Radiologic features caused by cholesterol granuloma in jaw bone

Abstract

Objectives: The present study was carried out to investigate the radiologic features of the jaw lesions which were accompanied by cholesterol granuloma and to find out their correlation with histopathological findings. Materials and Methods: CT and panoramic images of 40 patients that were histologically diagnosed as cholesterol granuloma in the jaw bone from 2003 to 2013 were reviewed retrospectively. Of the 40 cases, there was no available radiograph for 6 cases, 3 cases were found in the maxillary sinuses, and 4 cases showed insufficient microscopic slides for investigation. Finally 27 cases were selected. They were classified into 3 groups (low aggressiveness, moderate aggressiveness, high aggressiveness) according to the radiographic features, such as external root resorption, cortical perforation, septa within the lesion or scalloping margin, and abrupt expansion. Then the histopathologic features were reviewed to investigate the existence of cystic structure of cholesterol granuloma, its location, the area ratio of cholesterol granuloma and the degree of severity of inflammation. The relationship between the histopathologic features and the radiographic aggressiveness were examined. Results: According to radiographic impression, 27 cases were composed of 5 cases of dentigerous cyst, 6 cases of periapical cyst, 3 cases of ameloblostma, 6 cases of keratocystic odontogenic tumor, 1 case of myxoma, 1 case of incisive canal cyst and 1 case of residual cyst. While, by histopathologic examination, they were revealed as 7 cases of dentigerous cyst, 8 cases of periapical cyst, 8 cases of cholesterol granuloma, 1 case of simple bone cyst, 1 case of periapical abscess, 1 case of incisive canal cyst and so on. Concerning the location of the cholesterol granuloma, when cholesterol granuloma was located in the cavity, even though the size of cholesterol granuloma was big in the specimen, the radiographic impression showed low aggressiveness. When cholesterol granuloma was located in the cystic wall, the area occupied by cholesterol granuloma showed positive relationship with the radiographic aggressiveness. High aggressiveness group, moderate aggressiveness group and low aggressiveness group showed 75, 38, 10 unit area on average, respectively. However, the analysis on the relationship between severity of inflammation and the radiographic aggressiveness did not show statistically significant correlation. Conclusion: With cholesterol granuloma growing up in the cystic wall of the jaw lesions, their radiographic impressions show more aggressiveness.