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Hu SS, Yang J, Zhang HF, Chen J, Li XN, Liu FJ, Wang B. Challenging pitfalls in frozen section pathology: a case of mandible ghost cell odontogenic carcinoma and the literature review. BMC Oral Health 2024; 24:450. [PMID: 38614992 PMCID: PMC11015569 DOI: 10.1186/s12903-024-04190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/27/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Ghost cell odontogenic carcinoma (GCOC) is a rare malignancy characterized by the presence of ghost cells, preferably in the maxilla. Only slightly more than 50 case reports of GCOC have been documented to date. Due to the rarity of this tumor and its nonspecific clinical criteria, there is a heightened risk of misdiagnosis in clinical examination, imaging findings, and pathology interpretation. CASE PRESENTATION A 50-year-old male patient presented to the hospital due to experiencing pain in his lower front teeth while eating for the past 2 months. Upon examination, a red, hard, painless mass was found in his left lower jaw, measuring approximately 4.0 cm × 3.5 cm. Based on the malignant histological morphology of the tumor and the abundant red-stained keratinized material, the preoperative frozen section pathology misdiagnosed it as squamous cell carcinoma (SCC). The surgical resection specimen pathology via paraffin section revealed that the tumor was characterized by round-like epithelial islands within the fibrous interstitium, accompanied by a large number of ghost cells and some dysplastic dentin with infiltrative growth. The malignant components displayed marked heterogeneity and mitotic activity. Additionally, a calcified cystic tumor component of odontogenic origin was observed. Hemorrhage, necrosis, and calcifications were present, with a foreign body reaction around ghost cells. Immunoreactivity for β-catenin showed strong nuclear positivity in tumor cells, while immunostaining was completely negative for p53. The Ki67 proliferation index was approximately 30-40%. The tumor cells exhibited diffuse CK5/6, p63, and p40 immunoreactivity, with varying immunopositivity for EMA. Furthermore, no BRAFV600E mutation was identified by ARMS-PCR. The final pathology confirmed that the tumor was a mandible GCOC. CONCLUSION We have reported and summarized for the first time the specific manifestations of GCOC in frozen section pathology and possible pitfalls in misdiagnosis. We also reviewed and summarized the etiology, pathological features, molecular characteristics, differential diagnosis, imaging features, and current main treatment options for GCOC. Due to its rarity, the diagnosis and treatment of this disease still face certain challenges. A correct understanding of the pathological morphology of GCOC, distinguishing the ghost cells and the secondary stromal reaction around them, is crucial for reducing misdiagnosis rates.
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Affiliation(s)
- Sha-Sha Hu
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China
| | - Jian Yang
- Department of Wound Repair, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, 570311, China
| | - Hai-Fei Zhang
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China
| | - Jie Chen
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China
| | - Xin-Nian Li
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China
| | - Fu-Jin Liu
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China.
| | - Bo Wang
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China.
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Cholesterol Granuloma of the Maxillary Sinus Misdiagnosed as Nasal Polyp or Mucocele: Four Cases. J Craniofac Surg 2021; 32:e600-e602. [PMID: 34224463 DOI: 10.1097/scs.0000000000007899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT 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.
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Alghulikah A, Musallam N, Sumaily I, Fathaddin A, Aldossary S. Cholesterol Granuloma of the Maxillary Sinus-A Case Report and Literature Review. ALLERGY & RHINOLOGY 2021; 12:2152656720984785. [PMID: 33598335 PMCID: PMC7863139 DOI: 10.1177/2152656720984785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cholesterol Granulomas of the Maxillary Sinus, considered an unusual presentation at this anatomical site. Over last 2 decades, only few cases are reported in the literature (English) and no available comprehensive reviews or studies on this entity. Herein in this article we present a comprehensive literature review of the available reports of 16 cases along with reporting a new case which we managed, aided with its histopathological pictures. This review article can be a reference for practitioners in the field of otorhinolaryngology who may encounter these cases. Also, it attracts the attention to consider this pathology among the differential diagnoses of nasal masses. Moreover, including a described pathological imaging may help young pathologist to identify this pathology.
