Cholesterol Granuloma: An Unusual and Benign Cause of Focal FDG Uptake in the Breast Detected on PET/CT

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.

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Carcinoma on 68 Ga-FAPI-04 PET

ABSTRACT

68 Ga-FAPI-04 has great potential for the detection and staging evaluation of a variety of tumors. We report a case of suspected gallbladder carcinoma that was enrolled in a prospective study of 68 Ga-FAPI-04 imaging at our institution. This case was later histopathologically confirmed as xanthogranulomatous cholecystitis. This demonstrates that xanthogranulomatous cholecystitis might be disguised as gallbladder carcinoma in 68 Ga-FAPI-04 imaging. Thus, we suggest that nuclear clinicians evaluating 68 Ga-FAPI-04 imaging should be aware of this possibility.

Petrous Apex Cholesterol Granuloma Showing 68Ga-DOTATATE Uptake

ABSTRACT

The importance of 68Ga-DOTATATE PET/CT in the evaluation of neuroendocrine tumors is well established. However, false-positive results can occur due to inflammatory pathologies. We report a 47-year-old man who was diagnosed with a neuroendocrine tumor of the stomach. Initial 68Ga-DOTATATE PET/CT showed intense 68Ga-DOTATATE uptake in the petrous apex. Histopathological confirmation could not be obtained, thus the asymptomatic patient was followed with periodic clinical/radiologic examinations for more than 2.5 years. Therefore, this lesion was diagnosed as a cholesterol granuloma of the temporal bone. These results suggested that an initial wait-and-scan approach is a feasible management strategy for similar presentations.

Cholesterol Granuloma: Unusual Pitfall for Hodgkin Lymphoma Evaluation With 18F-FDG PET/CT

ABSTRACT

Cholesterol granuloma (CG) is a foreign body-type granuloma that forms in response to cholesterol crystals. Its etiology and pathogenesis are unclear. 18F-FDG is not a tumor-specific agent. Fibroblasts, macrophages, and multinucleated giant cells also take up 18F-FDG. Like sarcoid granulomas or fibrous dysplasia, CG avidly takes up 18F-FDG and can mimic tumor involvement. We present 2 cases of histologically proven CG, which has been misinterpreted as active residual Hodgkin lymphoma lesion.

An Unusual Case of Maxillary Sinus Cholesterol Granuloma Showing FDG Uptake on PET/CT

ABSTRACT

Cholesterol granuloma (CG) occurs primarily in the middle ear and rarely in the paranasal sinus. We report an unusual case of paranasal sinus CG with 18F-FDG uptake. A 76-year-old man presented with right refractory epistaxis. PET/CT showed FDG uptake in the maxillary sinus. CT findings are typically uncharacteristic, whereas MRI scans are characterized by a high signal on both T1-weighted and T2-weighted images. Nasal endoscopy from the ostium revealed a granulomatous lesion with hemorrhage at the base of the maxillary sinus. After pathological examination by endoscopic sinus surgery, the patient was diagnosed with CG.

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

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