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Intracalvarial cholesterol granulomas--clinicopathologic correlates of three cases
1Department of Pathology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
Insights
Cholesterol granulomas (CGs) are rare tumor-like lesions resulting from localized hemorrhage, often in the petrous apex. Recent cases highlight diverse clinical, radiographic, and pathological features, including Gamma-Gandy bodies and crystal deposits.
Area of Science:
- Neuropathology
- Histopathology
- Radiology
Background:
- Cholesterol granulomas (CGs) are uncommon tumor-like lesions that arise secondary to localized hemorrhage.
- These lesions typically occur in bony locations with impaired drainage, such as the petrous apex, orbit, or sinuses.
Observation:
- A review of three recent institutional cases of cholesterol granulomas is presented.
- The cases illustrate a spectrum of clinical, radiographic, and pathological findings associated with these mass lesions.
Findings:
- One case exhibited distinctive features, including Gamma-Gandy body formation (histiocytes with iron pigment) and extensive tophi.
- Tophi were likely composed of calcium pyrophosphate dihydrate (CPPD) crystals, associated with significant iron deposition.
Implications:
- Understanding the varied presentation of CGs is crucial for accurate diagnosis in neuropathology and radiology.
- The presence of Gamma-Gandy bodies and CPPD crystals in CGs offers insights into the complex pathophysiology of these lesions.
Abstract:
Cholesterol granulomas (CGs) are tumor-like lesions seldom encountered by neuropathologists. CGs develop in reaction to localized hemorrhage, often occurring in bony sites with possible impaired drainage of blood and blood products. The most common bony location is the petrous apex, although orbital, frontal sinus, and maxillary sinus sites have been reported. We compare and contrast three recent cases seen at our institution that illustrate the spectrum of clinical, radiographic, and pathologic features that can be seen with these mass lesions. One case demonstrated the unique pathological features of Gamma-Gandy body formation, epithelioid histiocytes heavily encrusted with iron pigments, and extensive tophi. The latter most likely represented aggregates of calcium pyrophosphate crystals associated with extensive iron deposition.