Cholesterol Granuloma [CG] is a rare pathology found in the paranasal sinuses and is usually associated with middle ear infections. The etiology of sinonasal CG is not yet known. The clinical manifestations are nonspecific. Most patient presents with nasal discharge, facial pain and nasal obstruction similar to current case. The additional feature observed in the present case was bilateral CG of the maxillary sinus which was extending into ostiomeatal complex and into the oral cavity, whose clinical, imaging and histological characteristics were unique.

Largely oral cancers are preceded by potentially malignant lesions, which may appear as white or red patches on the oral mucosa. Leukoplakia is one of the most common epithelial precursors of oral squamous cell carcinoma. Speckled leukoplakia is a rare type of leukoplakia with a very high risk of premalignant growth and mortality rate. Though it is the common precancerous lesion, it poses a major diagnostic and therapeutic challenge. We present a rare case of bilateral recurrent speckled leukoplakia with malignant transformation and discuss this relatively rare entity in light of current information from the literature. We also attempt to present the clinical relevance, and the therapeutic modalities available for the management of the disease.