midline granuloma (facial granuloma)

Introduction

Chronic inflammatory disease characterized by thrombosis of small blood vessels & focal necrosis leading to destruction of the nasal septum, palate, paranasal sinuses & midline facial structures.

Etiology

angiocentric T-cell lymphoma

Epidemiology

more frequent in women

Clinical manifestations

• initial manifestations
  • rhinorrhea
  • nasal congestion & pain
  • paranasal sinusitis
• advanced manifestations:
  • inflammation & ulceration of nasal septum & palate
  • perforation & destruction of midline facial structures
    • pharynx
    • eyes
    • sinuses
    • mouth
  • death from:
    • cachexia
    • pneumonia
    • meningitis
    • hemorrhage

Laboratory

• complete blood count (CBC): leukocytosis
• skin biopsy

More general terms

• granulomatous disease
• thrombophlebitis (includes superficial venous thrombosis)

Additional terms

• angiocentric T-cell lymphoma (lymphomatoid granulomatosis, polymorphic reticulosis, midline malignant reticulocytosis, Stewart's granuloma)