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. 2025 Jun 1;46(5):593-597.
doi: 10.1097/MAO.0000000000004471. Epub 2025 Feb 25.

Cholesterol Granuloma Mimicking CSF Otorrhea by beta-Trace-Protein Production

Andreas Radeloff, Katrin Radeloff  1 , Rolf-Peter Henke  2 , Sarah Hahnke  1 , Maureen Loewenthal  1
Affiliations

Cholesterol Granuloma Mimicking CSF Otorrhea by beta-Trace-Protein Production

Andreas Radeloff et al. Otol Neurotol. .

Abstract

Objective: To report a patient who was misdiagnosed and operated on for cerebrospinal fluid (CSF) otorrhea and to demonstrate that cholesterol granulomas mimic CSF leakage by secreting beta-trace protein (BTP).

Patients: Eleven consecutive patients undergoing ear surgery in whom cholesterol granulomas were discovered intraoperatively.

Intervention: Biochemical and histologic analysis of liquid and solid fractions of cholesterol granulomas.

Main outcome measures: BTP and beta-2-transferrin concentrations and BTP mRNA levels in surgical specimens.

Results: Cholesterol granulomas produce BTP and express high levels of BTP mRNA, but do not produce beta-2-transferrin.

Conclusions: Beta-2 transferrin analysis is preferable to BTP analysis for the detection of CSF otorrhea because BTP may be false positive in the presence of cholesterol granulomas.

Keywords: Beta-trace-protein; CSF; Cholesterol granuloma; Granuloma; Liquorrhea.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIG. 1
FIG. 1
Clinical (A, B) and histological (C, D) appearance of cholesterol granuloma: intraoperative finding of a cholesterol granuloma (asterisks) of the mastoid (A, B). The hematoxylin eosin staining shows typical histological signs of an unspecific chronic inflammation with foreign body reaction with foam cells (D, arrowheads) and giant cells (D, arrows) to cholesterol crystals (asterisks) and hemosiderin deposition (C, arrows). C, magnification ×40; D, magnification ×200.
FIG. 2
FIG. 2
BTP levels in serum and gene expression levels of BTP mRNA in cholesterol granuloma: The BTP values in the serum were determined and presented as x-fold the threshold value (A). Gene expression levels of PTGDS/BTP mRNA in cholesterol granuloma were normalized to the expression values of the housekeeping gene GAPDH (B; PTGDS = prostaglandin-D-synthase, GAPDH = glycerinaldehyde-3-phosphate-dehxdrogenase). The lines represent the mean values.
FIG. 3
FIG. 3
BTP levels versus BTP mRNA expression levels. Pearson’s correlation shows a high negative correlation between BTP levels and PTGDS mRNA expression levels, but due to the small number of samples, there is no statistical significance (r = 0.51, p = 0,3,853, n = 5).
See this image and copyright information in PMC

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