To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion. The purpose of surgery is to remove the lesion and create an adequate drainage.
Cholesteatoma, Middle Ear/*complications ; Cholesteatoma, Middle Ear/diagnosis ; Cholesteatoma, Middle Ear/surgery ; *Cholesterol ; Granuloma, Foreign-Body/*complications ; Granuloma, Foreign-Body/diagnosis ; Granuloma, Foreign-Body/surgery ; Otitis Media/diagnosis ; Otitis Media/*etiology ; Retrospective Studies

Adult ; Cholesterol ; Diagnosis, Differential ; Epididymis ; Genital Diseases, Male ; diagnosis ; Granuloma, Foreign-Body ; diagnosis ; Humans ; Male ; Scrotum

An ingested fish bone presenting as an unresolving inflamed neck mass is rare. The purpose of this article was to describe the clinical and microscopic features of a foreign-body granuloma in submandibular region that resulted from a fish bone embedded in the floor of mouth. A 45-year-old male patient complained of a hard mass in submandibular region. Computer tomography allowed that localize of the lesion and the fish bone penetrating a submandibular gland. We successfully operated on the patient to excise the mass. A microscopic examination showed a anewly-formed granuloma, composed of lympocytes and epithelioid cells, and some microabscess with neurophiles. The final diagnosis was a foreign-body granuloma with a fish bone. Even though foreign-body granulomas in submandibular region are rare lesions, surgeons should be familiar with their features and include them in the differential diagnosis of tissue masses.
Diagnosis, Differential ; Epithelioid Cells ; Granuloma ; Granuloma, Foreign-Body ; Humans ; Male ; Middle Aged ; Mouth Floor ; Neck ; Submandibular Gland

BACKGROUND: As the desire to maintain a youthful appearance escalates nationwide, the numbers of patients presenting with complications subsequent to cosmetic treatments performed by non-professionals are increasing. OBJECTIVE: The purpose of this study was to overview complications from cosmetic therapeutic attempts by non-professionals, and to discuss their management from a dermatologist's point of view. METHODS: During the period January 1st, 2011 to December 31st, 2013, a total of 24 patients who visited the Severance Hospital at Yonsei University for complications that developed after cosmetic treatments by oriental doctors, non-medical personnel, and general practitioners were enrolled in this study. Patient clinical characteristics, past history, diagnosis, biopsy results, and treatment information were collected. RESULTS: The most common complication was a granulomatous foreign body reaction (n=15, 62.5%), followed by skin necrosis (n=8, 33.3%), and misdiagnosis and malpractice by non-professionals (n=5, 20.8%). Three patients had more than 2 complications combined. Patients with granulomatous foreign body reactions were usually managed with conservative treatments or excisions, while those with skin necrosis were managed with debridement and secondary intention healing. CONCLUSION: As the number of cosmetic therapeutic attempts made by non-professionals increases, dermatologists need to understand the potential complications that can arise following these procedures, and should take an active role in managing the patients.
Adolescent ; Biopsy ; Debridement ; Diagnosis ; Diagnostic Errors ; Foreign Bodies ; Foreign-Body Reaction ; General Practitioners ; Granuloma, Foreign-Body ; Humans ; Intention ; Malpractice ; Necrosis ; Skin

Cholesterol granuloma is a chronic inflammatory process associated foreign body reaction to hemorrhage-related cholesterol crystals that have been precipitated in the tissue. Cholesterol granuloma of the middle ear usually accompany chronic middleear diseases with diminished ventilation. However, cholesterol granuloma of the paranasal sinus is rare. Impaired drainage, hemorrhage, inadequate ventilation play a significant role in its pathogenesis. Symptoms are diverse according to the location and size of the lesion, and also to the presence of wall erosion of the affected sinus. Diagnosis should be made with his tologic investigation of the operative specimen. Radical clearance of the disease using an endoscopic approach and drainage of the affected sinus cavity is the treatment of choice.
Cholesterol* ; Diagnosis ; Drainage ; Ear, Middle ; Ethmoid Sinus* ; Foreign-Body Reaction ; Granuloma* ; Hemorrhage ; Ventilation

Intramembranous tympanic membrane cholesterol granuloma (CG) occurs infrequently. Here, the authors report a case of CG in the tympanic membrane presenting as a blue eardrum in the right ear. In addition, a pinhole perforation noted in the anterosuperior area revealed a brown discharge. High-resolution temporal bone CT showed a bulging mass shadow in the middle ear and a soft tissue dense lesion that filled both the epitympanum and mastoid cavity. Tympanomastoidectomy was performed under general anesthesia. New bone formation was confirmed in the mastoid antrum and epitympanum, and the epitympanum was blocked by new bone. The tympanic membrane revealed a round, brownish mass with a glistening surface and a severely thickened pars tensa. We herein report this case and review pertinent medical literature.
Adult ; Cholesterol/*metabolism ; Granuloma, Foreign-Body/*diagnosis/radiography ; Humans ; Male ; Tympanic Membrane/*pathology/radiography

