GIANT CHOLESTEROL GRANULOMA OF THE BREAST MIMICKING CARCINOMA AND PHYLLODES TUMOR: A CASE REPORT

Abstract

Background: Cholesterol granuloma of the breast is a rare benign inflammatory lesion characterized histologically by cholesterol clefts surrounded by foreign body giant cells and chronic inflammatory infiltrate. Clinically and radiologically, it may closely mimic breast carcinoma, making preoperative diagnosis difficult. Most reported cases in literature describe small lesions measuring only a few centimeters in diameter. Giant cholesterol granulomas of the breast are extremely uncommon and may create significant diagnostic uncertainty. Case Presentation We report the case of a 75-year-old Indian woman who presented with a progressively enlarging right breast mass over two years associated with pain and stretching of the overlying skin. Clinical examination revealed a large 20 × 16 × 15 cm breast mass with prominent superficial veins and palpable axillary lymphadenopathy, raising suspicion for locally advanced breast carcinoma. Ultrasonography demonstrated a heterogeneous cystic lesion with solid components, suggesting a phyllodes tumour or malignancy. Because of significant skin thinning and the predominantly cystic nature of the lesion, preoperative core needle biopsy was deferred. The patient subsequently underwent right simple mastectomy with sentinel lymph node biopsy. Histopathological examination revealed numerous cholesterol clefts surrounded by foamy macrophages and foreign body giant cells within a background of chronic inflammatory infiltrate, confirming the diagnosis of cholesterol granuloma. No evidence of malignancy was identified. Conclusions Cholesterol granuloma of the breast may closely mimic malignant breast tumors both clinically and radiologically.  Although most reported lesions are small, this case demonstrates that cholesterol granuloma can occasionally present as a giant breast mass, creating significant diagnostic challenges. Awareness of this rare entity is important when evaluating suspicious breast lesions, and histopathological examination remains essential for establishing the definitive diagnosis.