Orbital cholesterol granuloma: a retrospective case series

Abstract Background To review the clinical features, radiographic features, therapy, pathological features and prognosis of orbital cholesterol granuloma(CG). Methods Twelve patients with orbital CG who were referred to Tianjin Eye Hospital between January 2002 and December 2020 were include in this retrospective case series study. Data collected included patient ophthalmic manifestations, imaging finding, treatment strategies, pathological features and prognosis were retrospectively reviewed. Results The patients comprised 10 males and 2 females. The mean age was 34.5±8.9 years(range 16 to 45 years). Four patients had a history of orbital trauma. The clinical manifestations at first visit were proptosis ( 7/12, 58.3%), periorbital or eyelids swelling (6/12,50%), limitation of eye displacement (4/12,33.3%), ptosis(2/12,16.7%), decreased visual acuity (1/12,8.3%).CT showed a non-enhancing,well-circumscribed lesion in the orbit with extensive erosion of the adjacent frontal bone and temporal bone.MRI showed a non-enhancing mass with intermediate to high signal intensity on T1- and T2-weighted imaging. Ten patients underwent lateral orbitotomy, and two patient underwent supraorbital orbitotomy,.All patients had aggressive bone erosion. Histopathologic evaluation of the cyst contents and wall revealed cholesterol clefts,multinucleated giant cells,histiocytes, foamy macrophages,and altered blood pigments. The median recurrence time of 79.6±49.8 months (range 19 month to 193 months). Three patients were lost to follow-up. No postoperative diminution of vision was noted,and no recurrence was observed. Conclusions Cholesterol granulomas can present as superiotemporal or temporal orbital lesions. The diagnosis can be established based on CT and MRI. Most of patients can have no history of orbital trauma.