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Lakkam BD, Astekar M, Alam S, Saleem A. Traumatic ulcerative granuloma with stromal eosinophilia: A puzzle. J Oral Maxillofac Pathol 2021; 25:S42-S45. [PMID: 34083969 PMCID: PMC8123250 DOI: 10.4103/jomfp.jomfp_321_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/29/2021] [Indexed: 11/09/2022] Open
Abstract
Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an ulcerative condition of the oral mucosa amid a chronic course and delayed healing. It is a reactive lesion that usually affects the tongue. TUGSE is a rare mucosal lesion to aid as an ulcer or an indurated submucosal mass and might cause diagnostic problems as it mimics a traumatic or neoplastic ulcer. However, chronic irritation from traumatic agents is well thought out to be a major initiating aspect. Histopathologically, it is categorized by an eosinophilic inflammatory infiltrate penetrating into the underlying muscle. It is significant to make out this mucosal lesion as it mimics malignant ulcers; the condition tends to resolve on its own. Thus, attentiveness of this entity is imperative to emphasize the accurate diagnosis of indurated ulcerated lesions and convey suitable and effective treatment. The present case highlights the clinical aspects, etiopathogenesis and histopathology of this unusual lesion.
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Affiliation(s)
- Bhagirathi D Lakkam
- Department of Oral Pathology and Microbiology, Sri Sai Krupa Dental Clinic, Gulburga, Karnataka, India
| | - Madhusudan Astekar
- Department of Oral Pathology and Microbiology, Bareilly International University, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Shakir Alam
- Department of Oral Pathology and Microbiology, Bareilly International University, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Adeeba Saleem
- Department of Public Health Dentistry, Bareilly International University, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
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Sharma B, Koshy G, Kapoor S. Traumatic Ulcerative Granuloma with Stromal Eosinophila: A Case Report and Review of Pathogenesis. J Clin Diagn Res 2016; 10:ZD07-ZD09. [PMID: 27891480 DOI: 10.7860/jcdr/2016/22265.8657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022]
Abstract
Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE) is an uncommon condition considered to be a, reactive benign lesion of the oral mucosa, usually affecting the tongue. Its aetiopathogenesis is still uncertain. However, trauma has been found to be a contributing factor in a majority of the cases. Clinically, it often presents as an isolated ulcer or an indurated submucosal mass. Microscopically, it is characterized by a diffuse polymorphic cell infiltrate composed predominantly of eosinophils, B and T lymphocytes, macrophages, and large atypical cells involving the superficial mucosa and extending deep into the submucosa causing degeneration of the underlying muscle. TUGSE is rare and may be easily mistaken for a cancer or microbial infection, but it is self-limiting and tends to resolve spontaneously. Thus, awareness of this entity is important to emphasize the correct diagnosis of indurated ulcerated lesions and deliver appropriate and effective treatment. The present case highlights the clinical aspects, aetiopathogenesis and histopathology of this uncommon lesion.
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Affiliation(s)
- Bhushan Sharma
- Associate Professor, Department of Oral Pathology, Christian Dental College, C.M.C. , Ludhiana, Punjab, India
| | - George Koshy
- Professor, Department of Oral Pathology, Christian Dental College, C.M.C. , Ludhiana, Punjab, India
| | - Shekhar Kapoor
- Associate Professor, Department of Oral Medicine and Radiology, Christian Dental College, C.M.C. , Ludhiana, Punjab, India
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Koslovsky DA, Kostakis VA, Glied AN, Kelsch RD, Wiltz MJ. An Unusual Lesion of the Tongue in a 4-Year-Old With Job Syndrome. J Oral Maxillofac Surg 2013; 71:1042-9. [DOI: 10.1016/j.joms.2012.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 11/15/2022]
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Traumatic ulcerative granuloma with stromal eosinophilia: a lesion with alarming histopathologic presentation and benign clinical course. Am J Dermatopathol 2011; 33:192-4. [PMID: 20966736 DOI: 10.1097/dad.0b013e3181e26db0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a chronic, benign, self-limiting lesion of the oral mucosa. Clinically, the ulceration is characterized by the presence of indurated elevated borders and may resemble pyogenic granuloma or even squamous cell carcinoma of the mouth. Pathogenesis of the lesion is unclear. Although it had been suggested that TUGSE may represent a CD30+ lymphoproliferative disorder, this theory is currently not supported by evidence. We are presenting a classic example of TUGSE, its clinical course, differential diagnosis, and treatment.
