Lymphomas of the head and neck. 1: Nasofacial T-cell lymphoma

Nasofacial T-cell lymphoma includes diseases otherwise called "lethal midline granuloma" and "necrosis with atypical cells". It is characterised by relentless destruction of nose and palate in particular but the lymphoma remains localised to the head and neck. The age of onset ranges from 10 to 87 and the survival ranges from a few months to several years. The histological appearances are of a polymorphic infiltrate but including atypical T cells in a background of macrophages. There is a strong association with Epstein-Barr virus infection.

Fireside conference 19. Wegener's granulomatosis and lethal midline granuloma

In summary, Wegener's granulomatosis is a systemic illness that is characterized pathologically by necrotizing granulomatosis and vasculitis. Lethal midline granuloma is not a pathological term. Lethal midline granuloma is a clinical term, and in reality, lethal midline granuloma has been proven to be polymorphic reticulosis and not Wegener's granulomatosis. Polymorphic reticulosis is now understood to be a T-cell lymphoma. Further study of these malignant lymphomas has shown that these T-cell lymphoproliferative disorders may be causally associated with Epstein-Barr virus. Although there is strong association between autoantibodies against cytoplasmic constituents of neurophils and monocytes in patients with active Wegener's granulomatosis, the exact pathogenic mechanism in Wegener's granulomatosis and the etiology is still unknown. IgG-C-ANAC (C-ANAC stands for Classical/Cytoplasmic Anti-Neutrophil Cytoplasm Antibodies) increases with increasing disease activity from undetectable levels to up to 95% of active Wegener's granulomatosis patients. Rhinologic symptoms in Wegener's granulomatosis include progressive nasal obstruction, bloody rhinorrhea with crusting, and vague pain and tenderness of the nasal dorsum. Usually these patients have mucosal ulcerations of the nose with or without a septal perforation. Other areas of the head and neck can be involved, and they include orbital, otologic, oral, and subglottic involvement. Hallmarks of malignant lymphoma (polymorphic reticulosis) when it involves the upper airway include rapid localized destruction of the nose, orbit, paranasal sinuses, and hard palate. Treatment for Wegener's granulomatosis includes antimicrobial agents in addition to a regimen of cyclophosphamide and glucocorticoids. The treatment for malignant lymphoma (polymorphic reticulosis) is primarily radiation, especially when confined to one site.

[Lethal midline granuloma (LMG). Review of the literature and report of a case]

After accurate review of current knowledge on etiology, pathogenesis, immunological studies and the clinical aspects of Lethal Midline Granuloma, the Authors report a recently observed case.

Wegener's granulomatosis

A review of 108 patients with Wegener's granulomatosis clarified the diverse clinical manifestations and disclosed some of the less well-known areas of involvement. Because of the frequency of nasal involvement in Wegener's granulomatosis, the otolaryngologist plays an important role in the early diagnosis and treatment.

THE PATHOLOGY OF MIDLINE GRANULOMA

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