In Reply.—I was pleased to read Dr Benecke's letter, as well as his recent article "Giant Cholesterol Granuloma Producing Brain-Stem Compression,"1 in which he describes a lesion that we probably would have classified as a giant cholesterol cyst of the petrous apex. While I do not wish to belabor an issue that may be largely semantic, my coauthors and I still agree with Graham et al2 that there are important distinctions between these petrous apex lesions and cholesterol granulomas typically found in the temporal bone. Virtually all surgeons experienced in chronic ear procedures have encountered cholesterol granulomas. They contain thick, brown, mucoid fluid, usually thickened mucosa and fibrous connective tissue, giant cells, and other histologic characteristics mentioned briefly in our article. The fluid is gritty, tenacious, and sometimes quite viscous. Giant cholesterol cysts of the petrous apex contain a thinner, brownish fluid that is waterlike in viscosity.
SATALOFF RT. Cholesterol Granulomas of Petrous Apex-Reply. Arch Otolaryngol Head Neck Surg. 1988;114(11):1334. doi:10.1001/archotol.1988.01860230128044
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