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Axelrod B, Reddy R, Steinberg M. An Unusual Clinical Presentation of Traumatic Ulcerative Granuloma With Stromal Eosinophilia. J Oral Maxillofac Surg 2024:S0278-2391(24)00337-9. [PMID: 38885935 DOI: 10.1016/j.joms.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024]
Abstract
Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a reactive and chronic ulcerative lesion that is most frequently found on the tongue. It appears as a large yellowish ulcer with elevated margins and central induration. TUGSEs exhibit a characteristic pattern of regression often spontaneously, following incisional biopsy, or after removal of the potential traumatic trigger. Herein, we present an unusual case of a TUGSE on the anterior maxillary gingiva of a 70-year-old male that regressed following incisional biopsy. Histopathologic evaluation revealed fragments of squamous mucosa and submucosal tissue with large atypical cells mixed with small lymphocytes, abundant eosinophils, and focal clusters of plasma cells. Immunohistochemistry was performed and the large, atypical cells were positive for CD3, CD4, CD5, and CD30 and negative for CD1a, CD8, CD20, CD56, CD117, ALK1, Langerin, and EBER ISH. To our knowledge, this is the first case of TUGSE reported in the anterior maxilla.
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Affiliation(s)
| | - Rekha Reddy
- Clinical Assistant Professor, Stony Brook School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Department of Pathology, Stony Brook, NY
| | - Mitchell Steinberg
- Clinical Assistant Professor, Stony Brook School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Stony Brook, NY
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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: 1] [Impact Index Per Article: 0.3] [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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Dhanrajani P, Cropley PW. Oral eosinophilic or traumatic ulcer: A case report and brief review. Natl J Maxillofac Surg 2016; 6:237-40. [PMID: 27390505 PMCID: PMC4922241 DOI: 10.4103/0975-5950.183854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Eosinophilic ulcer of the oral mucosa is considered to be a benign, reactive, and self-limiting lesion, with unclear pathogenesis, manifesting as a rapidly developing solitary ulcer. We report a case of a 42-year-old man who presented with a chronic indurated ulcer of buccal mucosa adjacent to the right upper wisdom tooth. Histopathological examination showed polymorphic inflammatory infiltrate, rich in eosinophilis, involving the superficial mucosa, and the deeper muscle layer. Immunohistochemical analysis revealed single CD30+ cells scattered within an inflammatory infiltrate. The lesion was excised, and healing was uneventful with no recurrence in more than a year.
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Affiliation(s)
- Parmanand Dhanrajani
- Department of Oral and Maxillofacial Surgery, HCF Dental Centre, Sydney, NSW 2000, Australia
| | - Peter W Cropley
- Department of Anatomical Pathology, Laverty Pathology, North Ryde, NSW 2113, Australia
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Sarangarajan R, Vaishnavi Vedam VK, Sivadas G, Sarangarajan A, Meera S. Traumatic ulcerative granuloma with stromal eosinophilia - Mystery of pathogenesis revisited. J Pharm Bioallied Sci 2015; 7:S420-3. [PMID: 26538890 PMCID: PMC4606632 DOI: 10.4103/0975-7406.163474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oral ulcers are a common symptom in clinical practice. Among various causative factors, different types of ulcers in oral cavity exist. Among this, traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) appears to be quite neglected by the clinicians due to the limited knowledge and awareness. On reviewing with a detailed approach to titles and abstracts of articles eliminating duplicates, 40 relevant articles were considered. Randomized studies, review articles, case reports and abstracts were included while conference papers and posters were excluded. Of importance, TUGSE cases been reported only to a minimal extent in the literature. Lack of its awareness tends to lead clinicians to a misconception of cancer. Thus, this particular lesion needs to be differentiated from other malignant lesions to provide a proper mode of treatment. The present article reviews various aspects of the TUGSE with emphasis on the clinical manifestation, pathogenesis, histological, and immunohistochemical study. This study provides the clinician contemporaries, a humble expansion to their knowledge of the disease, based on the searched literature, enabling a more comprehensive management of this rare occurrence.
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Affiliation(s)
- R Sarangarajan
- Department of Oral Pathology, Madha Dental College and Hospital, Kundrathur, India
| | - V K Vaishnavi Vedam
- Department of Oral Pathology, Faculty of Dentistry, Asian Institute of Medicine Science and Technology (AIMST) University, Malaysia
| | - G Sivadas
- Department of Pedodontics, Faculty of Dentistry, Asian Institute of Medicine Science and Technology (AIMST) University, Malaysia
| | - Anuradha Sarangarajan
- Private Dental Practitioner, Sai Raghav Dental Clinic, West Mambalam, Chennai, Tamil Nadu, India
| | - S Meera
- Private Dental Practitioner, Sree Sai Dental Care, Kolapakkam, Chennai, Tamil Nadu, India
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Eosinophilic ulcer of the oral mucosa: report of a case with multiple synchronous lesions. Am J Dermatopathol 2014; 36:594-6. [PMID: 24950420 DOI: 10.1097/dad.0b013e31829ae478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Eosinophilic ulcer of the oral mucosa is considered to be a benign, reactive, and self-limiting lesion, with unclear pathogenesis, manifesting as a rapidly developing solitary ulcer. We report the case of a 52-year-old man who presented with 4 synchronous ulcerations of the tongue. Histopathological examination showed polymorphic inflammatory infiltrate, rich in eosinophils, involving the superficial mucosa and the deeper muscle layer. Immunohistochemical analysis revealed single CD30 cells scattered within an inflammatory infiltrate. All the lesions began to regress spontaneously within 1 week after biopsy. A 4-year follow-up showed no recurrence.
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Chatzistamou I, Doussis-Anagnostopoulou I, Georgiou G, Gkilas H, Prodromidis G, Andrikopoulou M, Sklavounou A. Traumatic Ulcerative Granuloma With Stromal Eosinophilia: Report of a Case and Literature Review. J Oral Maxillofac Surg 2012; 70:349-53. [DOI: 10.1016/j.joms.2011.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 11/29/2022]
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Kwon JI, Kim HW, Nam W, Cha IH, Kim HJ. Traumatic ulcerative granuloma misjudged as oral squamous cell carcinoma (SCC) on the buccal cheek: case report. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.3.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jin-Il Kwon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyun-woo Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
- Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
- Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
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