Traumatic Ulcerative Granuloma with Stromal Eosinophilia: From Reactive Process to Low Grade CD30 + lymphoproliferative Disorder.

Abstract

Purpose of review: Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare, benign ulcerative lesion of the oral mucosa that exists in both adult and infantile (Riga-Fede) forms. This review examines TUGSE by exploring its clinical presentation, pathogenesis, histopathological features, and treatment approaches. It briefly discusses oral CD30+ T-cell lymphoproliferative disorders (TLPDs) and their potential relation with TUGSE lesions.

Recent findings: While traditionally considered reactive in nature, some recent evidence suggests TUGSE may share features with CD30+ T-cell lymphoproliferative disorders (TLPDs), potentially representing a spectrum of lesions and thereby complicating diagnosis and treatment approaches. Although some TUGSE cases demonstrate CD30 positivity and monoclonality of the T-cell receptor gamma (TCRγ) chain gene, no cases have progressed to widespread or systemic lymphoma. The rarely reported CD30+ TLPDs of the oral cavity appear to share features with their cutaneous counterparts, demonstrating indolent biologic behavior and excellent prognosis, with complete or partial regression frequently occurring after incisional biopsy. TUGSE presents as a slow-healing ulcer with raised borders and induration, commonly affecting the tongue and potentially mimicking squamous cell carcinoma. While trauma appears to be an important factor, the exact pathogenesis remains unclear. Histopathologically, lesions show ulceration with polymorphous infiltrate rich in eosinophils extending into the submucosa, with characteristic muscle fiber degeneration and variable presence of atypical mononuclear cells. The condition generally follows a self-limiting course with excellent prognosis, responding well to conservative management. Aggressive treatment and extensive follow-up may be unnecessary even for CD30+ cases with monoclonal TCRγ chain genes. Further research is needed to clarify the relationship between oral CD30+ TLPDs and TUGSE.