Midline Granuloma

Abstract

Midline granulomaor nasal type extranodal T/NK-cell non-Hodgkin’s lymphoma often cause various problem. This tumor is a disorder of the center of the face with the characteristic of progressive destruction and ulceration, including the nose, paranasal sinuse, palate, eyes, and facial soft tissues. Etiology and pathophysiologyis unclear between inflammatory and tumor reactions. Midline granulomais included innasal granuloma disease based on biopsy examination, where as The Revised European American Lymphoma (REAL) / Wordl Health Organization (WHO) classifiesmidline granulomainextranodal T/NK-cellnon-Hodgkin’s lymphomabased on immunohistologic examination. Epstein-Barr Virus (EBV) infections 90-100% are involved in the tumor formation process. Difficult diagnosis and wide-ranging diagnosis, requiring complete anamnesis and examination, especially biopsy, imunohistology, and cytogenetics in obtaining necrosis features with vascular destruction and ulceration, inflammation with pleomorphic cell infiltrate, CD56+, CD3+, cytotoxict and EBV+ proteins. Management with radiotherapy, chemotherapy, bone marrow transplant, and immunotherapy. Complications can occur locally or systemically with spread to peripheral blood circulation, soft tissue, lung, liver, skin, gastrointestinal tract, testes, central nervous and bone marrow. Poor prognosis is less than 50%of patient who respond fully after chemotherapy and radio therapy. Pronosis can only be assessed by the International Prognostic Index (IPI).
 Midline diagnosis of granulomais difficult,management is often delayed, while its progressive nature leads to various complications, thus further aggravating the prognosis.