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Cholesterol granuloma of the temporal bone: a pathologic designation or a clinical diagnosis?

Cholesterol granuloma has traditionally been defined as a light microscopic entity and specifically as a granulomatous lesion containing prominent cholesterol crystals. As such, the term has been used to describe the microscopic sequelae of hemorrhage into the middle ear and mastoid in cases of chronic otitis media; in addition, cholesterol granuloma may also develop quite rapidly in cases of acute hemorrhagic otitis. Although this lesion can be found in many areas of the body, including the paranasal sinuses, lung, pleura, mediastinum, peritoneum, thyroid, brain, orbit, jaw, testis, kidney and lymph node, the temporal bone is the commonest site in which cholesterol granulomas are detected [1,2]. Cholesterol granulomas have also been described under the names cholesterol cyst, idiopathic hemotympanum, blue drum membrane, blue eardrum, blue dome cyst, chocolate cyst, cholesterin pseudocyst, black cholesteatosis, black cholesteatoma and endogenous cholesteatoma. Cholesterol granuloma of the temporal bone was first described by Manasse [3] in 1894 and has often been confused with cholesteatoma by pathologists and clinicians; this is more than a mere semantic difference, however, and it is important to distinguish the two entities because of differences in their treatment [4]. Incidence