Abstract Midline lethal granuloma remains as much a mystery as when it was first described before the turn of the century.1 A rare condition which usually starts in the nose, it spreads centrifugally, involving both superficial and deep nasal tissues. There is first local thickening and gradual interference with tissue nourishment and drainage. Ulceration may occur early or late. Strangely, there is no leukocytosis or toxemia. Initially, the patient usually feels well except that he is concerned with his appearance. Not until the downward swing does the patient complain of fatigue. There is no regional lymphadenopathy so characteristic of canceration nor is there the lymphatic spread to satellite lesions seen in fungus infections. The process may be slow or rapid. Disfiguring lesions are markedly manifested during the terminal phase of the disease. The pathologic picture usually consists of a chronic fibrous, nonspecific inflammatory granulation tissue infiltrated by pleomorphic inflammatory cells. References 1. McBride, P.: Photographs of a Case of Rapid Destruction of Nose and Face , J. Laryng. & Otol. 12:64, 1897. 2. Alexander, F. W.: Lethal Granuloma of the Nose and Face , Ann. Otol. Rhin. & Laryng. 63:171, 1954. 3. McKibben, B. G., and Bayliss, M. W.: Lethal Midline Granuloma and Periarteritis Nodosa , U. S. Armed Forces M. J. 7:1665, 1956. 4. Ellis, M.: Malignant Granuloma , Brit. M. J. 1:1251,1955. 5. Lederman, M.: Radiotherapy in the Treatment of Orbital Tumors (Malignant Granuloma) , Brit. J. Ophth. 40:593, 1956. 6. Friedman, I.: Pathology of Malignant Granuloma , J. Laryng. & Otol. 69:331-341, 1955. 7. Moore, P. M.; Beard, E. E.; Thoburn, T., and Williams, H. L.: Idiopathic (Lethal) Granuloma of the Midline Facial Tissues Treated with Cortisone: Report of a Case , Laryngoscope , 61:320, 1951.
A.M.A. Archives of Otolaryngology – American Medical Association
Published: Apr 1, 1959