Cholesterol granuloma is a histopathological diagnosis with features of cholesterol clefts, foreign body giant cells, and macrophages filled with hemosiderin. It is commonly found in the mastoid or petrous apex, but the involvement of paranasal sinuses is very rare. Radiologically, cholesterol granuloma show typical findings of hyperintense signals on both T1- and T2-weighted images on magnetic resonance imaging (MRI). We report two cases of cholesterol granuloma in the sphenoid sinus, which were first misinterpreted as mucoceles due to unusual MRI images.
Cholesterol* ; Diagnosis ; Giant Cells, Foreign-Body ; Granuloma* ; Hemosiderin ; Macrophages ; Magnetic Resonance Imaging ; Mastoid ; Mucocele ; Paranasal Sinuses ; Sphenoid Sinus*

Leuprorelin acetate is a synthetic analog of luteinizing hormone-releasing hormone (LHRH). Recently, hormone-dependent tumors (prostate cancer and breast cancer) have been treated without surgery using this LHRH agonist. A 74-year-old man presented with a subcutaneous tumor in the abdomen. He had received a subcutaneous injection of depot leuprorelin acetate 2 months previously and radiotherapy for prostate cancer. The subcutaneous tumor was totally excised. Histopathologic findings revealed necrosis of fat tissue, many granulomatous nodules composed of giant cells with vacuoles in the dermis and subcutis, and inflammatory cell infiltrates, including mainly lymphohistiocytes. A diagnosis of foreign body granuloma due to depot injection of leuprorelin acetate was made. He revisited our hospital after 1 month with a subcutaneous tumor on his Lt. upper arm. He had received a subcutaneous injection of leuprorelin acetate 1 week ago on that site. We treated it with intralesional triamcinolone injection. Here, we report a case of granulomatous reaction due to leuprorelin acetate injection, which produced subcutaneous nodules.
Abdomen ; Aged ; Arm ; Breast ; Dermis ; Diagnosis ; Foreign Bodies* ; Giant Cells ; Gonadotropin-Releasing Hormone ; Granuloma, Foreign-Body* ; Humans ; Injections, Subcutaneous* ; Leuprolide* ; Necrosis ; Prostatic Neoplasms ; Radiotherapy ; Triamcinolone ; Vacuoles

To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion. The purpose of surgery is to remove the lesion and create an adequate drainage.
Adolescent ; Adult ; Cholesteatoma, Middle Ear ; complications ; diagnosis ; surgery ; Cholesterol ; Female ; Granuloma, Foreign-Body ; complications ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Otitis Media ; diagnosis ; etiology ; Retrospective Studies

OBJECTIVETo investigate the etiology and pathogenesis of cholesterol granuloma of the paranasal sinuses and the treatment for the disease.

METHODSTwenty four cases of cholesterol granuloma of the paranasal sinuses treated in our hospital during the period from March 1996 to March 2003 were retrospectively analysed. All cases were verified by surgery and pathology.

RESULTSOf all cases, 10 cases were diagnosed as chronic sinusitis, 8 cases as nasal sinus cyst, and 5 cases as nasal polyp before operation, only 1 case was considered as cholesterol granuloma. The main symptoms were nasal obstruction (20/24), rhinorrhea (18/24), dysosmia (10/24), headache (7/24), pain around the eye (5/24), double vision (2/24), et al. Different surgical approaches were selected depending upon different pathological changes. Good results were obtained in 23 cases and postoperative follow-up for at least one year showed no recurrence. Only one case received revision nasal endoscopic surgery two years after Caldwell-Luc operation because of recurrence, and remained symptom-free for three years.

CONCLUSIONSThe pathogenesis of cholesterol granuloma includes obstruction of ventilation and drainage and brooding in sinuses. Cholesterol granuloma of the paranasal sinuses seems to have a close relation with chronic sinusitis, especially sinus mucocele. The surgical approach depends upon the location, extension, and severity of the lesion. The principle of surgery is to eliminate the pathological focus and create an adequate drainage.

Adult ; Cholesterol ; Female ; Granuloma, Foreign-Body ; diagnosis ; therapy ; Humans ; Male ; Middle Aged ; Paranasal Sinus Diseases ; diagnosis ; therapy ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Sinusitis ; diagnosis ; therapy