12/09/2004 Case 3: Cholesterol granulomas of the CP angle

Clinical History:

A 32 year old man had progressive right-sided hearing loss, and a CT scan showed a mass in the right CP angle arising from the petrous apex. On MRI scans the lesion had a high signal on T1 weighted images and was heterogeneous in T2 weighted images. There was no contrast enhancement. Multiple small fragments were submitted from a gross total resection.

Diagnostic Notes:

The sections showed an inflammatory mass with cholesterol clefts, and multinucleated foreign-body type giant cells. There was also some hemosiderin. The diagnosis was Cholesterol Granuloma of the CP Angle. There was no evidence for keratin or epithelium as from a keratinous cyst or dernloid. Dr Rao noted that a case of this entity has been reported in association with a cholesteatoma (see Brain Pathology 2001).

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