Self-healing CD30- T-clonal proliferation of the tongue: report of an extremely rare case

Abstract

Background The etiology of traumatic ulcerative granulomas with stromal eosinophilia (TUGSE) is not clear, traumatic irritation having advocated as the most likely cause. TUGSEs are typically self-limiting slow-healing lesions of the oral mucosa with unclear pathogenesis, commonly manifesting as a rapidly developing, long-lasting ulcer. Case presentation Here we report a controversial case of a self-healing lesion of the tongue in a 57 year-old woman. A clonal T-cell proliferation and CD30 negative immunohistochemical (IHC) profile could be documented. Discussion and conclusion In view of the very peculiar clinical and histological features, a retrospective diagnosis of a TUGSE with scarce eosinophilic infiltrate (possibly in regression), displaying CD30- T-clonal proliferation was eventually rendered. The patient did not report signs of recurrence after a 3-year follow-up period.

A Case Report of Traumatic Ulcerative Granuloma With Stromal Eosinophilia (TUGSE): Clinical and Histopathological Diagnostic Challenges

“…A significant number of eosinophils are seen in TUGSE compared to non-specific ulcers [14], rendering eosinophils pathognomonic in TUGSE. However, the number of eosinophils can range from mild to moderate [1] or even sparse [15]. These eosinophils can be seen within the granulation tissue, and some may extend into the superficial and deep muscle layer [1].…”

“…In this case, a portion of large lymphoid cells was positive for CD30. CD30 is a lymphocyte activation antigen and a member of the tumor necrosis factor family [15]. Its presence is diagnostic of primary cutaneous CD30-positive T-cell lymphoproliferative disorders, classic Hodgkin's lymphoma, anaplastic large-cell lymphoma, and embryonal carcinoma [15].…”

A case report of traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) in a 21‐year‐old

“…7 Some lesions are infiltrated with polymorphic lymphocytes, and immunohistochemistry analysis of these lesions shows presence of lymphocytes with the following: CD3+, CD2+, CD4+, CD8-, CD5+, CD7-. 8 Traumatic ulcerative granuloma with stromal eosinophilia commonly occurs in elderly patients with a history of trauma and variations in oral anatomy. However, this case presented with none of these factors aside from the expected presentation of a solitary ulcer.…”

“…The ulcerated area of the lesion which can penetrate the muscle fibers contains eosinophils, neutrophils, and fibroblasts 7 . Some lesions are infiltrated with polymorphic lymphocytes, and immunohistochemistry analysis of these lesions shows presence of lymphocytes with the following: CD3+, CD2+, CD4+, CD8‐, CD5+, CD7‐ 8 …”

Ulceration and a White Lesion of the Tongue in a Male HIV Positive Patient: A Journey on the Avenue of Differential Diagnoses in Search of a Solution

“…The lesions can spontaneously resolve after the removal of the supporting factors [18]. Different therapeutic approaches have been proposed: "watch and wait", antibiotics and topical, intralesional or systemic approaches, as well as surgical interventions (curettage, cryosurgery, surgical excision) [16,19].…”