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Affiliation(s)
| | - Norah Musallam
- ENT Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- ENT Department, King Fahd Central Hospital in Jazan, Jazan, Saudi Arabia
| | - Amany Fathaddin
- Pathology Department, King Saud University, Riyadh, Saudi Arabia
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Endoscopic Removal of Huge Cholesterol Granuloma in the Maxillary Sinus Confused With Odontogenic Keratocyst. J Craniofac Surg 2020; 31:507-509. [PMID: 31895863 DOI: 10.1097/scs.0000000000006199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cholesterol granuloma is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. Furthermore, a huge and aggressive cholesterol granuloma involving the maxillary sinus, hard palate, buccal space, and maxillary alveolus is extremely rare and has not been reported previously. This article reports a case of huge cholesterol granuloma in the maxillary sinus confused with an expansile odontogenic keratocyst, which was treated successfully via transnasal endoscopic approach.
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Yücel Ekici N. Huge Cholesterol Granuloma in Nasoseptal Region. EAR, NOSE & THROAT JOURNAL 2019; 100:NP278-NP280. [PMID: 31581831 DOI: 10.1177/0145561319870486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nur Yücel Ekici
- Department of Otorhinolaryngology-Head and Neck Surgery, 64130Adana City Training and Research Hospital, Adana, Turkey
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Lee JH, Lee DH. Endoscopic View of Cholesterol Granuloma of the Maxillary Sinus. EAR, NOSE & THROAT JOURNAL 2019; 98:634-635. [PMID: 31847558 DOI: 10.1177/0145561318823419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jae-Hoon Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Chonbuk, Korea
| | - Dam Ho Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Chonbuk, Korea
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Qin Y, Lu Y, Zheng L, Liu H. Ghost cell odontogenic carcinoma with suspected cholesterol granuloma of the maxillary sinus in a patient treated with combined modality therapy: A case report and the review of literature. Medicine (Baltimore) 2018; 97:e9816. [PMID: 29443742 PMCID: PMC5839843 DOI: 10.1097/md.0000000000009816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Ghost cell odontogenic carcinoma (GCOC) is a rare malignant odontogenic tumor with aggressive growth characteristics. PATIENT CONCERNS A 41-year-old Chinese male visited our hospital in 2013, with a 4-month history of bloody purulent rhinorrhea with a peculiar smell in the right nasal cavity. DIAGNOSES The patient suffered from recurrent GCOC with suspected cholesterol granuloma of the maxillary sinus. The patient was incorrectly diagnosed with a calcifying epithelial odontogenic tumor at his first recurrence. Physical examination, radiological examination, and histopathology were used to identify GCOC. INTERVENTIONS Considering the recurrence of GCOC and poor effects of single surgery, postoperative adjuvant chemotherapy and concurrent chemoradiotherapy were performed after radical surgical excision. OUTCOMES So far, no significant evidence has suggested recurrence or metastasis after a long-term follow-up. LESSONS We advocate wide surgery with clean margins at the first accurate diagnosis. Combined modality therapy could be taken for the recurrent GCOC. We expect to provide a new treatment strategy to prevent the growth of this neoplasm.
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Affiliation(s)
| | | | | | - Hong Liu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Cholesterol Granuloma in the Maxillary Sinus: Are Endodontically Treated Teeth Involved in Its Etiopathogenesis? Case Rep Pathol 2017; 2017:5249161. [PMID: 29201480 PMCID: PMC5671700 DOI: 10.1155/2017/5249161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022] Open
Abstract
Cholesterol granuloma (CG) is a tissue reaction in response to the accumulation of cholesterol crystals rarely found in the maxillary sinus. The etiopathogenesis of maxillary sinus CG remains unclear. We reviewed the literature and added two new reports of cholesterol granuloma in maxillary sinus related to endodontically treated maxillary posterior teeth. The first report refers to a 45-year-old woman diagnosed with rhinitis, who was submitted to endodontic retreatment of maxillary molar, and subsequently showed maxillary sinus opacity with cystic appearance. The second case describes a young adult woman, who presented a cystic mass in maxillary sinus after endodontic treatment, in close association with the apex of the maxillary right second premolar. Both patients were treated by a classic Caldwell-Luc surgery and the microscopic analyses revealed maxillary sinus CG. In the following, the authors discuss the probable involvement of endodontically treated maxillary posterior teeth in the etiopathogenesis of maxillary sinus CG.
