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Atypical radiographic features of skull base cholesterol granuloma

  • Otology
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Abstract

Cholesterol granulomas (CGs) are the most common benign lesions of the petrous apex (PA) and have distinct computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. On CT, CGs of the PA (PACG) present as expansile lesions with erosion of bony trabeculae. MRI shows a hyperintense lesion on T1-and T2-weighted images and do not enhance with gadolinium. The objective is to describe the radiographic features of CGs of the skull base that do not arise from the PA. This study is a retrospective review. Three patients were operated on for suspected recurrent endolymphatic sac tumor, intracranial cholesteatoma, and recurrent sphenoid wing meningioma based on CT and MRI findings. Pathology results were consistent with CG in all three cases. All patients had bone erosion on CT. These skull base CGs did not demonstrate similar MRI features. These lesions were hyperintense, iso-to-hyperintense, and hypointense on T1-weighted MRI, respectively. These CGs were hyperintense in two cases and iso-to-hyperintense in one case on T2-weighted MRI. These lesions either demonstrated central or rim enhancement after gadolinium administration. Skull base CGs that do not arise from the PA demonstrate a broad spectrum of radiographic characteristics on MRI that are not typical of PACG.

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References

  1. Brackmann D, Toh E (2002) Surgical management of petrous apex cholesterol granulomas. Otol Neurotol 23:529–533

    Article  PubMed  Google Scholar 

  2. Jackler RK, Cho M (2003) A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol 24:96–106

    Article  PubMed  Google Scholar 

  3. Narayan A, Jain R, Chwang W, Seidman M, Rock J (2012) Hemorrhagic petrous apex cholesterol granuloma. Arch Otolaryngol Head Neck Surg 138(12):1180–1183

    Article  PubMed  Google Scholar 

  4. Yamil S, Wood J, Telischi F, Casiano R, Angeli S (2013) Development of cholesterol granuloma in a temporal bone petrous apex previously containing marrow exposed to air cells. Otol Neurotol 34:958–960

    Article  Google Scholar 

  5. Hoa M, House JW, Linthicum FH, Go JL (2013) Petrous apex cholesterol granuloma: pictorial review of radiological considerations in diagnosis and surgical histopathology. J Laryngol Otol 127(4):339–348

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Connor SEJ, Leung R, Natas S (2008) Imaging of the petrous apex: a pictorial review. Br J Radiol 81:427–435

    Article  CAS  PubMed  Google Scholar 

  7. Royer MC, Pensak ML (2007) Cholesterol granulomas. Curr Opin Otolaryngol Head Neck Surg 15:319–322

    Article  PubMed  Google Scholar 

  8. Alkonyi B, Gunthner-Lengfeld T, Rak K, Nowak J, Solymosi L and Hagen Rudolf (2014) An endolymphatic sac tumor with imaging features of aneurysmal bone cysts: differential diagnostic considerations. Childs Nerv Syst [Epub ahead of print]

  9. Megerian CA, Semaan MT (2007) Evaluation and management of endolymphatic sac and duct tumors. Otolaryngol Clin N Am 40:463–478

    Article  Google Scholar 

  10. Corrales CE, Blevins NH (2013) Imaging for evaluation of cholesteatoma: current concepts and future directions. Curr Opin Otolaryngol Head Neck Surg 21(5):461–467

    Article  PubMed  Google Scholar 

  11. Masaany M, Siti HS, Murliza I, Mazita A (2008) Bilateral middle ear cholesterol granuloma in familial hypercholesterolemia. Otolaryngol Head Neck Surg 138(6):803–804

    Article  PubMed  Google Scholar 

  12. Kuo SW, Cheng PW, Yang LH (2006) Bilateral giant cholesterol granuloma of the temporal bones. Otol Neurotol 27(8):1197–1198

    Article  PubMed  Google Scholar 

  13. Eby TL, Guthrie BL (1998) Bilateral cholesterol granulomas of the temporal bone ORL. J Otorhinolaryngol Relat Spec 60(6):318–321

    Article  CAS  Google Scholar 

  14. Linstrom CJ, McLure TC 3rd, Gamache FW Jr, Saint-Louis LA (1989) Bilateral cholesterol granulomas of the petrous apices: case report and review. Am J Otol 10(5):393–401

    CAS  PubMed  Google Scholar 

  15. Henick DH, Feghali JG (1994) Bilateral cholesterol granuloma: an unusual presentation as an intradural mass. J Otolaryngol 23(1):15–18

    CAS  PubMed  Google Scholar 

  16. Verret DJ, Samy RN (2005) Bilateral cholesterol granulomas. Otol Neurotol 26(5):1041–1044

    Article  CAS  PubMed  Google Scholar 

  17. Gamache FW Jr, McLure T, Deck M, Linstrim C (1988) Bilateral cholesterol granuloma of the skull base: case report and review of the literature. Neurosurgery 22(6 Pt 1):1098–1101

    Article  PubMed  Google Scholar 

  18. Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T (2014) Magnetic resonance imaging of meningiomas: a pictorial review. Insights Imaging 5(1):113–122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL, 33136, USA

    Christine T. Dinh, Stefania Goncalves, Kim Truong, Fred Telischi, Simon Angeli & Adrien A. Eshraghi

  2. Department of Neurosurgery, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Suite W279, Miami, FL, 33136, USA

    Rita Bhatia & Jacques Morcos

Authors
  1. Christine T. Dinh
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  2. Stefania Goncalves
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  3. Rita Bhatia
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  4. Kim Truong
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  5. Fred Telischi
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  6. Simon Angeli
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  7. Jacques Morcos
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  8. Adrien A. Eshraghi
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Correspondence to Adrien A. Eshraghi.

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Dinh, C.T., Goncalves, S., Bhatia, R. et al. Atypical radiographic features of skull base cholesterol granuloma. Eur Arch Otorhinolaryngol 273, 1425–1431 (2016). https://doi.org/10.1007/s00405-015-3705-7

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  • DOI: https://doi.org/10.1007/s00405-015-3705-7

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