title: Tympanomastoid cholesterol granuloma: radiological and intraoperative findings of blood source connection.
abstract: The hypothesis that the close contiguity between the cholesterol granulomas and some rich blood sources provided the trigger to the aggressive nature of tympanomastoid cholesterol granulomas has been recently reported. To corroborate this new etiopathogenetic theory we retrospectively reviewed a series of 14 patients with primary middle ear and mastoid cholesterol granulomas and investigated the temporal bone marrow invasion and its hematopoietic potentialities and a possible cholesterol granulomas contiguity with relevant vascular structures such as the carotid artery, sigmoid jugular system, mastoid or dural vein. Eight cases did not show radiological sign of bone marrow invasion or hematopoietic potentialities visible in MRI. Besides no intraoperative vascular connections that could explain an initial bleeding source were found. Cholesterol granulomas bone marrow invasion was present in six patients. A bone marrow hematopoietic potentiality was showed in four of these patients, whereas, an evident anatomical contiguity of the cholesterol granuloma with some important temporal bone vascular structures was visible in five cases. Analysis of cardiovascular risk factors showed that four patients presented one or more of the risk factors analysed.
authors.affiliation: 'Organi di Senso' Department, 'Sapienza' University of Rome, Viale del Policlinico, 151, 00161, Rome, Italy.
authors.forename: Giannicola
authors.initials: G
authors.lastname: Iannella
authors.affiliation: Emergency Radiology Department, 'San Camillo' Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stasolla
authors.affiliation: 'Organi di Senso' Department, 'Sapienza' University of Rome, Viale del Policlinico, 151, 00161, Rome, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Pasquariello
authors.affiliation: Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Re
authors.affiliation: 'Organi di Senso' Department, 'Sapienza' University of Rome, Viale del Policlinico, 151, 00161, Rome, Italy. giuseppemagliuloorl@yahoo.com.|, Via Gregorio VII n. 80, 00165, Rome, Italy. giuseppemagliuloorl@yahoo.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magliulo
mesh_terms: D001808:Blood Vessels / Q000473:pathology; D001856:Bone Marrow Examination / Q000379:methods; D002784:Cholesterol; D018450:Disease Progression; D004428:Ear Neoplasms / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D015745:Granuloma, Foreign-Body / Q000097:blood / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D013506:Otologic Surgical Procedures / Q000379:methods; D010579:Petrous Bone / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D002784:Cholesterol
keywords: Cholesterol granuloma; Exposed marrow theory; Obstruction vacuum theory; Petrous bone