P 375
Cholesterol granuloma rare cystic tumor of the orbit
J. Kraft
Cholesterol granuloma of the orbit is a rare lesion usually involving the frontal bone in the region of the lacrimal fossa. It might be an enlarging and painful process. The etiology is still not completely understood, trauma and hemorrhage into the diploe are supposed to be the cause of cholesterol granuloma.
Case report: Three male patients (37, 39 and 61 years old) presented with unilateral proptosis, in two cases associated with retrobulbar pain. Clinical investigation revealed an exophthalmus of 3-6mm and a limitation of the eye movement (elevation). In ultrasonography a well defined tumor in the upper orbit with low to middle reflectivity was found. Differential diagnosis in the CT scan were dermoid cyst, sinus mucocele, adenoma or carcinoma of the lacrimal gland. Extraperiostal surgical removal was performed in all cases via either Kronlein`s operation or superior orbitotomy. Intraoperatively a subperiostal cystic lesion with a yellowish secret of crumbly contens was found. Histological investigation revealed a granulomatous inflammation with histiocytes and giant cells as well as residual hemorrhages. The diagnosis was: cholesterol granuloma. These findings are in agreement with the assumption that trauma and hemorrhage into the diploe cause cholesterol granuloma. The outcome of all patients was good with no recurrence yet.
Conclusion:
In case of orbital tumors in the superotemporal orbit with bone involvement especially after trauma a cholesterol granuloma has to be considered in the differential diagnosis.
Department of Ophthamology, Julius-Maximilian-University Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg