Adult T-cell leukemia-lymphoma manifesting as lethal midline granuloma; A case report.

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A 44-year-old male was referred to our hospital with a spiking fever, a fetid necrotic mass in the left nasal cavity, and erosion in the midline of the hard palate. These clinical findings suggested a lethal midline granuloma. Biopsies were done several times, and the final pathological diagnosis was malignant lymphoma, diffuse pleomorphic type. Immunohistological examination showed a malignant lymphoma of the inducer/helper T cell type. The anti-ATLA antibody titer was 1: 320. On the basis of these findings, this case was classified as ATLL, and treatment with combined irradiation and chemotherapy was instituted. The patient recovered well, and no recurrence has been observed during the one year follow-up.Midline granuloma is not a pathological entity, and lymphoma is one of the many pathological conditions that may give rise to necrosis in the nose. ATLL is discussed in relation to this problem.
耳鼻咽喉科臨床学会の論文