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Abdel-Naser M, Tsatsou F, Hippe S, Knolle J, Anagnostopoulos I, Stein H, Zouboulis C. Oral Eosinophilic Ulcer, an Epstein-Barr Virus-Associated CD30+ Lymphoproliferation? Dermatology 2011; 222:113-8. [DOI: 10.1159/000325460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 02/07/2011] [Indexed: 11/19/2022] Open
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Joseph BK, BairavaSundaram D. Oral traumatic granuloma: report of a case and review of literature. Dent Traumatol 2010; 26:94-7. [DOI: 10.1111/j.1600-9657.2009.00816.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hirshberg A, Amariglio N, Akrish S, Yahalom R, Rosenbaum H, Okon E, Kaplan I. Traumatic ulcerative granuloma with stromal eosinophilia: a reactive lesion of the oral mucosa. Am J Clin Pathol 2006; 126:522-9. [PMID: 16938660 DOI: 10.1309/afha406gbt0n2y64] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a benign lesion of the oral mucosa of an unclear pathogenesis. We analyzed the profile of the inflammatory infiltrate in 12 cases of TUGSE by using immunohistochemical analysis and polymerase chain reaction-based repertoire analysis to detect T- and B-cell receptor gene rearrangements. The inflammatory infiltrate consisted in most cases of B and T lymphocytes, macrophages, abundant eosinophils, and large atypical cells. In 5 cases, CD30+ cells were found. Spectratyping analysis displayed a polyclonal rearrangement of the T-cell receptor g gene in 6 cases and oligoclonality in 5 cases. Monoclonality was observed in 1 case that also fulfilled histologic criteria for lymphoma. Healing was uneventful in all cases, including the one suspected of being lymphoma, with no recurrences in more than 2 years'follow-up. TUGSE can be regarded reactive. Some cases, however, may harbor a dominant clonal T-cell population; in these cases, long-term follow-up is mandatory.
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Affiliation(s)
- Abraham Hirshberg
- Department of Oral Pathology and Oral Medicine, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Kiderman A, Torten R, Furst AL, Reinus K. Bi-lateral eosinophilic ulcers in an infant treated with propolis. J DERMATOL TREAT 2001; 12:29-31. [PMID: 12171685 DOI: 10.1080/095466301750163554] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Propolis is a natural substance, produced by the honey bee, containing amino acids, flavanoids, terpenes and cinnamic acid. It has long been used in folk-medicine for topical inflammatory conditions including ulcerative lesions of different aetiologies. METHODS A 13-month-old female infant developed bilateral eosinophilic ulcers of the mouth, becoming the youngest patient in the literature so far reported to have done so. Following a protracted 4-month course, during which time the lesions remained unchanged despite various treatments, the ulcers were treated locally with a lanolin-based propolis ointment. RESULTS Application of the propolis ointment was associated with the rapid resolution of the ulcers within 3 weeks and they did not subsequently recur. CONCLUSIONS Although inevitably circumstantial, the abrupt healing of this child's chronic eosinophilic ulcers suggests that, in the light of its previously known therapeutic associations, propolis deserves further evaluation in the treatment of this condition, and perhaps in other forms of oral ulceration as well.
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Affiliation(s)
- A Kiderman
- Division of Family Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Ficarra G, Prignano F, Romagnoli P. Traumatic eosinophilic granuloma of the oral mucosa: a CD30+(Ki-1) lymphoproliferative disorder? Oral Oncol 1997; 33:375-9. [PMID: 9415340 DOI: 10.1016/s1368-8375(97)00014-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Traumatic eosinophilic granuloma of the oral mucosa, also known as eosinophilic ulcer, is considered to be a reactive lesion of unknown aetiology. It usually presents as a tongue ulcer and injury has been considered to play a role in its cause. We present a 72-year-old man who had suffered multiple episodes of recurrent eosinophilic ulcers of the oral mucosa which underwent self-healing. Biopsy specimens (including fresh tissue) were studied with a combination of histology, electron microscopy and immunohistochemistry. A dense cell infiltrate composed of eosinophilis, lymphocytes and large mononuclear cells was constantly shown. Immunostains showed that the infiltrate was mainly composed of CD3+,CD4+,CD8-T-cells and CD1a + dendritic cells. Approximately 70% of the T-cells expressed CD30 (Ki-1) antigen. On the basis of the clinical behaviour, histology and antigenic features, it seems reasonable to suggest that traumatic eosinophilic granuloma of the oral mucosa may represent the oral countpart of primary cutaneous CD30 (Ki-1)-positive lymphoproliferative disorders. This group of cutaneous lymphomas are indeed characterised by non-aggressive clinical behaviour (sequential evolution in ulceration, necrosis and self-regression) and expression of CD30 antigen by the infiltrating large T-cells.