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Reddy BVR, Kuruba KK, Yalamanchili S, Mupparapu M. Granulomatous Diseases Affecting Jaws. Dent Clin North Am 2017; 60:195-234. [PMID: 26614955 DOI: 10.1016/j.cden.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The common aspect of all granulomatous diseases is the typical form of chronic inflammatory response with distinct microscopic granulomas that are formed secondary to either definitive etiologic agents, like bacteria, fungal, or parasitic, or due to an unknown etiologic agent, such as trauma, autoimmune, or even neoplastic process. Although they can be histologically distinct, granulomatous diseases demonstrate a variety of clinical features that may not seem to be inflammatory. Two types of granulomas are typically encountered: foreign body granulomas and immune granulomas. The differences between the two types of granulomas lie in the pathogenesis.
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Affiliation(s)
- Baddam Venkat Ramana Reddy
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Kiran K Kuruba
- Department of Oral & Maxillofacial Pathology, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, 522601, India
| | - Samatha Yalamanchili
- Department of Oral Medicine & Radiology, Sibar Institute of Dental Sciences, Guntur, India
| | - Mel Mupparapu
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, #214, 240 South 40th Street, Suite 214, Philadelphia, PA 19104, USA.
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Cholesterol granuloma of ethmoid sinuses: Report of two cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sun Z, Cao Y, Zhai LZ. Java brucea and Chinese herbal medicine for the treatment of cholesterol granuloma in the suprasellar and sellar regions: A case report and literature review. Medicine (Baltimore) 2017; 96:e5930. [PMID: 28151875 PMCID: PMC5293438 DOI: 10.1097/md.0000000000005930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/27/2016] [Accepted: 12/29/2016] [Indexed: 11/27/2022] Open
Abstract
RATIONALE A cholesterol granuloma (CG) is usually found in the middle ear, papilla, orbits, petrous apex, and choroid plexus, but is highly uncommon in the skull. In spite of benign clinicopathological lesions, bone erosion can be seen occasionally in the patient with CG. The optimal treatment strategy is radical surgery, but complete excision is usually impossible due to anatomical restrictions and a risk of injury to the key structures located nearby. Here, we report a patient with CGs in the suprasellar and sellar regions who was successfully treated with Java brucea and Chinese herbal medicine. PATIENT CONCERNS A 31-year-old man presenting with progressive decreased vision in both eyes was analyzed. DIAGNOSES A skull magnetic resonance imaging (MRI) scan showed a low-density tumor in the uprasellar and sellar regions and histopathological examination revealed a CG. INTERVENTIONS The patient was referred the surgery and radiotherapy. In the meantime, brucea soft capsules and herbal medicine combined were administered to him. OUTCOMES The related clinical symptoms and signs resolved significantly after several months, as his therapy progressed. The patient showed no sign of recurrence during the treatment period. Furthermore, he was still alive and disease-free at 37 months of follow-up visit. LESSONS Overall, brucea soft capsules and a Chinese herbal formula treatment combined could be beneficial in improving the patient's quality of life with CG in the skull.
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Affiliation(s)
- Zhe Sun
- First clinical medical college of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong,China
| | - Yang Cao
- Department of Oncology Center, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lin-zhu Zhai
- Department of Oncology Center, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Cholesterol granuloma of ethmoid sinuses: Report of two cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:300-302. [PMID: 28073431 DOI: 10.1016/j.otorri.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/11/2016] [Accepted: 08/17/2016] [Indexed: 11/20/2022]
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Sumathi S. Endometrial Cholesterol Granuloma Associated with Prolapsed Uterus- A Rare Case Report with Unusual Clinical Presentation. J Clin Diagn Res 2016; 10:ED05-6. [PMID: 27134881 DOI: 10.7860/jcdr/2016/17223.7400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
Abstract
Cholesterol granuloma is a chronic inflammatory reaction to cholesterol deposition. It may develop in variety of sites including middle ear, mastoid process, para nasal sinuses, mediastinum, breast, testis and kidney. But endometrial cholesterol granuloma is a rarely reported case and is usually presented clinically as pyometra. This article reports a case of cholesterol granuloma in the endometrium associated with prolapsed uterus. In this case the patient clinically presented with urinary retention and overflow incontinence of urine. The reason of acute urinary retention in this case was pelvic fibrosis and adhesion secondary to this chronic inflammatory reaction. This was supported by the presence of pus like yellowish material over the uterine surface and pelvic adhesion, noted during surgery. Endometrial biopsy revealed cholesterol granuloma that confirmed the source of chronic inflammatory reaction and pelvic fibrosis.
