Multiple cranial nerve palsies in late metastasis of midline malignant reticulosis

A 12-year-old man had a sudden onset of multiple cranial nerve palsies after treatment for a necrotizing lesion of the soft palate two years previously. It was thought that neurologic signs were secondary to extension of the local disease and radiation therapy to the base of the brain was begun. The patient died shortly thereafter. A diffuse atypical histiocytic lymphoma involving multiple cranial nerves, lumbosacral nerves, orbital muscles, and other organs was found on autopsy. Initial nasopharyngeal biopsy and autopsy findings were compatible with midline malignant reticulosis, a malignant lesion of the upper airway sometimes associated with metastasis. Our case is the first reported autopsy-documented case, to the best of our knowledge, of metastatic involvement of the cranial nerves in midline malignant reticulosis.