A Case Report of Traumatic Ulcerative Granuloma With Stromal Eosinophilia (TUGSE): Clinical and Histopathological Diagnostic Challenges

Traumatic ulcerative granuloma with stromal eosinophilia is a reactive, self-limiting ulcer within the oral cavity; however, clinically, it mimics a malignant ulcer. Here, we report the case of a 13-year-old boy who presented with a painful solitary indurated ulcer at the lower lip for a week. Histopathological examination revealed an ulcerated lesion with significant infiltration of eosinophils, small lymphocytes, and large lymphoid cells. Further immunohistochemistry showed the inflammatory cells were CD3-positive T cells and CD68-positive, with a minority of the cell population showing CD30 positivity. CD1a-positive dendritic cells were also observed. We discuss the clinical and histopathological differential diagnoses of Langerhans cell histiocytosis and CD30-positive T-cell lymphoproliferative disorders and how to correlate them in formulating the final diagnosis.