Basement membrane‐type heparan sulfate proteoglycan (perlecan) and low‐density lipoprotein (LDL) are co‐localized in granulation tissues: a possible pathogenesis of cholesterol granulomas in jaw cysts

Abstract

These results suggest that perlecan, which is abundantly produced and accumulated in the cyst wall of immature granulation tissue, traps Ox-LDL locally, and that Ox-LDL is phagocytosed by macrophages. Thus, LDL-laden foamy macrophages are aggregated in the granulation tissue, and free cholesterol from ruptured macrophages may be concentrated locally to be crystallized, which may induce foreign body granulomas in the cyst wall.

Perlecan, a Basement Membrane-type Heparan Sulfate Proteoglycan, in the Enamel Organ: Its Intraepithelial Localization in the Stellate Reticulum

“…ies, we showed that perlecan was most enhanced in the early phase of granulation tissue formation processes, which showed myxoid appearance, in the oral cavity (Murata et al 1997;Yamazaki et al 2004) and gastrointestinal tracts (Ohtani et al 1993). Similar results were obtained in the myxoid stroma of adenoid cystic carcinoma (Cheng et al 1992), pleomorphic adenoma (Saku et al 1990), and adenomatoid odontogenic tumor (Murata et al 2000).…”

Histopathological study of radicular cysts diagnosed in a Brazilian population

“…These defense cells may also phagocytose cholesterol crystals and are called foamy macrophages (3,4,21). However, phagocytosis may not occur in the presence of some crystals exhibiting a large diameter, an event that induces the release of cytokines such as IL-1, impairing the repair process after endodontic treatment (3,6,(20)(21)(22)(23).…”

“…However, phagocytosis may not occur in the presence of some crystals exhibiting a large diameter, an event that induces the release of cytokines such as IL-1, impairing the repair process after endodontic treatment (3,6,(20)(21)(22)(23). Thus, the presence of cholesterol crystals is an important factor for lesion persistence (3,4,(20)(21)(22). These crystals may originate from the crystallization of lipids ingested from the vascular system itself, or may result from the production of local metabolites in the granulation tissue of the cystic wall and from the phagocytosis of the cell membranes of dead cells (21).…”

“…During these events of defense, different cells produce cytokines, mainly interleukin 1 (IL-1), IL-6 and tumor necrosis factor alpha (TNF-α), which are involved in this immunoinflammatory response and play a role in bone resorption and in the stimulation of mitogenesis (2). In addition, foreign body-type material and other morphological findings might be observed in RCs, either potentiating the inflammatory process (3,4) or as a result of the defensive mechanism of the organism itself.…”

Cholesterol granuloma in the wall of a mandibular dentigerous cyst: a rare case report

“…The deposited cholesterol crystals act as an irritant which attracts foreign body giant cells and causes fibrosis (2).Based on this mechanism, cholesterol granuloma is not expected to occur in the mandible due to the absence of intrabony cavities or drainage pathways. A recent study by Yamazaki et al (8) suggests that perlecan (a basement membrane heparan sulfate proteoglycan) which is present abundantly in the cyst wall of immature granulation tissue might be related to the development of cholesterol granulomas. To the best of our knowledge, the case reported by Hirschberg et al (9) is the only case of cholesterol granuloma reported in the mandible in English literarure.…”