Traumatic ulcerative granuloma with stromal eosinophilia: A diagnostic dilemma?

Abstract

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a slow growing reactive lesion that commonly aff ects the tongue. The pathogenesis of this lesion is obscure. Chronic irritation from traumatic agents is considered to be one of the contributing factors in most of the cases. It usually presents as an ulcer or an indurated submucosal mass. Histopathologically, it is characterized by eosinophilic infl ammatory infi ltrate penetrating into the submucosal layers degenerating the underlying muscle. It is important to recognize this mucosal entity as it has a close resemblance with malignancy of the oral cavity. The pathognomonic feature of TUGSE is that it resolves on its own after excisional biopsy. A 25-year-old Sudanese boy had reported to us with an ulceroproliferative growth in the left side of the mouth.

Enlarging Right-Sided Tongue Mass in an Adult Male

“…The pathophysiology of this benign, self-limiting condition is poorly understood, but it is thought to be related to aberrant wound-healing and is of clinical importance because it can mimic malignant entities such as SCC or mucoepidermoid carcinoma . This entity is usually seen in individuals with a history of trauma or iatrogenic tongue injury and demonstrates rapid healing after incisional biopsy, presumably due to induction of normal healing pathways, features not present in the present case.…”

“…He denied recent injury, fever, chills, odynophagia, or difficulty breathing. Laboratory examination was significant for leukocytosis (white blood cell count, 15 700/μL) and hypercalcemia (total calcium level, 13.1 mg/dL) (to convert white blood cells to ×10 9 per liter, multiply by 0.001; to convert calcium to millimoles per liter, multiply by 0.25). Physical examination was notable for a 4-to 5-cm pedunculated, ulcerative mass on the dorsal oral aspect of the tongue near midline, anterior to the foramen cecum, without palpable cervical lymphadenopathy.…”