Eosinophilic ulcer of the tongue

Eosinophilic ulcer of the oral mucosa

BACKGROUND

The eosinophilic ulcer is a rare lesion of the oral mucosa that has been infrequently described in the literature.

OBJECTIVE

We attempted to characterize the history, demographics, clinical features, histologic features, pathogenesis, and treatment of the eosinophilic ulcer.

METHODS

We observed three new cases of eosinophilic ulcer and reviewed the English-language literature.

RESULTS

Eosinophilic ulcer occurs in any age group, without sex preference. The most common site in the oral cavity is the tongue, and the average size at diagnosis is 1.6 cm2. These lesions are often ulcerated, may be tender, and are sometimes multiple. The histologic features are characteristic but likely represent a spectrum of related disorders. Most eosinophilic ulcers will resolve spontaneously within a month. Recurrences are uncommon (< 15%).

CONCLUSION

The eosinophilic ulcer is a benign, self-limited, reactive process of the oral mucosa of unknown origin. Its histologic features are characteristic but may be confused with atypical histiocytic granuloma and angiolymphoid hyperplasia with eosinophilia or, more importantly, lymphoma. This condition most likely represents a spectrum of related disorders with overlapping clinical and histologic features. After the diagnosis has been histologically confirmed, conservative management is suggested.

Multiple linear ulcers on the dorsum of the tongue in a patient with Waldenstrom's macroglobulinemia

An unusual clinical presentation of an eosinophilic ulcer of the tongue has been described. This lesion is seen most often in the fourth to sixth decades of life and has been shown to have a strong predilection for males. The etiology is unknown although trauma has been implicated by several investigators. Because of the clinical resemblance of eosinophilic ulcer to carcinoma, biopsy examination is recommended. After the diagnosis is made, conservative management is most appropriate.

Eosinophilic ulcer of the oral mucosa

Two additional cases of eosinophilic ulcer of the oral mucosa are presented. Both patients were treated with corticosteroids, with favorable results. A review of the literature provided useful information on the clinical characteristics, histologic features, method of treatment, and benign course of the lesions.

Traumatic ulcerative granuloma with stromal eosinophilia (Riga-Fede's disease and traumatic eosinophilic granuloma)

A review of the English literature revealed ten lesions classified as Riga-Fede's disease and nineteen lesions classified as traumatic eosinophilic granuloma. These two entities have the same histologic features and are often associated with a history of trauma. These are benign, reactive, nonosseous lesions that occur either in infancy or later in life. It is suggested that they be considered as one entity. To delineate them from more aggressive lesions, such as the eosinophilic granuloma of histiocytosis X, the author suggests the term traumatic ulcerative granuloma with stromal eosinophilia. Forty-one previously unreported cases are described. Histologic examination revealed the presence of mast cells in addition to eosinophils. A pathogenesis for traumatic ulcerative granuloma with stromal eosinophilia, based on the hypothesis that mast cells release an eosinophilic chemotactic factor and that eosinophils may act as cytotoxic agents, is suggested.

Traumatic granuloma of the tongue

The traumatic granuloma is a rare, reactive lesion that occurs primarily in the tongue of males. It can mimic other diseases, including malignancy, both clinically and histologically. It is, therefore, a lesion with which clinicians and pathologist should be familiar.