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Clinical Problem Solving: Pathology
April 2008

Pathology Quiz Case: Diagnosis

Author Affiliations

Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Otolaryngol Head Neck Surg. 2008;134(11):1234. doi:10.1001/archotol.134.11.1234

Cholesterol granulomas are benign lesions that can develop in various parts of the body, including the breast, testis, and head and neck.1,2In the head and neck area, the most common site of involvement is the temporal bone, and this site is often associated with chronic otitis media and cholesteatoma. Cholesterol granulomas of the paranasal sinuses are less common. Of the paranasal sinuses, the maxillary sinus is most commonly involved.3Cholesterol granulomas of the maxillary sinus usually occur in males and are predominantly unilateral.4The presenting symptoms of maxillary sinus CGs may include nasal obstruction, facial pain, and, rarely, clear, golden-yellow rhinorrhea.5Cholesterol granulomas are often expansile lesions that can cause bony destruction and compression of adjacent structures. Radiographically, the erosive, expansile features of CGs may be suggestive of malignancy; therefore, biopsies must provide sufficient tissue to definitively rule out malignancy. Because CGs can be morphologically similar to a malignant neoplasm with necrotic features, an excisional biopsy may be preferable to a deep incisional biopsy in order to provide adequate tissue for diagnosis.