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

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.

Cholesterol granuloma mimicking ovarian cancer

Cholesterol granuloma is a consequence of a chronic inflammatory reaction with accumulation of cholesterol crystals in the tissue. Ovarian cholesterol granuloma is rarely reported in the literature and can be misdiagnosed as ovarian cancer during surgery due to pelvic fibrosis and adhesion secondary to chronic inflammation, especially in postmenopausal women. We present a patient who had been referred to our gynecologic oncology clinic. The patient was a 65-year-old overweight female. She was referred to our tertiary hospital due to suspicion of ovarian cancer since she had CA 125 level above 3000 U/ml with a pelvic mass. To date, no cases of cholesterol granuloma causing CA 125 level above 3000 U/ml have been reported in the literature. We performed an elective diagnostic laparotomy to rule out occult malignancy. After removing the mass, it was sent for frozen section intraoperative consultation. Grossly the mass had irregular surface with yellow-brown appearance. The final diagnosis of cholesterol granuloma with serous cystadenofibroma was made. No evidence of malignancy was found. Symptoms, clinical and intraoperative findings of ovarian choloesterol granuloma can be misdiagnosed as cancer. Since the final diagnosis of a pelvic mass depends on histologic analysis, cholesterol granuloma should be kept in mind as a differential diagnosis of pelvic mass.