Cholesterol granuloma in the wall of dentigerous cyst

Abstract

Cholesterol granuloma is an inflammatory reaction to cholesterol crystals deposition which may develop in a variety of sites including the middle ear, mastoid process or even paranasal sinuses. A dentigerous cyst is the one that encloses the crown of unerupted tooth by expansion of its follicle & is attached to the neck of the tooth. Histopathological examination usually shows a thin fibrous cyst wall which, being derived from dental follicle, consists of young fibroblast widely separated by stroma and ground substance rich in mucopolysaccharide. cholesterol crystals which presents as longitudinal clefts in histologic sections, are frequent feature in the inflammatory lesions like radicular cyst but are very rare in dentigerous cyst. This case study presents an unusual case of cholesterol granuloma occurring in dentigerous cyst wall.

Cholesterol Granuloma in Odontogenic Cyst: An Enigmatic Lesion

“…Lowest incidence was reported in noninflammatory cysts such as odontogenic keratocyst [5]. In all of our cases, CG is seen in the wall of cysts with developmental background.…”

Cholesterol Granuloma in Dentigerous Cyst: A Diagnostic Dilemma

“…14 Although rare but inflamed dentigerous cyst walls occasionally may contain cholesterol crystals similar to those reported in radicular cysts. 4 Sahuran et al in 2018 also reported a case of infected dentigerous cyst with cholesterol clefts in the mandible in a 58-year-old man with type 2 diabetes. A similar case was reported by Bhullar et al in which he presented an unusual case with the presence of longitudinal cholesterol clefts in dentigerous cyst histopathologically in 43-year-old male patient.…”

“…A similar case was reported by Bhullar et al in which he presented an unusual case with the presence of longitudinal cholesterol clefts in dentigerous cyst histopathologically in 43-year-old male patient. 4 Cholesterol granuloma is a large collection of longitudinal clefts representing sites of cholesterol crystals which have dissolved during processing, with surrounding foreign body giant cells and macrophages filled with hemosiderin and embedded in fibrous granulation tissue. 15 It is known to develop in a variety of body areas such as: the middle ear which is the most common site, followed by mastoid process, testis, lungs, apex of temporal bone pyramid, and paranasal sinuses.…”

“…3 Although dentigerous cyst do not show signs of inflammation but inflamed dentigerous cyst walls occasionally may contain cholesterol crystals, hemosiderin pigments, and Ruston's hyaline bodies similar to those reported in radicular cysts. 4 So, here we present a rare case of dentigerous cyst with cholesterol clefts. The main aim of the case presentation is its unique nature and rare prevalence.…”

Relação entre presença de fendas de cristais de colesterol em lesão periapical e nível de colesterol sérico

“…De acordo com a literatura, existem algumas vias de formação do colesterol, sendo que Schulz et al 6 (2009) e Bhullar et al 11 (2012) sugerem que o colesterol pode ser liberado por uma combinação de reações de tecidos diferentes, tais como desintegração dos linfócitos, plasmócitos, macrófagos e vasos sanguíneos dentro da lesão periapical. Além disso, tem-se observado a presença do perlecan, um proteoglicano de sulfato da membrana basal do tipo heparan, em lesões inflamatórias, de modo que, dentre as suas cadeias dominantes, a segunda é receptora da lipoproteína de baixa densidade (LDL) 12,13 .…”