Orbital Cholesterol Granuloma and Cholesteatoma: Significance of Differentiating the Two

Abstract

Cholesteatoma and cholesterol granuloma are relatively rare lesions of the orbit. Both may involve the superior orbit and present with globe ptosis, proptosis, and double vision developing over weeks to years. In addition to their etiology being unknown, the nomenclature regarding these tumors historically has been confusing, with a variety of names being used to describe them. Their histopathology shares numerous similarities but has one key distinguishing feature: The cholesterol granulomas lack an epithelial lining, whereas the cholesteatomas have an epithelial lining. Surgical removal is the treatment of choice for both tumors. It is important to differentiate the two as the prognosis with recurrence differs. Cholesteatoma may recur with the possibility of malignancy found at the time of re-exploration. We present a case of each tumor type, illustrating their similarities and highlighting the histopathologic findings and treatment recommendations.

The pterional approach for the surgical resection of an orbital cholesteatoma: a case report

“…Cholesteatomas and cholesterol granulomas are benign lesions of presumed inflammatory origin that rarely affect the orbit [3]. However, due to their invasive, recidivating, and progressive characteristics, their management requires a complete resection from their bony bed [4]. The optimal surgical approach to these tumors is unknown, and as for other orbital lesions, their management has been based on their extension, growth rate, and localization within the orbit.…”

“…Depending on the presence or absence of an epithelial component, these lesions are classified as "true cholesteatomas" and "cholesterol granulomas," respectively. Independently of their histological characteristics, both entities require a complete surgical resection due to the recidivating nature and potential of malignant progression of cholesteatomas, as well as the extension and erosive capacity of cholesterol granulomas [3,4].…”

Orbitofrontal cholesterol granuloma: case report and review of the literature

“…It is crucial to distinguish these two lesions in view of difference in recurrence rate. In fact, the cholesteatoma may recur with possibility of malignancy found at the time of re-exploration (18).…”

Imaging Diagnosis—mri Characteristics of a Fourth Ventricular Cholesterol Granuloma in a Dog

“…The terms cholesterol granuloma and cholesteatoma are used interchangeably in the reports of occurrence in animals; however, these entities are distinct. Cholesteatomas, also known as epidermoid cysts, have an epithelial lining and may recur after surgical removal and/or undergo malignant transformation . Furthermore, cholesteatomas in dogs are typically considered as aural neoplasms although intracranial cholesteatomas have been described.…”

“…Cholesteatomas, also known as epidermoid cysts, have an epithelial lining and may recur after surgical removal and/or undergo malignant transformation. 11,12 Furthermore, cholesteatomas in dogs are typically considered as aural neoplasms although intracranial cholesteatomas have been described.…”