Cholesterol granuloma in an antrochoanal polyp. A rare lesion in children.

José-Fernando Val-Bernal, María Martino, Natalia Castaneda-Curto, Montserrat García-Triana, Vicente Teigeiro-Núñez

Journal: Revista espanola de patologia : publicacion oficial de la Sociedad Espanola de Anatomia Patologica y de la Sociedad Espanola de Citologia 2019;51(4):262-266

PMID: 30269780

Full Text on Elsevier Science View on PubMed

Abstract

Antrochoanal polyps (ACPs) are an infrequent clinical entity. Cholesterol granulomas (CGs) are commonly associated with chronic middle ear disease but are rare in the paranasal sinuses. We describe a case of a 10-year-old girl with a concomitant CG in an ACP which was surgically excised by nasosinusal endoscopic surgery. To our knowledge, there are only five previously published cases of CGs in ACPs and of these, only two were pediatric cases. We describe a third case in the youngest patient yet reported. Increased intrasinus pressure may affect venous and lymphatic drainage, leading to hemorrhages with hemolysis and deposition of cholesterol crystals and their esters initiating the formation of granulomas in the polyp. In addition, the insufficient lymphatic drainage prevents the complete elimination of lipids, contributing to the formation of cholesterol granulomas. The treatment and the outcome of an ACP associated with a CG are the same as for usual ACPs.

Address: Pathology Unit, Medical and Surgical Sciences Department, University of Cantabria and IDIVAL Research Institute, Santander, Spain. Electronic address: [email protected].; Anatomical Pathology Service, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL Research Institute, Santander, Spain.; Otorhinolaryngology Service, Laredo Hospital, Cantabria, Spain.; Diagnostic Radiology Service, Laredo Hospital, Cantabria, Spain.

DOI: 10.1016/j.patol.2018.03.004

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MeSH Terms: Adenoidectomy, Child, Cholesterol, Diagnosis, Differential, Endoscopy, Female, Granuloma, Humans, Maxillary Sinus, Nasal Polyps, Nasopharynx, Paranasal Sinus Diseases, Polyps, Tomography, X-Ray Computed