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Gotecha S, Chugh A, Punia P, Reddy R, Gaud J, Rege I. Orbital Cholesterol Granuloma : A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:4661-4663. [PMID: 39376333 PMCID: PMC11455840 DOI: 10.1007/s12070-024-04747-z] [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: 03/08/2024] [Accepted: 05/06/2024] [Indexed: 10/09/2024] Open
Abstract
Cholesterol Granuloma is a rare lesion which occurs at locations like ear, peritoneum, lungs, breast etc. and formed due to interaction of Cholesterol and living tissue. But Cholesterol Granuloma occurring in the orbit is a very rare entity and so we authors present a case of Cholesterol Granuloma of the orbit.
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Affiliation(s)
- Sarang Gotecha
- Department of Neurosurgery, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra 411044 India
| | - Ashish Chugh
- Department of Neurosurgery, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra 411044 India
- Sector 27, Plot No-415, Pradhikaran, Nigdi, Pune, Maharashtra 411044 India
| | - Prashant Punia
- Department of Neurosurgery, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra 411044 India
- C1/604 , Mahendra Antheia, Nehru Nagar Road, Pimpri, Pune, Maharashtra 411018 India
| | - Rajeev Reddy
- Department of Neurosurgery, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra 411044 India
- Flat C1 904, Mahendra Antheia , Nehru Nagar Road, Pimpri, Pune, Maharashtra 411018 India
| | - Jayant Gaud
- Department of Neurosurgery, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra 411044 India
| | - Ishant Rege
- Department of Neurosurgery, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra 411044 India
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Zhao Y, Li J, Ji Z, Yu S, Lin J, Zhao H. Clinicopathological Features and Management of Orbital Cholesterol Granuloma. J Curr Ophthalmol 2023; 35:401-404. [PMID: 39281388 PMCID: PMC11392298 DOI: 10.4103/joco.joco_200_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 09/18/2024] Open
Abstract
Purpose To investigate the clinical features, radiographic features, treatment strategies, pathological features, and prognosis of orbital cholesterol granuloma (CG). Methods Twelve patients with orbital CG who were referred to Tianjin Eye Hospital between January 2002 and December 2020 were included in this retrospective case series study. Data collected including patient ophthalmic manifestations, imaging findings, treatment strategies, pathological features, and prognosis were retrospectively reviewed. Results The patients comprised 10 males and 2 females. The mean age was 34.5 years (standard deviation [SD] = 8.9, median: 36 and range: 16-45 years). Four patients had a history of orbital trauma. The clinical manifestations at the first visit were proptosis (7/12, 58.3%), periorbital or eyelid swelling (6/12, 50%), limitation of eye movement (4/12, 33.3%), ptosis (2/12, 16.7%), and decreased visual acuity (1/12, 8.3%). Computed tomography (CT) showed a nonenhancing, well-circumscribed lesion in the orbit with extensive erosion of the adjacent frontal bone and temporal bone. Magnetic resonance imaging (MRI) showed a nonenhancing mass with intermediate-to-high signal intensity on T1- and T2-weighted images. Ten patients underwent lateral orbitotomy, and two patients underwent supraorbital orbitotomy. All patients had aggressive bone erosion. Histopathologic evaluation of the cyst contents and wall revealed cholesterol clefts, multinucleated giant cells, histiocytes, foamy macrophages, and altered blood pigments. The mean follow-up time of 79.6 months (SD = 49.8, range: 19-193 months). Three patients were lost to follow-up. No postoperative diminution of vision was noted, and no recurrence was observed. Conclusions CGs can present as superotemporal or temporal orbital lesions. The diagnosis can be established based on CT and MRI. Most of the patients can have no history of orbital trauma.
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Affiliation(s)
- Yun Zhao
- Department of Ocular Plastic and Orbital Disease, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Department of Ophthalmology, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Jiagen Li
- Department of Ocular Plastic and Orbital Disease, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Department of Ophthalmology, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Zhongkun Ji
- Department of Ophthalmology, Wendeng Orthopaedic and Traumatologic Hospital of Shandong Province, Weihai, China
| | - Shasha Yu
- Department of Ocular Plastic and Orbital Disease, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Department of Ophthalmology, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Jinyong Lin
- Department of Ophthalmology, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Nankai University, Eye Hospital, Tianjin, China
| | - Hong Zhao
- Department of Ocular Plastic and Orbital Disease, Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin, China
- Department of Ophthalmology, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
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Hughes JD, Jacob JT, Garrity JA, Salomao DR, Link MJ. Orbitofrontal Cholesterol Granuloma: Four Case Reports and a Systematic Review of the English Literature. World Neurosurg 2016; 87:355-61. [DOI: 10.1016/j.wneu.2015.11.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/25/2022]
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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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Rizvi SAR, Hasan M, Alam MS. Cholesterol granuloma of the orbit: an atypical presentation. Indian J Ophthalmol 2013; 62:344-6. [PMID: 23619491 PMCID: PMC4061677 DOI: 10.4103/0301-4738.111187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cholesterol granuloma is a rare, well-defined lesion of the orbit. In the orbit, diploe of the frontal bone is involved almost exclusively. We report an atypical case of cholesterol granuloma involving superomedial quadrant of orbit. A 42-year-old male presented with progressive, painless, proptosis with infero-temporal displacement of left eye. A large mass was felt beneath the bony orbital margin in the superomedial quadrant of the left orbit. Computerized tomography (CT) scan revealed an extraconal superomedial, heterogeneous enhancing mass which was isodense with brain and pushing the globe inferolaterally and anteriorly. Excision biopsy of the tumor revealed the typical features of a cholesterol granuloma without any epithelial elements. Cholesterol granuloma of the orbit is a rare entity, but it can be diagnosed and differentiated from other lesions of the superior orbit by its characteristic clinical, radiological and histopathological features. An appropriate intervention in time carries a good prognosis with almost no recurrence.
