Traumatic ulcerative granuloma with stromal eosinophilia mimicking a squamous cell carcinoma

Abstract

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare lesion of a traumatic-reactive nature of the oral mucosa that can clinically mimic an oral carcinoma. A 59-year-old male patient presented painful ulceration with indurated margins on the base of the tongue, extending to the floor of the mouth. The use of ill-fitting denture hurting the mucosa of the region was reported by the patient. The evolution time was 45 days. The presumptive diagnoses were oral squamous cell carcinoma and chronic ulcer. An incisional biopsy revealed an ulceration associated with an eosinophil-rich inflammatory infiltrate and a bed of proliferating histiocyte-like cells in either diffuse or fasciculate arrangement. There was diffuse immunopositivity for CD3, but focal for CD68 and α-SMA, and negativity for CD30. The final diagnosis was TUGSE. The use of the ill-fitting dental prosthesis was suspended and the lesion had complete spontaneous remission three weeks later. TUGSE is an uncommon traumatic self-limiting lesion that must be included in the differential diagnosis of ulcerative lesions resembling oral cancer. The correlation of clinical and histopathological findings is pivotal for a proper diagnosis, avoiding unnecessary aggressive surgical approaches. Key words:Oral ulcer, eosinophilia, immunohistochemical, differential diagnosis.

Figure 1

(A) Clinical examination showing an ulceration with and slightly raised bright-red borders and bed covered by white-yellow fibrinous pseudomembrane. (B) HE-stained histological slides showing the oral ulcerated oral mucosa and granulation tissue underlying (40 x). (C) Details of the granulation tissue rich in capillary vessels associated with intense inflammatory infiltrate (400 x). (D) Fasciculated proliferation of histiocyte-like cells permeated by eosinophils (400 x). (E) Intense inflammatory infiltrate composed of lymphocyte, neutrophils and eosinophils (400 x). (E) Detail of the eosinophils (800 x). Captions: asterisks – capillary vessels; arrows: eosinophils.

Figure 2

Immunohistochemical analysis of the lesion. (A) Diffuse positivity for CD3 in lymphocytes and (B) focal and sparse positivity for CD68 in histiocyte-like cells. (C) Positivity for α-SMA was mainly observed surrounding small vessels, and focally in some stromal spindle cells. (D) CD30 showed to be negative (SABC, 400 x).