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Han and Choi: A Case of Cholesterol Granuloma of Maxillary Sinus Misdiagnosed as Odontogenic Cyst
CASE REPORT

J Rhinol 2018;25(2):108-113.

Published online: 19 January 2018

DOI: https://doi.org/10.18787/jr.2018.25.2.108

A Case of Cholesterol Granuloma of Maxillary Sinus Misdiagnosed as Odontogenic Cyst

Byung Hyun Han, MD, Ick Soo Choi, MD, PhD

Department of Otorhinolaryngology-Head and Neck Surgery, Inje University of College of Medicine, Ilsan Paik Hospital, Ilsan, Korea

교신저자：최익수, 10380 경기 고양시 일산서구 주화로 170 인제대학교 의과대학 일산백병원 이비인후과학교실 Tel: +82-31-910-7250, Fax: +82-31-910-7518, E-mail: leochoics@gmail.com

Received 24 October 2017       Revised 23 January 2018       Accepted 23 May 2018

Copyright © 2018 Journal of Rhinology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cholesterol granuloma is a disease in which cholesterol crystals act as a foreign substance in the surrounding tissues and cause granulomatous reaction and fibrosis within the chamber. It is found in various locations of the body, but the most common location is the temporal bone associated with middle ear disease. Because the disease is associated with breathing disturbance, it may also occur in the paranasal sinus. However, it has been rarely reported since its first report by Graham and Michaels in 1978. Recently, we experienced a case of cholesterol granuloma of the right maxillary sinus of a 63-year-old female patient without any nasal symptoms. We successfully managed this case with Caldwell-Luc operation. Also, we summarized the cases of cholesterol granuloma of the sinonasal region reported in Korea.

Keywords: Cholesterol granuloma, Maxillary sinus.

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Fig. 1
Preoperative paranasal sinus CT scans. Axial (A) and coronal (B) view of paranasal sinus CT scan shows about 2 cm sized inflammatory cyst bordered by a thin rim of cortical bone (line arrow: bony septation, dot arrow: lateral wall thinning).
jr-25-108f1.tif
Fig. 2
Preoperative paranasal sinus MRI images. Axial (A) and coronal (B) T1-weighted MRI image shows a cystic mass in the maxillary sinus with iso to high or intermediate signal intensity. Axial (C) and coronal (D) T2-weighted MRI image shows a cystic mass in the maxillary sinus with heterogenous signal intensity.
jr-25-108f2.tif
Fig. 3
Histopathological examination of the lesion of demonstrated numerous cholesterol clefts with surrounding foreign body giant cells, inflammatory cells (A: H&E ×40, B: H&E ×100).
jr-25-108f3.tif
Fig. 4
Postoperative (6 months) paranasal sinus CT scans. Axial (A) and coronal (B) view of paranasal sinus CT scan at postoperative 6 months later notes no visible previously noted cystic lesion in right maxillary sinus except for post-op change.
jr-25-108f4.tif
Table 1.
Cases of cholesterol granuloma of sinonasal region reported in Korea
Number Sex/Age Chief complaint Physical examination Region Operation Reference
1 M/18 NO (R), Ophthalmalgia (R) Exophthalmos (R) Ethmoid CL-op 22)
2 M/32 NO (B) MPR (B), ITH (R), SD (L) Maxilla CL-op 23)
3 F/50 Diplopia ITH (B) Sphenoid CL-op, ESS 15)
4 F/63 Medial canthus discomfort (R) SD (L) Ethmoid ESS 5)
5 M/38 NO (R) MPR (R) Maxilla ESS 5)
6 M/29 NO (R) Polyp (R) Maxilla CL-op, ESS 5)
7 M/56 NO (R) Polyp (R) Maxilla CL-op, ESS 5)
8 F/73 NO (R), Maxilla foreign body sense (R) MPR Maxilla CL-op, ESS 5)
9 M/42 NO (B) Septal perforation, MPR (B), Middle meatus mass (R) Maxilla ESS 24)
10 F/75 Visual disturbance (B) Superior turbinate lateralization (B) Sphenoid ESS 25)
11 F/76 Orbital swelling (R) MPR Frontal & Ethmoid ESS 26)
12 F/52 Impaired vision (R) SD (R) Ethmoid ESS 27)
13 M/44 Medial canthal mass (R) Middle meatus mass (R) Ethmoid ESS 27)
14 F/68 Glabellar mass (R) MPR (B) Frontal ESS 28)
15 M/61 Headache, Ophthalmalgia (B) MPR (B), CL-op status Sphenoid ESS 29)
16 M/67 Dizziness CL-op status Sphenoid CL-op 30)
17 -/49 Headache Reduction in visual acuity Sphenoid ESS 30)
18 M/22 NO SD (L), ITH (R) Septum ESS 31)
19 F/74 Headache Septal bulging (L) Septum ESS 32)

R: Right, L: Left, B: both, NO: Nasal Obstruction, CL-op: Caldwell-Luc operation, ESS: Endoscopic Sinus Surgery, MPR: Muco-Pru-lent Rhinorrhea, ITH: Inferior Turbinate Hypertrophy, SD: Septal Deviation

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