Cholesterol granuloma of the orbit

Abstract

Objective: To report a patient with cholesterol granuloma and describe the distinct clinical, radiologic, and histopathologic findings.

Methods: This is a case report.

Results: A 33-year-old man presented with a 12-month history of diplopia on left upward gaze. He underwent repair of wound laceration at the right fronto-temporal area 25 years prior to consultation due to a head bump sustained in a vehicular accident. Examination revealed nonaxial proptosis, inferior globe displacement, and mild limitation on left upward gaze. Orbital imaging revealed an ovoid extraconal expansile soft-tissue mass in the left orbit, slightly compressing the globe inferiorly, and thinning and widening of the superior portion of the orbital wall. Excision biopsy of the orbital mass was done through a lateral orbitotomy with bone flap. Histopathology revealed characteristic features of cholesterol granuloma including abundant cholesterol clefts, foreign-body giant cells, lipid-laden histiocytes, and hemosiderin macrophages with absence of epithelial components.

Conclusion: Orbitofrontal cholesterol granulomas have typical clinical, radiologic, and histopathologic features. Surgical excision has a high success rate with a low incidence of recurrence.