Orbital cholesterol granuloma with destruction of the lateral orbital roof

Purpose: Orbital cholesterol granuloma in a 51-year-old man is described, Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) were done. Results: Both Studies showed a mass in the left orbit, with evidence of orbital roof destruction in the CT scan. On the basis of clinical and imaging findings, a diagnosis was made of malignant orbital tumor with destruction of the lateral orbital roof. Surgical exploration revealed a thickly encapsulated mass densely adherent to the left superior orbital bone and periosteum. Although the dura mater was intact, bone destruction in the lateral orbital roof was seen. The entire mass was successfully excised and histopathological evaluation was performed. Histopathology showed numerous inflammatory cells, blood degradation products, and cholesterol clefts. The absence of epithelial elements led to the diagnosis of cholesterol granuloma. Conclusions: Care must be taken to differentiate cholesterol granuloma from malignant orbital tumor. CT scan and MRI imaging seem well-suited to detecting the characteristic findings of cholesterol granuloma. Jpn J Ophthalmol 2000;44:179-182 (C) 2000 Japanese Ophthalmological Society.