Large Cholesterol Granuloma Arising From the Frontal Sinus. Case Report.

Abstract

A 59-year-old male presented with a large cholesterol granuloma arising from the frontal sinus manifesting as a large, fluctuated, soft mass in his brow, compressing left eye. Skull radiography showed dilation of the frontal sinus. Computed tomography and magnetic resonance imaging revealed a cystic mass extending into the left orbit and anterior cranial fossa. Gross inspection at the frontal craniotomy showed mucinous, dark green fluid intermingled with shining material. The histological diagnosis was cholesterol granuloma with epithelial lining. Large cholesterol granuloma with facial deformity is always associated with bone and cosmetic problems. Wide opening of the frontal sinus followed by cyst wall removal and plastic repair of the skull is necessary.

Cholesterol Granuloma of the Orbit. Report of Cases and Analysis of Controversial Treatment

“…The most accepted one is the presence of a non-absorbed hematoma from an episode of mucosal bleeding, resulting in formation of cholesterol crystals and a foreign body chronic inflammatory reaction. Within the middle ear, obstruction of air draining may result in edema and hemorrhage and subsequent granuloma formation [4]. However, other explanation such as local tissue breakdown has been reported to play an important role as source of cholesterol in the petrous sinus region [4].…”

“…Within the middle ear, obstruction of air draining may result in edema and hemorrhage and subsequent granuloma formation [4]. However, other explanation such as local tissue breakdown has been reported to play an important role as source of cholesterol in the petrous sinus region [4]. In the frontal sinus, cholesterol granuloma may be caused by disturbance of air drainage by middle nose polyps [5].…”

Cholesterol granuloma in the wall of a mandibular dentigerous cyst: a rare case report

“…Hematoma from the mucosal bleeding would not be absorbed, resulting in its conversion to cholesterol crystals. The deposited cholesterol crystals act as an irritant which attracts foreign body giant cells and causes fibrosis (2).Based on this mechanism, cholesterol granuloma is not expected to occur in the mandible due to the absence of intrabony cavities or drainage pathways. A recent study by Yamazaki et al (8) suggests that perlecan (a basement membrane heparan sulfate proteoglycan) which is present abundantly in the cyst wall of immature granulation tissue might be related to the development of cholesterol granulomas.…”

“…It usually develops in association with chronic middle ear diseases and affects the mastoid antrum and air cells within the temporal bone. However, it can rarely develop in the paranasal sinuses (1,2). Only very few cases of cholesterol granuloma occuring in jaws were reported in the English literature.…”

Nasoseptal Cholesterol Granuloma<subtitle>A Case Report and Review of Pathogenesis</subtitle>

“…The exposed marrow hypothesis indicates that direct hemorrhage into air-filled spaces is a nidus for pathogenesis especially when considering the high vascularity of both the septum's elastic submucosal space and the mucosa of aerated paranasal sinuses. 6 In addition, a history of chronic sinusitis may cause small hemorrhages, further contributing to disease progression. 7 In keeping with the obstructionvacuum theory, mucosal edema from infectious or allergic triggers can create ventilation obstruction and air trapping.…”