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Affiliation(s)
- Syed A R Rizvi
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India
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Ezzat TF, Alowami S. Cholesterol granuloma of the anterior mediastinum with osseous metaplasia. Rare Tumors 2012; 4:e47. [PMID: 23372911 PMCID: PMC3557561 DOI: 10.4081/rt.2012.e47] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 07/13/2012] [Accepted: 07/13/2012] [Indexed: 11/24/2022] Open
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
Orbitofrontal cholesterol granuloma is a rare entity that has a predilection for men in their fourth or fifth decade and occurs almost exclusively within the frontal bone overlying the lacrimal fossa. Surgery by drainage and curettage is virtually curative in all cases and recurrence is very rare. We describe the case of a 77-year-old man with recurrent orbitofrontal cholesterol granuloma 11 years after surgery, presumably due to subtotal curettage. The potential use of an endoscope to aid complete removal of lesion is discussed.
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Affiliation(s)
- David I T Sia
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.
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Khalatbari MR, Moharamzad Y. Recurrent orbitofrontal cholesterol granuloma in pediatric patient: case report and review of the literature. Childs Nerv Syst 2012; 28:291-6. [PMID: 22038150 DOI: 10.1007/s00381-011-1611-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 10/05/2011] [Indexed: 11/24/2022]
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.
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Alsuhaibani AH, Al-Rubaie K, Al-Khiary H, Nerad JA. Different patterns of orbital roof involvement by cholesterol granuloma. Middle East Afr J Ophthalmol 2012; 18:333-5. [PMID: 22224029 PMCID: PMC3249826 DOI: 10.4103/0974-9233.90142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Two patients presented with cholesterol granuloma (CG), with completely different patterns of orbital roof involvement. One patient had a large intraorbital cystic CG, whereas the other had a very large intraosseous CG of the frontal bone. The presentation of CG with variable orbital roof involvement highlights the importance of being aware of the clinical characteristics and the imaging features of CG.
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Affiliation(s)
- Adel H Alsuhaibani
- Department of Ophthalmology, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
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Barnes LD, Pearce JW, Berent LM, Fox DB, Giuliano EA. Surgical management of orbital nodular granulomatous episcleritis in a dog. Vet Ophthalmol 2010; 13:251-8. [PMID: 20618804 DOI: 10.1111/j.1463-5224.2010.00781.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 27 kg, 6-year-old, male castrated German shorthaired pointer presented to the University of Missouri, Veterinary Teaching Hospital with the complaint of progressive exophthalmia of 2 years duration optical density (OD). Lack of retropulsion OD was noted on physical examination. Anterior segment examination OU and fundic examination OS did not reveal any abnormalities. Examination of the fundus OD revealed focal scleral indentation of the inferior nasal globe. The indentation changed location with globe movement OD. MRI and CT scan revealed a well-circumscribed, approximately 2 cm in diameter mass located caudal and ventral to the affected globe that appeared to communicate with the nictitating membrane with absence of any bony involvement. A modified lateral orbitotomy was recommended and performed to remove the orbital mass and nictitating membrane en-bloc. Histopathology and immunohistochemistry of the mass confirmed a diagnosis of nodular granulomatous episcleritis (NGE). Postoperatively, the dog developed absolute keratoconjunctivitis sicca (KCS). Examples of primary episcleral inflammation in the dog include diffuse episcleritis, NGE, nodular fasciitis, fibrous histiocytoma, proliferative conjunctivitis/keratoconjunctivitis, pseudotumor, and Collie granuloma. The etiology of these episcleral inflammations is presumed to be immune mediated. To our knowledge, this is the first report of NGE affecting the orbital region of a dog. Development of absolute KCS resulting from excision of the nictitating membrane is also supported by this case.
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Affiliation(s)
- Laura D Barnes
- College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
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