Lethal midline lymphoma causing acute dacryocystitis.

'Midline lethal granuloma' or 'nonhealing midline granuloma' is a rare and dramatic condition causing progressive ulceration and destruction of the nasopharynx, nose, and face and the demise of the patient from a disfiguring and most unpleasant illness. The differential diagnosis covers a wide spectrum of inflammatory and neoplastic diseases, but there are a group of patients where no precise diagnosis is made. The pathology of this group has recently been clarified' and the diagnosis of midline granuloma is no longer universally accepted.2 Many of these previously undiagnosed lesions have been shown to have a lymphomatous origin,3 and an appreciation of this has rationalised their therapy, which had previously been based on the clinical response to steroids, cytotoxic drugs, or radiotherapy. We report the case and pathology of a patient with a midline lymphoma that was fatal. During the course of her illness she developed acute dacryocystitis, which was a considerable management problem for the ophthalmologists.