This 70-year-old patient presented with a transient left sided weakness. Their past medical history included hypertension, hypothyroidism, and coronary artery disease status-post placement of cardiac stents. Laboratory studies showed mild elevation of CPK (500). Brain MRI showed acute lacunar ischemic infarcts involving the left pons.
What do the cleft-like optically clear spaces within the foci of granulomata represent?
A. Cholesterol
B. Foreign body
C. Talc
D. Artifact
This medium magnification image shows multiple well-circumscribed areas of hypercellularity with the perimysium. Occasional lymphocytes are noted toward the periphery of the collections.
Higher magnification shows that the cells have cytomorphologic features of macrophages (i.e. this represents granuloma formation). Multiple biconcave optically clear areas (arrows) are present towards the center of the granuloma.
Answer: Cholesterol
The optically clear spaces are characteristic of cholesterol crystals. Lipids (including cholesterol) are extracted during tissue processing for paraffin block embedding. The biconcave optically clear spaces correspond to the areas that were occupied by cholesterol from cellular breakdown and/or atheroemboli.
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