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Affiliation(s)
- G Ficarra
- Institute of Stomatology, University of Florence, Italy
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Gopalakrishman R, Miloro M, Allen CM. Indurated ulceration of the tongue. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:119-21. [PMID: 8925387 DOI: 10.1016/s1079-2104(96)80213-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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12
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Movassaghi K, Goodman ML, Keith D. Ulcerative eosinophilic granuloma: a report of five new cases. Br J Oral Maxillofac Surg 1996; 34:115-7. [PMID: 8645663 DOI: 10.1016/s0266-4356(96)90148-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Five new cases of ulcerative eosinophilic granuloma were diagnosed at the Massachusetts General Hospital between 1982 and 1993. In all cases the site was the tongue. They were unifocal, did not recur, and had a benign course. This report illustrates their benign nature despite the occasional aggressive presentation, and outlines possible aetiology.
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Abstract
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.
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Affiliation(s)
- M M Mezei
- Division of Dermatology, University of British Columbia, Vancouver, Canada
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Lombardi T, Küffer R, Samson J. Eosinophilic ulceration of the oral mucosa. A case report. Int J Oral Maxillofac Surg 1993; 22:366-7. [PMID: 8106814 DOI: 10.1016/s0901-5027(05)80670-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chronic ulcerative lesions affecting the maxillary vestibular mucosa and the lower labial mucosa of a white female patient are described. Histopathologic examinations indicated a diagnosis of eosinophilic ulceration. Clinical aspects, pathogenesis, and histopathology of this uncommon lesion are discussed.
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Affiliation(s)
- T Lombardi
- Division of Stomatology and Oral Surgery, Dental School of Medicine, Faculty of Medicine, University of Geneva, Switzerland
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el-Mofty SK, Swanson PE, Wick MR, Miller AS. Eosinophilic ulcer of the oral mucosa. Report of 38 new cases with immunohistochemical observations. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:716-22. [PMID: 8515985 DOI: 10.1016/0030-4220(93)90429-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Eosinophilic ulcer of the oral mucosa (traumatic eosinophilic granuloma) mimics oral cancer clinically and is occasionally misdiagnosed as lymphoma on microscopic examination. Trauma is believed to play a role in its development, but its exact pathogenesis is not known. The demographic, clinical, and histologic features of 38 previously unreported cases of eosinophilic ulcer of the oral mucosa are reviewed. Nine representative cases were studied immunohistochemically. Microscopically, the lesions contained a polymorphic inflammatory infiltrate extending deep into the submucosa, underlying muscle, and salivary glands. Numerous eosinophils and large mononuclear cells with pale nuclei and frequent mitoses were seen in all lesions. Lymphocytes, histiocytes, plasma cells, granulocytes, and mast cells were also present. Immunohistochemical stains showed that the lymphocytic infiltrate was composed predominantly of T cells. T-cell-specific antigen-presenting cells were more numerous than the non-antigen-presenting cell type. The large cells with pale nuclei stained positively only for vimentin; the possible myofibroblastic nature of these cells is discussed. Although trauma might have an etiologic role, the pathogenesis of eosinophilic ulcer of the oral mucosa is probably T cell mediated.
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Affiliation(s)
- S K el-Mofty
- Department of Pathology, Washington University School of Medicine, St. Louis
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de Vicente Rodriguez JC, Santos Oller JM, Junquera Gutierrez LM, López Arranz JS. Atypical histiocytic granuloma of the tongue: case report. Br J Oral Maxillofac Surg 1991; 29:350-2. [PMID: 1742270 DOI: 10.1016/0266-4356(91)90126-p] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Primary malignant lymphomas of the tongue have rarely been described, and reported cases are usually related to the posterior part of the tongue which is rich in lymphoid tissue, forming part of Waldeyer's ring. Making a distinction between pseudolymphoma and malignant lymphoma is important. Pseudolymphoma is a benign lesion not requiring aggressive therapy. Several lesions in the oral cavity, including atypical histiocytic granuloma, angiolymphoid hyperplasia with eosinophilia, and traumatic ulcerative granuloma with stromal eosinophilia have been described as having certain microscopic features similar to those of pseudolymphoma. Atypical histiocytic granuloma is not associated with systemic disease or dissemination and heals spontaneously despite its microscopic appearance.
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Abstract
A 10-year review of biopsy accessions revealed 15 cases of eosinophilic ulcer. Six manifested recurrent or multiple lesions, and two exhibited histologic atypia. The possible relationships to other oral and systemic diseases are discussed.
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Affiliation(s)
- J L Doyle
- Department of Pathology, Fairleigh Dickinson University, College of Dental Medicine, Hackensack, New Jersey 07601
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Zulian M, Bellome J, DeBoom GW. Multiple linear ulcers on the dorsum of the tongue in a patient with Waldenstrom's macroglobulinemia. J Am Dent Assoc 1987; 114:79-80. [PMID: 3100597 DOI: 10.14219/jada.archive.1987.0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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