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Affiliation(s)
- S Sumathi
- Associate Professor, Department of Pathology, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research Institute , Melmaruvathur, Kanchipuram, Tamilnadu, India
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Laudien M. Orphan diseases of the nose and paranasal sinuses: Pathogenesis - clinic - therapy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc04. [PMID: 26770278 PMCID: PMC4702053 DOI: 10.3205/cto000119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rare rhinological diseases are a diagnostic challenge. Sometimes it takes months or even years from the primary manifestation of the disease until the definitive diagnosis is establibshed. During these times the disease proceeds in an uncontrolled or insufficiently treated way. (Irreversible) damage results and sometimes life-threatening situations occur. The unexpected course of a (misdiagnosed) disease should lead to further diagnostic reflections and steps in order to detect also rare diseases as early as possible. The present paper discusses granulomatous diseases of the nose and paranasal sinuses caused by mycobacteria, treponema, Klebsiella, fungi, and protozoa as well as vasculitis, sarcoidosis, rosacea, cocaine-induced midline destruction, nasal extranodal NK/T cell lymphoma, and cholesterol granuloma. Furthermore, diseases with disorders of the mucociliary clearance such as primary ciliary dyskinesia and cystic fibrosis are presented, taking into consideration the current literature.
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Affiliation(s)
- Martin Laudien
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine of Kiel, Christian-Albrechts-University, Kiel, Germany
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Lee DH, Yoon TM, Lee JK, Lim SC. Cholesterol granuloma of a Haller cell associated with unilateral exophthalmos and diplopia. Br J Oral Maxillofac Surg 2015; 54:833-5. [PMID: 26719083 DOI: 10.1016/j.bjoms.2015.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
Abstract
Cholesterol granuloma is rare in the paranasal sinuses. We present what is to our knowledge the first case of cholesterol granuloma of a Haller cell associated with unilateral exophthalmos and diplopia in a 55-year-old man.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Jeonnam, Korea
| | - Tae Mi Yoon
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Jeonnam, Korea
| | - Joon Kyoo Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Jeonnam, Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Jeonnam, Korea.
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Durgam A, Batra PS. Paranasal sinus cholesterol granuloma: systematic review of diagnostic and management aspects. Int Forum Allergy Rhinol 2012; 3:242-7. [PMID: 23044766 DOI: 10.1002/alr.21093] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/07/2012] [Accepted: 07/17/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cholesterol granuloma (CG) is an expansile, cystic lesion most commonly observed in the temporal bone. CG is rarely encountered in the paranasal sinuses. Given its paucity in this region, the diagnostic and management aspects remain to be elucidated. METHODS Systematic review of the literature yielded 66 cases reported as individual data in 37 articles; an additional 69 cases were reported as aggregate data in 5 case series. RESULTS The mean age of the 135 patients was 43.8 years, with a male:female ratio of 5.6:1. The most common presenting symptoms were orbital (66%), followed by headaches (19.3%). The most common location for CG was the frontal sinus (60%), followed by maxillary (34.1%) and ethmoid (3.7%) sinuses. Computed tomography (CT) imaging was used in 84 patients (63.3%), with bone erosion being noted in 80% of cases. Magnetic resonance imaging (MRI) was reported in only 9 cases (6.7%); high signal on T1- and T2-weighted images was evident in 77.8% and 66.7%, of cases respectively. Surgical data was available on 65 cases; drainage was achieved by open and endoscopic techniques in 52 (80%) and 13 (20%) cases, respectively. Primary symptom improvement and CG cavity patency was achieved in 92% of cases at a mean follow-up of 34.5 months. CONCLUSION Paranasal sinus CG is most commonly observed in middle-aged males, arises in the frontal sinus, and typically presents with orbital symptoms. Both open and endoscopic techniques can be used with high success rate. The present study represents the first attempt in the literature to construct a clinical profile of this rare entity.
