See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/236338621 Cholesterol granuloma of the orbit: An atypical presentation Article in Indian Journal of Ophthalmology · April 2013 DOI: 10.4103/0301-4738.111187 · Source: PubMed CITATIONS READS 2 77 3 authors: Syed Ali Raza Rizvi Mahboob Hasan Aligarh Muslim University Aligarh Muslim University 33 PUBLICATIONS 77 CITATIONS 16 PUBLICATIONS 36 CITATIONS SEE PROFILE SEE PROFILE Md Alam Sankara Nethralaya 71 PUBLICATIONS 127 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: External DCR Project View project Oculoplasty View project All content following this page was uploaded by Syed Ali Raza Rizvi on 02 June 2014. The user has requested enhancement of the downloaded file.
IJO_712_10R7 1 AOP Brief Communications Cholesterol granuloma of the orbit: of vision in the same eye. No history of trauma or previous surgery could be elicited. An atypical presentation Orbital examination revealed 4 mm of proptosis with inferolateral displacement of the globe [Fig. 1]. A large mass Syed A R Rizvi, Mahboob Hasan 1 , was felt beneath the bony orbital margin in the superomedial Mohammad S Alam quadrant of the lefu orbit. The mass was fjrm in consistency. Ocular movements were restricted in the upgaze. On ocular examination, the best corrected visual acuity of right eye was Cholesterol granuloma is a rare, well-defined lesion of the 20/20, whereas in the afgected eye it was 3/200. Near vision in orbit. In the orbit, diploe of the frontal bone is involved almost the right eye was N6, while in the lefu eye it was N60. Also, exclusively. We report an atypical case of cholesterol granuloma color vision was impaired and Amsler grid showed distortion involving superomedial quadrant of orbit. A 42-year-old male of horizontal and vertical lines in the lefu eye. Choroidal folds presented with progressive, painless, proptosis with infero- were present on fundoscopy. temporal displacement of lefu eye. A large mass was felt beneath the bony orbital margin in the superomedial quadrant of the Computerized tomography (CT) scan of lefu orbit revealed lefu orbit. Computerized tomography (CT) scan revealed an an extraconal superomedial, heterogeneous enhancing mass extraconal superomedial, heterogeneous enhancing mass which measuring 3.7 × 3.2 × 2.6 cm which was isodense with brain was isodense with brain and pushing the globe inferolaterally and pushing the globe inferolaterally and anteriorly. There was and anteriorly. Excision biopsy of the tumor revealed the typical thinning of cortices in medial wall, lateral wall, and roof of lefu features of a cholesterol granuloma without any epithelial orbit with bony defjcit in the lateral aspect of roof of lefu orbit elements. Cholesterol granuloma of the orbit is a rare entity, [Fig. 2]. No mass was felt or seen in the typical superolateral area but it can be diagnosed and difgerentiated from other lesions of of the orbit either on radiological or on clinical examination. the superior orbit by its characteristic clinical, radiological and Routine investigations were within normal limits. histopathological features. An appropriate intervention in time The mass with golden brown content was completely carries a good prognosis with almost no recurrence. excised by anterior orbitotomy approach through an upper Key words: Atypical, cholesterol granuloma, orbit eyelid crease incision. Curettage of the frontal bone was also done to remove the residual granulomatous material. Cholesterol granuloma is a foreign body response to the Histopathological examination shows cholesterol crystals presence of crystallized cholesterol. [1] It is a rare but well surrounded by foreign body giant cells, packed macrophages, characterized orbital entity which occurs almost exclusively lymphocytes and extravasated RBCs [Fig. 3a and b] within the frontal bone overlying the lacrimal fossa. [2] Other Discussion regions of the head, namely; zygomatic bone, and petrous bone, have also been found to be involved. [1,3] The few cases Orbitofrontal cholesterol granuloma is a rare entity; mostly that have been reported in the last decade have a superolateral occurring in middle-aged men and generally presents with a presentation. [2-5] We report an atypical case of cholesterol gradual mass efgect in the superolateral orbit. [2] The fjrst orbital granuloma in a 42-year-old male, involving superomedial case was reported by Denig in 1902. [6] quadrant of orbit. Detailed search on search engine MEDLINE could not fjnd any such case in the literature. The common sites of occurrence are the middle ear, mastoid antrum and petrous apex. [7] Less commonly, it has also been Case Report reported in frontal bone, zygoma, paranasal sinuses, breast, peritoneum, testes, intima of atheromatous arteries, lung and A 42-year-old male presented with progressive, painless, within tumors such as thyroid adenoma and odontoma. [2] proptosis of lefu eye for the past 18 months. The onset was insidious and had been associated with progressive diminution Though the exact event responsible for such granuloma has not yet been elucidated, difgerent mechanisms have been suggested for its formation. Access this article online Quick Response Code: Website: Trauma with hemorrhage has been put forward as the www.ijo.in initiating event in the cholesterol granuloma of the orbit. The predilection of frontal bone and the male preponderance DOI: further support the trauma theory. [3] However, there was no *** history of trauma in our case. There are also some reports PMID: where no history of trauma could be elicited. [3] *** A ventillatory obstruction in the petrous apex has also been proposed as a cause of cholesterol deposition. [8] However, this mechanism cannot be applied to orbital cholesterol granuloma Institute of Ophthalmology, and Department of 1 Pathology, Jawaharlal as they are quiet separate from frontal sinus. [4] Nehru Medical College, AMU, Aligarh, Utuar Pradesh, India Correspondence to: Dr. Syed Ali Raza Rizvi, 7, Alig Apartments, The typical CT fjndings are of a non-calcifying extraconal Shamshad Market, Aligarh – 202002,Uttar Pradesh, India. mass in the supero-temporal quadrant of the orbit which is E-mail: draliraza12@hotmail.com isodense with brain and is associated with thinning of the Manuscript received: 10.12.10; Revision accepted: 06.06.11 inner and outer tables and ragged areas of bone erosion with
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