Cholesterol granuloma mimicking ovarian cancer

Abstract

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.

Keywords: Cholesterol granuloma; cholesterol crystals; female genital system; ovarian cancer.

Figure 1

CT imaging of intraabdominal mass. A. CT imaging of intraabdominal mass, axial section. B. CT imaging of intraabdominal mass, sagittal section.

Figure 2

Gross photograph of pelvic mass with irregular surface and yellow-brown appereance.

Figure 3

Adipose tissue showing aggregates of longitudinal clefts of cholesterol crystals surrounded by multinucleated giant cells, epithelioid histiocytes, and chronic inflammatory cells [H&E × 40].

Figure 4

Adipose tissue showing aggregates of longitudinal clefts of cholesterol crystals surrounded by multinucleated giant cells, epithelioid histiocytes, and chronic inflammatory cells [H&E × 200].