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141:Clinical Considerations Associated with Traumatic Ulcerative Granuloma with Stromal Eosinophilia[AAOM2021]
EP36047
Poster Title: 141:Clinical Considerations Associated with Traumatic Ulcerative Granuloma with Stromal Eosinophilia[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Mohammed Bindakhil, D.D.S., M.S. 1 , Miche’ Richards, D.D. 2 , Zoya Kurago, D.D.S., Ph.D 1
Affiliations: 1 Department of Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta, Georgia 2 Rural Health Services, Aiken, South Carolina
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 270
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Poster Information
Abstract: Background

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an uncommon mucosal lesion clinically characterized by slow-healing ulceration. Although the exact etiology is not clear, it is widely accepted that TUGSE is caused by trauma. TUGSE typically affects the tongue and rarely, other oral mucosal sites, such as the buccal mucosa. TUGSE may mimic clinical manifestations of squamous cell carcinoma to a significant degree, and biopsy is essential for diagnosis. Without surgical intervention, TUGSE can take up to a year to heal; this is attributed to a lack of transforming growth factor secretion, which may be related to the presence of eosinophils.

Case Report

A 57-year-old female presented to an oral medicine clinic for evaluation of a painful ulceration on the buccal mucosa present for two months. The patient reported constant pain aggravated by consumption of hard food. The patient’s medical history included hypertension and hypothyroidism. Medication included lisinopril 10mg and levothyroxine 50 mcg daily. No known drug allergies were reported. Family history included a sibling with Type I diabetes and a child with sickle cell anemia. Social history included occasional alcohol and marijuana use. Review of systems revealed chills lasting for one day during the week prior to the visit. Extraoral examination did not reveal lymphadenopathy or salivary gland enlargement. Intraoral examination revealed a 2-cm indurated ulceration with a bright-red surface and slightly raised borders located on the right buccal mucosa. Differential diagnosis included squamous cell carcinoma, TUGSE, and deep fungal infection. Incisional biopsy revealed parakeratinized stratified squamous epithelium adjacent to an ulcer with exuberant granulation tissue, endothelial cell proliferation, numerous immature vessels, and diffuse dense infiltrates of neutrophils, lymphocytes, macrophages, and eosinophils. The cumulative findings were consistent with TUGSE, and the patient underwent additional removal of the ulcerated mucosa. During the patient’s two weeks of follow-up care, the lesion appeared to be appropriately healing.

Conclusions

TUGSE can mimic conditions that present with ulceration, such as squamous cell carcinoma, and it rarely presents on the buccal mucosa. The lesion may require surgical treatment to achieve complete resolution. Clinicians must understand the diagnostic, therapeutic, and prognostic implications of TUGSE.
Summary: Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an
uncommon mucosal lesion clinically characterized by slow healing
ulceration.[1] Although the exact etiology is not clear, it is widely accepted that TUGSE is caused by trauma.

Ask the author questions about this poster:Bindakhil@hotmail.com
References: 1.Shen WR, Chang JY, Wu YC, Cheng SJ, Chen HM, Wang YP. Oral traumatic ulcerative granuloma with stromal
eosinophilia: A clinicopathological study of 34 cases. J Formos Med Assoc. 2015 Sep;114(9):881 5.
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