsequently, a core needle biopsy of the mass was performed. Despite the alarming radiologic features, microscopic findings were consistent with breast cholesterol granuloma.

Cholesterol Granuloma of the Liver Mimicking Malignant Tumor: A Case Report

Cholesterol granuloma is a benign, tumor-like lesion with an accumulation of cholesterol crystals in the tissue and is a consequence of a chronic inflammatory reaction. It commonly occurs in the middle ear but rarely in the liver. There is only one previous case report of cholesterol granuloma of the liver, which was caused by cholesterol hepatolithiasis. We report a case of cholesterol granuloma of the liver in a patient with no intrahepatic cholesterol stones; it was difficult to rule out malignant liver tumor preoperatively. The patient was a 79-year-old woman in whom a lesion in the liver was detected on abdominal ultrasonography. She was referred to our hospital for detailed examination and treatment. Abdominal contrast-enhanced computed tomography showed a 20 mm lesion with ring enhancement in the lateral segment of the liver during the arterial and delayed phases. Since a malignant tumor could not be ruled out radiologically, laparoscopic lateral segment hepatectomy was performed for definitive diagnosis and treatment. The resection specimen showed a yellowish-white lesion measuring 15 mm in diameter. Pathological examination showed a granulomatous lesion with cholesterol crystals surrounded by foreign body giant cells. The lesion was diagnosed as cholesterol granuloma of the liver. The postoperative course was good, and the patient was discharged on postoperative day 5. She was healthy, and no recurrence of the cholesterol granuloma was detected at the 5-month follow-up. This is the first case report of cholesterol granuloma of the liver mimicking a malignant liver tumor in a patient with no intrahepatic cholesterol stones.

Cholesteroloma of the breast: A 10 year retrospective review of 79 cases with radiology correlation

A cholesteroloma or cholesterol granuloma of the breast is an uncommon lesion representing an inflammatory/reactive process with unclear etiology. In this study, we reviewed our 10-year experience with cholesteroloma of the breast with clinical, radiologic, and histopathological correlation. Seventy-nine cases were selected. The mean patient age was 57.7 (range 25-90) years old. Patients had hypercholesterolemia with mean blood cholesterol level of 201 mg/dL (P < 0.001). The mean body mass index (BMI) was 26.7 kg/m² (P = 0.1976). The indications for the breast biopsies were mass lesion on radiology (85.5%, n = 65) and microcalcifications (10.5%, n = 8). Of the 65 cases of the mass lesions, 52 presented as solid masses and 13 were cystic. On the diagnostic mammogram or ultrasound, 81.9% were BI-RADS 4% and 6.9% were BI-RADS 5. Macrocysts were the most common pathological finding associated with cholesteroloma suggesting the etiology of cholesteroloma may be the result of repair process from obstruction and rupture of the macrocysts. Six cases (9.2%) of cholesterolomas had persistent masses during follow-up. The recognition of this lesion and radio-pathological correlation can help us better understand this entity and distinguish it from its mimickers.

Increasing Size of Cholesterol Granuloma of the Breast in the Vicinity of a Previous Breast Biopsy: Imaging Features and Review of the Literature

Patient: Female, 52

Final Diagnosis: Cholesterol granuloma of the breast

Symptoms: None

Medication: —

Clinical Procedure: Core needle biopsy

Specialty: Radiology

Multifocal thymic cysts with cholesterol granuloma

A 56-year-old female presented to our department with chest discomfort. Contrast-enhanced computed tomography (CT) revealed a cyst and nodule in the anterior mediastinum; positron emission tomography-CT showed an increased uptake in the nodule. Total thymectomy was performed to obtain a definitive diagnosis and treatment. A pathological diagnosis of multifocal thymic cysts with cholesterol granuloma was made. Microscopic examination revealed different-sized cysts scattered in the thymus. These cysts were filled with cholesterol clefts and manifested three different phase characters. The nodule comprised granuloma-containing cholesterol clefts. We report a rare case of a patient whose histopathology presented a series of cholesterol granuloma formations.

T1-Weighted Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) to Distinguish Between Concurrent Cholesterol Granuloma and Invasive Ductal Carcinoma of the Breast: A Case Report

Patient: Female, 52

Final Diagnosis: Cholesterol granuloma of the breast

Symptoms: Follow up

Medication: —

Clinical Procedure: Surgical excision

Specialty: Radiology

Sonographic appearance of a cholesterol granuloma mimicking breast cancer

A breast cholesterol granuloma is a rare benign condition that can be a pitfall in diagnosing breast cancer. We describe a cholesterol granuloma in the breast mimicking breast cancer on sonography. The mass was confirmed to be a cholesterol granuloma through a core needle biopsy, but an excisional biopsy was eventually performed due to suspicious sonographic appearance and histopathological examination of the specimen confirmed the diagnosis. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:608-611, 2017.

Cholesterol granuloma of the breast mimicking malignancy

Cholesterol granuloma of the breast is an unusual non-neoplastic condition which frequently resembles malignancy clinically as well as radiologically. We herein report a case of a 28-year-old woman who presented with a lump in the upper outer quadrant of right breast. Physical examination and ultrasonography strongly suggested a carcinomatous lesion, but histopathological examination confirmed the diagnosis to be cholestrol granulomas. This article highlights the perplexing clinical presentation of cholesterol granulomas and affirms the role of histopathological examination in diagnosing these lesions correctly.

The unusual ultrasound features of a breast cholesterol granuloma manifesting as an intracystic mass: case report and literature review

Cholesterol granuloma of the breast is a rare, benign disease. Here, we present the unique ultrasonographic findings of breast cholesterol granuloma manifesting as an intracystic mass. The findings of this case report may help expand existing knowledge regarding differential diagnosis of intracystic breast masses, which are found on ultrasonographic examination.

[Cholesterol granuloma of the kidney: a case report]

A 58-year-old woman was referred to our outpatient clinic for further examination of a mass detected in the right kidney on follow-up ultrasonography performed for active surveillance of right ovarian cancer. Ultrasonography and computed tomography showed a cyst (diameter, 30 mm) with an irregular wall in the middle of the right kidney. Right nephrectomy was performed since malignancy was suspected. Histological findings of the mass indicated cholesterol granuloma. Although cholesterol granulomas in the middle ear have been frequently reported, those in other organs have been reported in few studies. In this patient, the cholesterol granuloma could be barely distinguished from the cancer by using imaging techniques.

Cholesterol granuloma of the breast with unusual ossification features (osseous metaplasia)

Cholesterol granuloma of the breast is a rare benign condition that can be mistaken for breast cancer. We present a case of a 42-year-old woman who presented with a 1-year history of asymptomatic palpable nodule in the upper external quadrant of the right breast. Mammography and ultrasonography suggested carcinoma, but excisional biopsy revealed cholesterol granuloma with unusual osseous metaplasia. Although reported to occur more frequently in the middle ear and mastoid process, we believe that better awareness of this rare benign condition is most important to avoid misdiagnosis and unnecessary surgery.

Suspected Gouty Tophus in a Woman's Breast

A postmenopausal woman treated with diuretics for hypertension and who underwent surgery for a previous fibroadenoma of the left breast presented, in December 2003, with a sudden bloody discharge of the left nipple with local swelling, redness, and pain. Radiologic investigations revealed a well-delimited tumor under the areola. Needle aspiration disclosed many histiocytes but no bacteria. Despite improvement with antibiotics, the tumor was removed. Pathological examination shows features suggesting the tumor was a gouty tophus. Birefringent crystals were retrospectively found on the smears of the aspirated material. To our knowledge, only 3 similar cases have been reported in the literature.