A rare oral mucosal lesion known as TUGSE, or traumatic ulcerative granuloma with stromal eosinophilia, has been identified as more prevalent in women. This condition manifests as a slow-healing ulcer with an elevated border, similar to oral squamous cell carcinoma. To confirm the diagnosis and rule out malignancy, a biopsy is necessary. TUGSE is believed to be triggered by trauma and typically resolves within a year, with recurrence being rare. The tongue is the most common location for TUGSE, followed by the buccal mucosa and vestibular mucosa. Less common sites include the floor of the mouth, retro molar area, gingiva, alveolar mucosa, lip, labial frenum, and palate. In children, TUGSE was previously referred to as Riga-Fede’s disease. Histopathologically, TUGSE is characterized by a chronic inflammatory infiltrate with eosinophils. The primary treatment involves a biopsy procedure, which promotes rapid healing of the lesion.
In a recent case report, a 28-year-old male patient experienced pain from a lesion on the floor of his mouth. Initially assuming it to be another episode of recurrent aphthous stomatitis/ulcers, the patient attempted topical treatments. However, the lesion persisted for two months without responding to these treatments. Subsequently, a biopsy was performed, revealing the characteristic features of TUGSE. Notably, the lesion resolved within two weeks after the procedure. It is important to note that the patient’s history of recurrent aphthous stomatitis/ulcers was unrelated to the development of TUGSE.
Histologically, TUGSE presents as a polymorphic inflammatory infiltrate consisting of histiocytes, T-lymphocytes, and eosinophils. In some cases, this infiltrate may extend into deeper tissues. There is no known association between TUGSE and recurrent aphthous stomatitis/ulcers. The differential diagnosis for TUGSE includes traumatic ulcers, oral squamous cell carcinoma, CD30 lymphoproliferative disorder, syphilis, Epstein-Barr virus mucocutaneous ulcers, and recurrent aphthous stomatitis/ulcers. Due to the resemblance of TUGSE to oral squamous cell carcinoma, biopsy plays a crucial role in achieving an accurate diagnosis.
In conclusion, TUGSE is a rare oral mucosal lesion that typically presents as a slow-healing ulcer with an elevated border. It is more commonly found in women and often affects the tongue. However, it can also occur in other sites, such as the floor of the mouth. To confirm the diagnosis and exclude malignancy, a biopsy is essential. TUGSE is believed to be triggered by trauma and usually resolves within a year, with recurrence being uncommon. Treatment primarily involves a biopsy procedure, which facilitates rapid healing of the lesion. Clinicians should be knowledgeable about the diagnosis, clinical appearance, natural course, and treatment of TUGSE, particularly when it occurs in less common locations like the floor of the mouth.