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Case Reports
. 2023 Mar 13;23(1):98.
doi: 10.1186/s12886-023-02842-3.

Orbitofrontal cholesterol granuloma masquerading as frontal sinus mucoceles: report of two cases

Ruimiao Li  1 , Mingyu Ren  2 , Wenjing Wang  3 , Ruixin Li  1 , Lili Zhang  1 , Limin Liu  1
Affiliations
Case Reports

Orbitofrontal cholesterol granuloma masquerading as frontal sinus mucoceles: report of two cases

Ruimiao Li et al. BMC Ophthalmol. .

Abstract

Background: Two cases of orbitofrontal cholesterol granuloma masquerading as frontal sinus mucoceles were reported to understand image findings, clinical and histopathologic features of orbitofrontal cholesterol granuloma to improve its diagnosis and treatment.

Case presentation: Two East Asian patients aged 41 and 27 without personal or familial medical or trauma history presented with the common complaint of proptosis and inferomedial displacement of the eyeballs. The computed tomography (CT) of both cases showed an irregularly shaped, well-defined lesion in the left frontal bone associated with bony erosion. The lesions resulted in the bone absorption of frontal bone and orbital roof, which extended into the superior orbital space. Anterior orbitotomy through subbrow incision by drainage and curettage resulted in a curative outcome. The histopathological examination revealed inflammatory granulation tissues, fibrous capsule wall, cholesterol clefts with altered blood pigments, and calcifications, consistent with the diagnosis of cholesterol granuloma. No recurrence was observed for one year after surgery in one case and three years in the other.

Conclusions: When the following features are observed: orbital CT exhibits cystic lesion with irregular bone destruction in the superolateral orbit, magnetic resonance imaging (MRI) depicts lesions are hyperintense signals on T1 weighted images (T1WI), and T2 weighted images (T2WI), and the contrast-enhanced imaging reveals that the most of tumor is showed a non-significant enhancement, orbitofrontal cholesterol granuloma should be considered.

Keywords: Case report; Diagnostic imaging; Frontal sinus mucoceles; Orbitofrontal cholesterol granuloma; Surgical therapy.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
CT scan displayed a soft tissue mass in the left frontal sinus, eroding the floor of sinus, orbital roof, and extending into the superior orbital space
Fig. 2
Fig. 2
Enhanced magnetic resonance imaging showed a non-enhancing mass that presented hyperintense
Fig. 3
Fig. 3
Surgical sample showed a well-circumscribed cyst
Fig. 4
Fig. 4
The histopathological examination of cyst contents and wall revealed inflammatory granulation tissues, fibrous capsule wall, cholesterol clefts with altered blood pigments, and calcifications, consistent with the diagnosis of cholesterol granuloma
Fig. 5
Fig. 5
CT scan exhibited an irregularly shaped promiscuous dense occupying lesion in the left frontal bone, resulting in the bone absorption in the frontal bone and orbital roof, and penetrating down into the orbit
Fig. 6
Fig. 6
Contrast-enhanced imaging revealed that most parts of the tumor display a non-significant enhancement
Fig. 7
Fig. 7
The sample after complete resection
Fig. 8
Fig. 8
The histopathological examination of the cyst contents and wall revealed cholesterol clefts, multinucleated giant cells, histiocytes, foamy macrophages, fiber textures, altered blood pigments, and calcifications, which was consistent with the diagnosis of cholesterol granuloma
See this image and copyright information in PMC

References

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