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Affiliation(s)
- Aditya Durgam
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Endoscopic trans-sphenoidal removal of cholesterol granuloma of the petrous apex: case report and literature review. The Journal of Laryngology & Otology 2010; 125:169-72. [PMID: 20974018 DOI: 10.1017/s0022215110002227] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We report a case of cholesterol granuloma of the petrous apex which was surgically treated via an endoscopic trans-sphenoidal approach. METHODS Case report and review of the literature concerning cholesterol granulomas of the petrous apex and their management. RESULTS The lesion was approached endoscopically via a bilateral sphenoidotomy with removal of the vomer. A large cholesterol granuloma was evacuated and marsupialised. The patient made an uneventful recovery. CONCLUSION Trans-sphenoidal access to the petrous apex represents an alternative route for the drainage and ventilation of cholesterol granulomas. This approach is the technique of choice when the cholesterol granuloma abuts the posterior wall of the sphenoid sinus. The trans-sphenoid approach, unlike other lateral approaches to the petrous apex, spares cochlear and vestibular function and allows post-operative endoscopic follow up.
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Cassano M, Pennella A, Taranto FD, Limosani P, Simone M. Cholesterol granuloma of the maxillary sinus in a young patient with associated neurosurgical pathology. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.pedex.2008.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Karaky AA, Sawair FA, Baqain ZH, Hassona Y, Khraisat A. Cholesterol granuloma of the maxillary sinus encountered during floor augmentation procedure: A case report. Clin Implant Dent Relat Res 2009; 12:249-53. [PMID: 19438963 DOI: 10.1111/j.1708-8208.2009.00151.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cholesterol granuloma (CG) is a foreign-body reaction to the deposition of cholesterol crystals. Its occurrence in the paranasal sinuses is very rare. PURPOSE This report describes a new case of maxillary sinus CG discovered incidentally during sinus-floor augmentation for dental implant placement in a 60-year-old female patient. MATERIALS AND METHODS The preoperative clinical and radiological examinations revealed a normal maxillary antrum with no evidence of sinus pathology. After lateral osteotomy, a dark-green, viscous soft tissue mass appeared through the thin mucous membrane inside the sinus. Enucleation and curettage of the sinus contents including the sinus membrane were performed for histopathologic analysis. The augmentation and implant placement procedures were postponed. RESULTS Histopathologic analysis showed several fragments of granulation tissue containing diffuse cholesterol clefts surrounded by mixed chronic inflammatory cell infiltrate including plasma cells and lymphocytes. These features were compatible with the diagnosis of CG. The patient was followed up for 3 months after the first procedure, and a second attempt of sinus augmentation and dental implant insertion was then carried out. The inserted dental implants were followed up for 6 months without any complications. CONCLUSIONS CG of maxillary sinus can be an incidental finding. For this reason, the final diagnosis can only be achieved after examination of the material under the microscope.
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Affiliation(s)
- Ashraf Abu Karaky
- Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology and Periodontology, The University of Jordan, Amman, Jordan.
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Almada CBDM, Fonseca DR, Vanzillotta RR, Pires FR. Cholesterol granuloma of the maxillary sinus. Braz Dent J 2009; 19:171-4. [PMID: 18568234 DOI: 10.1590/s0103-64402008000200015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cholesterol granuloma (CG) is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. This article reports a case of CG in the maxillary sinus of a 22-year-old man, manifesting as a swelling on the right maxilla associated with pain and nasal obstruction. Computed tomography (CT) imaging showed complete opacification of the right maxillary sinus with cortical bone expansion and destruction. Incisional biopsy showed a solid mass filling the sinus and histological examination showed foreign body reaction to cholesterol crystals. The microscopic findings associated to tooth vitality, CT images and absence of a cavity during the surgical procedure were compatible with the diagnosis of CG of the maxillary sinus. Complete surgical excision of the mass under general anesthesia was suggested, but the patient did not return to conclude the treatment. CG must be included in differential diagnosis of diseases that cause opacification on the paranasal sinuses, especially sinusitis, and cystic and tumoral lesions.
