An unusual case of breast cholesterol granuloma

Abstract

Cholesterol granuloma (CG) is a rare and benign inflammatory tissue reaction caused by the accumulation of lipid and cholesterol crystals in the tissue, resulting from such incidents as localized trauma and hemorrhage. It has been suggested that the reaction starts with the lysis of blood cells in the tissue and the cellular components, leading to a foreign body reaction in the tissue. As a result of this process, a nodular mass forms in the tissue, and the pressure of this mass on the surrounding tissues can cause pain and the loss of various functions. CG commonly occurs in such anatomic areas as the mastoid bone, petrous apex, tympanic cavity and sinus maxillaris, and more rarely in the breast. CGs of the breast mimic breast cancer both clinically and radiologically, which makes such masses important. Incisional or excisional biopsy is recommended for radiographically suspected cases. The presence of multinucleated giant cells, cholesterol clefts, foamy macrophages, and hemosiderin in surrounding damaged cells and tissues in the specimen, as histopathological findings, can steer diagnosis. It should be noted that CGs may occur in atypical localizations besides their usual anatomic localizations, and the case in the present study is particularly interesting due to its rare atypical presentation.