PMC5498906_01
The left tympanic membrane is thick and white. A left tympanic membrane perforation is evident, but with no discharge.
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The left tympanic membrane was thick and white on otomicroscopic examination, with no discharge from an obvious perforation of the left tympanic membrane (Figure 1).
(a) Coronal CT of the temporal bone showing bony destruction of the middle cranial fossa. (b) Axial CT showing bony destruction of the middle and posterior cranial fossae. (c, d) Postoperative CT at 3 years after the operation shows no recurrence of cholesterol granuloma.
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Computed tomography (CT) showed a soft-tissue mass that had destroyed the bony plate of the posterior and middle cranial fossa (Figures 2(a) and 2(b)). Temporal bone computed tomography (CT) revealed no recurrence of the cholesterol granuloma at 4 years postoperatively (Figures 2(c) and 2(d)).
(a) Axial T1-weighted temporal bone MRI showing a signal-hyperintense mass neighboring the posterior cranial fossa and extending to the middle fossa. (b) Axial T2-weighted imaging of the temporal bone shows a high-intensity periphery and low-intensity central mass. (c) DWI shows an isointense signal rather than high intensity.
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T1-weighted imaging (Figure 3(a)) and a high-intensity periphery surrounding a low-intensity central signal on T2-weighted imaging (Figure 3(b)). The mass compressed the middle cranial fossa without invasion of the brain. Diffusion-weighted imaging (DWI) revealed an isointense signal, rather than the high intensity that would typically be seen with cholesteatoma (Figure 3(c)).
Intraoperative picture showing pulsating bleeding was seen from the dura in the middle cranial fossa (arrow) in removing the cholesterol granuloma (arrowhead) from the dura. Black arrow indicates the dura in the middle cranial fossa.
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This was attributed to a blood vessel of the dura in the middle cranial fossa (Figure 4).
The pathological specimen showing a typical cholesterol granuloma. Granulation contains clefts of cholesterol crystals, giant cells, and infiltration of inflammation tissue (arrow). HE stain, 100x.
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Histologically, the lesion was consistent with a typical cholesterol granuloma; the granulation tissue contained clefts of cholesterol crystals, giant cells, and infiltration with inflammatory cells (Figure 5).