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Kang H, Kim JK, Kim Y. Association of cholesterol granuloma and aspergillosis in the sphenoid sinus. Korean J Radiol 2008; 9 Suppl:S30-3. [PMID: 18607122 PMCID: PMC2627201 DOI: 10.3348/kjr.2008.9.s.s30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cholesterol granuloma (CG) is usually associated with chronic middle ear disease, and is not common in the paranasal sinuses. Additionally, it is very rare for cases of CG to be associated with a fungal infection. However, in this paper, we report a case of sphenoid sinus CG that is associated with aspergilloma in a 78-year-old male patient who presented with right hemifacial pain, headache and toothache. CT revealed the presence of an expansile cystic mass lesion in the sphenoid sinus that showed a high signal intensity on both the T1 and T2 weighted images. This mass was later determined to be CG. The suspected etiologic mechanisms of both CG and aspergilloma of the paranasal sinuses are similar, and impaired drainage and obstruction of the ventilation of the paranasal sinuses are considered to be the causative mechanism of both diseases. Overall, the results of this study indicate that the use of MRI findings could be helpful for differentiating CG from other paranasal sinus mass lesions.
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Affiliation(s)
- Hyunkoo Kang
- Department of Radiology, Seoul Veterans Hospital, Seoul, Korea.
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Astarci HM, Sungu N, Samim EE, Ustun H. Presence of cholesterol granuloma in the maxillary and ethmoid sinuses. Oral Maxillofac Surg 2008; 12:101-3. [PMID: 18618168 DOI: 10.1007/s10006-008-0110-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 05/09/2008] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although cholesterol granuloma associated with chronic middle ear disease is shown to be common in the mastoid antrum and air cells of the temporal bone (Leon et al., Arch Pathol Lab Med 126:217-219, 2002), its presence in the maxillary and ethmoid sinuses is rarely encountered. There are few cases reported regarding the incidence of cholesterol granuloma in these sinuses (Ko et al., Am J Otoryngol 27:370-372, 2006). CASE Here, we report a case of concomitant cholesterol granuloma in the maxillary and ethmoid sinuses of a 33-year-old man who underwent surgical excision. DISCUSSION Histopathological examination of the removed specimen revealed fragments of respiratory mucosa with cholesterol clefts surrounded by multinucleated foreign-body giant cells.
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Affiliation(s)
- Hesna Muzeyyen Astarci
- Department of Pathology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.
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Chao TK, Liu CM, Huang WH. Significance of blood-tinged post-nasal drip in paranasal sinus disease. The Journal of Laryngology & Otology 2007; 122:814-7. [PMID: 17888198 DOI: 10.1017/s0022215107000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Blood-tinged post-nasal drip is a rare manifestation of paranasal sinus disease. Although the presence of such a symptom would intuitively prompt suspicion of malignancy, no previously published study has addressed this issue. METHODS One hundred and ninety-three patients with paranasal sinus lesions, who had undergone endoscopic sinus surgery for treatment or biopsy, were prospectively recruited. Their clinical information was collected and analysed. RESULTS In patients without blood-tinged post-nasal drip, 177/181 (97.8 per cent) had chronic paranasal sinusitis and fungal sinusitis. However, in patients who presented with this symptom, six of 12 (50 per cent) were diagnosed with other conditions. The difference was statistically significant (Fisher's exact test, two tails, p < 0.001). In patients with blood-tinged post-nasal drip, diagnoses other than chronic paranasal sinusitis and fungal sinusitis were found more frequently in older males. CONCLUSION The chance of diagnoses other than the usual sinusitis increased significantly in patients with paranasal sinus diseases who presented with blood-tinged post-nasal drip, especially in older males.
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Affiliation(s)
- T-K Chao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Pan-Chiao, Taipei, Taiwan.
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Bibliography. Current world literature. Nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 2007; 15:48-55. [PMID: 17211184 DOI: 10.1097/moo.0b013e32802e6d9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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