Endometrial Cholesterol Granuloma Associated with Prolapsed Uterus- A Rare Case Report with Unusual Clinical Presentation

Abstract

Cholesterol granuloma is a chronic inflammatory reaction to cholesterol deposition. It may develop in variety of sites including middle ear, mastoid process, para nasal sinuses, mediastinum, breast, testis and kidney. But endometrial cholesterol granuloma is a rarely reported case and is usually presented clinically as pyometra. This article reports a case of cholesterol granuloma in the endometrium associated with prolapsed uterus. In this case the patient clinically presented with urinary retention and overflow incontinence of urine. The reason of acute urinary retention in this case was pelvic fibrosis and adhesion secondary to this chronic inflammatory reaction. This was supported by the presence of pus like yellowish material over the uterine surface and pelvic adhesion, noted during surgery. Endometrial biopsy revealed cholesterol granuloma that confirmed the source of chronic inflammatory reaction and pelvic fibrosis.

Keywords: Endometrium; Pyometra; Urinary retention.

[Table/Fig-1]:

Photomicrograph of endometrial curetting showing haemorrhagic necrotic material. (H&E x 50).

[Table/Fig-2]:

Gross photograph of uterus cervix with dilated endometrial cavity containing yellowish haemorrhagic material.

[Table/Fig-3]:

Photomicrograph of endometrium showing cholesterol granuloma (Long arrow) & Intact endometrial gland (Short arrow). (H&E x 100).

[Table/Fig-4]:

Photomicrograph shows cholesterol clefts, inflammatory cells & foreign body giant cells. (H&E x 400).

[Table/Fig-5]:

Photomicrograph shows myometrial extension of cholesterol granuloma (H&E x 100). Arrow points out smooth muscle tissue.

[Table/Fig-6]:

Photomicrograph showing benign endocervical mucosa & glands. (H&E x 50). Inset shows benign squamous lining of cervix. (H&E x 100).