Cholesterol granulomas in lymph nodes draining a benign ovarian neoplasm.
A 69-year-old woman underwent a hysterectomy and bilateral salpingo-oophorectomy for a 20-cm right ovarian tumor. Multiple peritoneal and lymph node biopsy specimens were obtained to determine the clinical stage. Despite the surgeon's concern of malignancy, pathologic examination demonstrated a benign mucinous cystadenoma. Periaortic and external iliac lymph nodes showed an unusual granulomatous reaction, with multinucleated giant cells surrounding cholesterol-like clefts. Analysis of cyst fluid from the ovarian tumor revealed high concentrations of protein and lipid; the lipid component was predominantly free cholesterol (0.61 mumole/mL) and phospholipid (0.225 mumole/mL). We speculate that fluid from the ovarian neoplasm drained into regional lymph nodes, causing this unusual granulomatous response.
D000368:Aged; D002784:Cholesterol; D003537:Cystadenoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D006099:Granuloma / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery
D002784:Cholesterol