Primary lymphoma of the nose including a relationship to lethal midline granuloma

From 1933 through 1962 thirty-three patients who had nasal lymphoreticular lesions previously diagnosed as lymphoma were seen at the Mayo Clinic. Of the thirty-three patients twenty-three were men and ten were women. Their ages ranged from twenty-five to seventysix years and 70 per cent were more than forty years of age. The most frequent complaints were progressive nasal obstruction and nasal, facial, or orbital swelling. The nasal involvement was bilateral in 27 per cent of the cases. Cell types of twenty-four lesions were those of typical lymphoma and those of nine lesions had a polymorphocellular composition. The growths exhibiting typical lymphoma cell types more often grossly tumorous and symptomatically of shorter duration, while the polymorphic type was more frequently ulcerative and had longer prodromata of nasal symptomatology in many cases. Radiotherapy was the treatment of choice. The five year survival rate in the thirty-three cases was 56.7 per cent and the ten year survival rate, 34.8 per cent. Patients having stage I lesions without extension to neighboring sinuses, orbit, or pharynx did much better than those with this extension or patients with stage II involvement. The most striking feature of our study was that the five year survival rate of the twenty-four patients with typical lymphoma in stage I was 41.2 per cent with an over-all survival rate of 38.1 per cent while all nine patients with polymorphic lesions survived five or more years. A relationship may exist between these nine polymorphic lesions and certain lesions reported as lethal midline granuloma, although polymorphic reticulosis is suggested as a more descriptive morphologic term.