Diagnosis and treatment of the so-called malignant granuloma of the nose is discussed in a study of 27 cases. This gangrenous condition consists of two diseases, one reticulum cell sarcoma, the other Wegener's granulomatosis. However, a few cases with undefined clinical and histological features remain neither to be distinguished. But these cases will be certainly classified into either of the two in near future.
Differential diagnosis of the two diseases is as follows. In Wegener's granulomatosis, 1) superficial and bilateral lesions of the nasal cavity, 2) frequent involvements in the middle ear, larynx and trachea without lesions of the face, 3) rare involvement in the pharynx, 4) round shadow or cavity formation in X-ray of the lung, 5) increase in the serum globulin value, 6) giant cell granuloma and vascular changes in histological findings, and 7) renal or respiratory failure in the terminal stage are noticed.
In reticulum cell sarcoma, 1) destructive and unilateral lesion of the nasal cavity, 2) occasional facial lesion with bony destruction, 3) involvements in the soft palate and in the pharynx without lesions in upper respiratory tract, 4) occasional pneumonia, 5) normal serum globulin value, 6) non-specific granulation or sarcomatous changes in the histological findings, and 7) pneumonia, extensive destruction of the nasal lesion and cachexia in the termination are found.
It is widely agreed that irradiation is the most promising therapy for reticulum cell sarcoma and that the use of steroids is most effective for Wegener's granulomatosis. However, when the diagnosis is not definitely decided by the initial biopsy and clinical findings, it is emphasized that combined irradiation therapy with the use of steroids, antibiotics and occasional blood transfusion should be performed at early stage of the disease and further biopsies and clinical examination must be carried out for the differential diagnosis. Prognosis of the malignant granuloma of the nose is fairly good in our cases. Fifteen of 27 cases are alive (55%). Five years survival ratio is 58% in fourteen cases of Wegener's granulomatosis, 50% in ten cases of reticulum cell sarcoma and 0% in three cases which were not differentially diagnosed.
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