Orbitofrontal cholesterol granuloma: distinct diagnostic features and management

Area of Science:

• Ophthalmology
• Neurosurgery
• Radiology

Background:

• Cholesterol granuloma is a rare condition that can affect the orbitofrontal region.
• Understanding its distinct clinical, radiologic, and histopathologic findings is crucial for diagnosis and management.

Purpose of the Study:

• To describe the characteristic clinical, radiologic, and histopathologic features of orbitofrontal cholesterol granulomas.
• To outline effective treatment approaches for this condition.
• To present two atypical cases, including the smallest and most extensive reported lesions.

Main Methods:

• Retrospective review of 8 patients diagnosed with orbital cholesterol granuloma.
• Analysis of clinical presentation, imaging findings (CT, MRI), and histopathology.
• Evaluation of surgical treatment outcomes and recurrence rates.

Main Results:

• The mean age of presentation was 45 years, with a male predominance (6/8 patients).
• Proptosis was the most common symptom (50%). Imaging revealed lytic lesions in the superolateral orbit and frontal bone, with associated soft tissue masses or cystic components.
• MRI showed non-contrast-enhancing lesions with high signal intensity on T1- and T2-weighted images. Surgical treatment (aspiration, curettage, or excision) was successful in 7/8 patients, with only one recurrence.

Conclusions:

• Orbitofrontal cholesterol granulomas exhibit typical clinical and radiologic characteristics.
• Surgical excision is a highly effective treatment modality with a low risk of recurrence.