Radiotherapy of polymorphic reticulosis.

The term "lethal mid-line granuloma" does not properly reflect current knowledge that several different diseases can produce non-infectious mid-facial destruction. The disorders producing erosion of the upper aerodigestive passages are more accurately classified by clinical and histological criteria as either Wegener's or non-Wegener's causes. The non-Wegener's causes of mid-facial erosion include extranodal lymphoma, idiopathic mid-line granuloma and polymorphic reticulosis. Polymorphic reticulosis (PR) is a rare disease which is histologically identical to lymphomatoid granulomatosis (LG). The term PR has been used to describe LG localized to the upper airways. PR-LG is characterized by a remarkably polymorphic angiocentric mixed cellular infiltrate. The disease is locally invasive, has the potential for distant spread, and can cause fever, sweats and weight loss. When it is localized to the upper airways, PR-LG is potentially controllable by radiation therapy. Local symptoms at other body sites can be successfully palliated by radiation. The clinical presentation of two recent patients with PR-LG is summarized, as well as the radiotherapy employed. The pertinent literature is reviewed.