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Lethal Midline Granuloma

When your diagnosis contains the word "Lethal," it's OK to feel a twinge of apprehension. But if they've found an expanding eruption of granulomatous tissue gnawing a cavity behind your nose and eyeballs, then you'd better start reading the fine print on your life insurance policy.

Tiny foci of lingering inflammation can grow into "granulomas" of inflammatory cells that are gradually walled off into harmless balls of bone-like calcium. This is a normal response to a tough-to-beat infections like histoplasmosis or tuberculosis. But when granulomas "go rogue" -- appearing for no reason in your lungs or kidneys, annihilating blood vessels or, in the case of Lethal Midline Granuloma, attacking the bone of your sinuses and carving a massive hole in your face -- then you have a problem that will make your doctor want to go hide under his bed.

Don't expect much help from any patient-advocate groups. Most of the people diagnosed with this disease are probably already dead. Don't go looking for links to nasty pictures. Believe me -- you don't want to see them. Treatment choices are slim, but as in international politics, there is always a "nuclear option" -- massive, focused radiation to kill the tumor. However, what's left may not resemble the picture in your high school yearbook.

Fortunately, Lethal Midline Granuloma is rarely diagnosed -- and in fact it may now be nonexistent. Because the disease is so hard to treat, most doctors have taken to calling it something else, the more cheerful-sounding "Extranodal NK-T-cell Lymphoma." A cure for that is expected any time now.

Your headache and occasional nosebleed are probably just a sinus infection, so don't lose any sleep over this one. However, the next time you see someone reach for the nasal spray, be sure to inquire: "Is it Lethal Midline Granuloma?"

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