Wolk Rachelle, Trochesset Denise
Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, 345 East 24th Street, New York, NY, 10010, USA.
Head Neck Pathol. 2025 May 26;19(1):70. doi: 10.1007/s12105-025-01802-1.
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.
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.
伴有基质嗜酸性粒细胞增多的创伤性溃疡性肉芽肿（TUGSE）是一种罕见的口腔黏膜良性溃疡性病变，有成人型和婴儿型（里加 - 费德型）两种形式。本综述通过探讨TUGSE的临床表现、发病机制、组织病理学特征和治疗方法来对其进行研究。简要讨论口腔CD30 + T细胞淋巴增殖性疾病（TLPDs）及其与TUGSE病变的潜在关系。
虽然传统上认为TUGSE本质上是反应性的，但最近一些证据表明，TUGSE可能与CD30 + T细胞淋巴增殖性疾病（TLPDs）有共同特征，可能代表一系列病变，从而使诊断和治疗方法变得复杂。虽然一些TUGSE病例显示CD30阳性和T细胞受体γ（TCRγ）链基因的单克隆性，但尚无病例进展为广泛或全身性淋巴瘤。口腔中罕见报道的CD30 + TLPDs似乎与其皮肤对应物有共同特征，表现为惰性生物学行为和良好预后，切开活检后常出现完全或部分消退。TUGSE表现为边界隆起和硬结的愈合缓慢的溃疡，通常累及舌头，可能酷似鳞状细胞癌。虽然创伤似乎是一个重要因素，但其确切发病机制仍不清楚。组织病理学上，病变表现为溃疡，伴有富含嗜酸性粒细胞的多形性浸润延伸至黏膜下层，具有特征性的肌纤维变性和不同程度的非典型单核细胞存在。该病通常呈自限性病程，预后良好，对保守治疗反应良好。即使对于具有单克隆TCRγ链基因的CD30 +病例，积极治疗和广泛随访可能也不必要。需要进一步研究以阐明口腔CD30 + TLPDs与TUGSE之间的关系。
