Traumatic Ulcerative Granuloma With Stromal Eosinophilia

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.

Oral Eosinophilic Ulcer, an Epstein-Barr Virus-Associated CD30+ Lymphoproliferation?

“…Constituents of eosinophil secretory granules include a number of highly cytotoxic proteins, such as eosinophilic cationic protein, major basic protein and eosinophil-derived neurotoxin. Immunohistochemical studies demonstrated that the atypical mononuclear cells are atypical large CD30+ T cells with polymorphic convoluted nuclei and prominent nucleoli [33,34]. In our case, no CD8+ cells were found, but perforin was expressed by CD30+ cells which may be, together with eosinophilic cytokines, responsible for the ulceration.…”

“…Trauma has been suggested to play a major role as previously mentioned, albeit widely regarded as a factor initiating a hypersensitive T cell-mediated immune response to altered tissue antigens or unknown factors (e.g. viral particles, toxic microbial products) [15,34]. Likewise, increased stromal mast cell infiltration has been reported [15], a finding that was not confirmed by others [8].…”

Traumatic ulcerative eosinophillic granuloma with stromal eosinophilia of tongue

“…Abraham et al . [1] found in his study a positivity for marker of cytotoxic T cell activity in all his cases, supporting the role of cytotoxic T cells in the pathogenesis of TUGSE.…”

“…TUGSE can occur anywhere in the oral cavity, and the most common sites include the ventral surface of the tongue, buccal mucosa, vestibule and floor of the mouth. [1] Although it usually follows some form of trauma, most patients do not have a history of trauma. Most commonly, the lesion presents as a self-healing solitary ulcer with rolled up or indurated margins of weeks to months duration.…”

Oral Pyoderma Gangrenosum: Diagnosis, Treatment and Challenges: A Systematic Review

“…The characteristic features of these conditions are detailed in Table 3 [41][42][43][44][45]. The diagnosis of PG is primarily based on recognition of the characteristic morphology and evolution of the lesion, the presence of an underlying systemic disease (if any) and, the exclusion of other disease processes using proper diagnostic tools.…”