Midline destructive granuloma: fact or fiction

Although differentiation of Wegener's granulomatosis from other destructive midline lesions is now clearly recognized by clinicians and pathologists, confusion persists regarding the management of what has erroneously been called "lethal midline granuloma." The experiences of 36 patients with destructive midline granuloma supports the view that probably all are manifestations of malignant lymphoma and should be treated as such. Although radical dosage radiotherapy will control most local lesions, dissemination of lymphoma may still occur despite absence of systemic disease at initial diagnostic work-up. Subsequent control with cytotoxic drugs is frequently unsuccessful, and it is suggested that chemotherapy should be given routinely to every patient with primary nasal lymphoma and possibly to those with polymorphic reticulosis or necrosis with atypical cellular exudate (NACE).