Midline destructive lesions: A diagnostic challenge

Midline destructive lesions (MDLs) are a diagnostic challenge due to an extensive differential diagnosis and vague presenting signs and symptoms. It may be due to neoplastic, autoimmune, traumatic, infectious, or unknown. The lethal lesions are characterized by ulcerative destruction of midline structures of the face like the nose, paranasal sinus and palate. A spectrum of diseases with myriad clinicopathological features can present as midline destructive lesions. Immunohistochemistry has played a major role in discerning the wide range of diseases into specific categories over the years.