Pathology of 'nonhealing (midline) granuloma'

Abstract

In a histologic study of biopsy and postmortem material from 30 cases of nasal disease in which the clinical diagnosis of 'midline granuloma' or Wegener's granuloma had been made, 10 cases selected on the basis of the presence of widespread coagulative necrosis and atypical cells. Evidence is provided that such changes represent a malignant neoplasm of histiocytic lymphoma type. Local invasion and spread to cervical and more distant lymph nodes, spleen, liver, and kidney were seen in some of the cases. Erythrophagocytic activity was marked in the spleen in 3 cases and histiocytic infiltration of the bone marrow in 2 cases, indicating a more generalized activity of histiocytic cells. Terms such as 'malignant granuloma' should be abandoned. In obstructive and ulcerating conditions of the nose, an accurate histiologic diagnosis should be made.