Traumatic Ulcerative Granuloma with Stromal Eosinophilia of The Lateral Border of Tongue Mimicking Oral Squamous Cell Carcinoma: A Case Report

Abstract

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an uncommon benign inflammatory lesion of the oral mucosa characterized by persistent ulceration accompanied by a dense eosinophil-rich inflammatory infiltrate within the connective tissue. Clinically, the lesion often presents as a chronic indurated ulcer and may closely resemble oral squamous cell carcinoma, creating diagnostic uncertainty. Histopathologically, it typically shows ulcerated stratified squamous epithelium with a polymorphous inflammatory infiltrate predominantly composed of eosinophils extending into deeper connective tissue and skeletal muscle bundles. We report a case of a 75-year-old female presenting with a persistent ulcer on the right lateral border of the tongue associated with chronic mechanical irritation. The clinical, histopathological and follow-up findings were consistent with traumatic ulcerative granuloma with stromal eosinophilia, and the lesion resolved completely after elimination of the traumatic factor.

Keywords:

Traumatic ulcerative granuloma, eosinophilic ulcer, stromal eosinophilia, tongue ulcer

References

Shapiro L, Juhlin EA. Eosinophilic ulcer of the tongue. Dermatologica. 1970;140:242–250.

El-Mofty SK, Swanson PE, Wick MR, Miller AS. Eosinophilic ulcer of the oral mucosa: report of 38 new cases with immunohistochemical observations. Oral Surg Oral Med Oral Pathol. 1993;75:716–722.

Ficarra G, Carlos R. Eosinophilic ulcer of the oral mucosa. J Oral Pathol Med. 2009;38:3–9.

Hirshberg A, Akrish S, Amariglio N. Traumatic ulcerative granuloma with stromal eosinophilia: a reactive lesion of the oral mucosa. Oral Oncol. 2008;44:741–746.

Kaplan I, Anavi Y, Hirshberg A. Traumatic ulcerative granuloma with stromal eosinophilia: literature review and case report. Oral Dis. 2015;21:1–7.

Segura S, Pujol RM. Eosinophilic ulcer of the oral mucosa: clinicopathological review. Actas Dermosifiliogr. 2008;99:621–629.

Salisbury CL, Budnick SD, Li S. CD30 expression in traumatic ulcerative granuloma with stromal eosinophilia. Am J Clin Pathol. 2009;132:722–727.

Gleich GJ. Mechanisms of eosinophil-associated inflammation. J Allergy Clin Immunol. 2000;105:651–663.

Sarangarajan R, Vaishnavi VVK, Sivadas G. Traumatic ulcerative granuloma with stromal eosinophilia: pathogenesis revisited. J Pharm Bioallied Sci. 2015;7:S420–423.

Hirshberg A, Amariglio N, Akrish S. Reactive nature of traumatic ulcerative granuloma with stromal eosinophilia. Am J Clin Pathol. 2006;126:522–529.