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Prepared and presented by Karim, Muhaned, Hassan Ali, Ehdaa, Hassan Badr, Abdulrahman
Traumatic Ulcerative Granuloma - Oral Medicine Case Presentation
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Prepared and presented by Karim, Muhaned, Hassan Ali, Ehdaa, Hassan Badr, Abdulrahman

Traumatic Ulcerative Granuloma - Oral Medicine Case Presentation

Lesion Photo

Traumatic ulcerative granuloma is an uncommon lesion of the oral mucosa affecting the tongue mainly and is considered a reactive lesion. The aetiopathology is unclear but trauma have been found the contributing factor in most cases. We report a case of a 28-years-old man who presented with a chronic ulcer of the lateral border of the tongue. No Histopathologicalic examination were done as the patient reported that the ulcer appeared right after the trauma and didn't change in size for 2 months. The lesion was treated with hydroxyproply cellulose films for pain relief

Abstract

Traumatic ulcerative granuloma is a rare, chronic and benign lesion of the oral mucosa. It has been known by different names, sublingual granuloma, traumatic granuloma, eosinophilic granuloma, eosinophilic ulcer, and ulcerative eosinophilic granuloma. It is most commonly found in the 5th decade of life and exhibits a slight female predominance. The tongue is the most common site involved and clinically it presents as a chronic ulcer, with raised and indurated borders, and rarely presents as a tumor.

Introduction

This is a 28 year old male patient; he presented with a painful area in his tongue that persisted for over 2 months. The lesion appeared right after injury to the tongue and hasn't changed since initial appearance according to the patient.

Summary of Case:

It is a 2cm in diameter ulceration found on the the left lateral surface of the tongue; it has an erythematous center with a white and raised border. The lesion is painful and has been present for over 2 months.

Discription of the lesion and clinical findings:

1. Traumatic Ulcerative Granuloma: results from injury and mostly found on the tongue. Could remain for extended periods of time. It is a well-circumscribed ulceration with white border that surrounds erythema. These lesions are also male predominant and are painful.2. Major Apthous Ulcer: these lesions are the most common ulcers. They are painful and persist for months. They have well-circumscribed border and are round or ovoid in shape. They are not commonly seen in keratinized mucosa like the dorsum of the tongue.3. Squamous cell carcinoma: commonly found on the tongue. It could be an erythematous ulceration with irregular borders and is usually 2cm in diameter and male predominant.

Differential Diagnosis:

*Diagnosis: The patient reported an ulceration that resulted from trauma. It has been present for over 2 months and not exhibiting any changes. Based on that the most likely diagnosis is Traumatic Ulcerative Granuloma.*Treatment: Dycyclonine HCL or hydroxypropyl cellulose films for temporary pain relief and a biopsy for further diagnostics.

Diagnosis and Treatment:

Traumatic Ulcerative Granuloma is a rare but benign entity that can easily be mistaken for SCC or infectious diseases, such as primary syphilis or EBV-associated mucocutaneous ulcer. With clinical inspection alone, a malignant process cannot be excluded, wherefore a biopsy is always mandatory. Screening for the aforementioned infectious diseases is recommended. The typical histological findings are vaguely granulomatous tissue changes, sometimes jigsaw-like appearance. The lesion presents a diffuse polymorphic inflammatory infiltrate, predominately consisting of histiocytes, activated and predominantly T-lymphocytes, and of eosinophils and histiocytes. The ulceration is often extending into the submucosa, deeper muscle fibers, and salivary glands. The pathogenesis of this lesion is still under debate, although a local traumatic event has been suggested to be a major contributing factor, as it also became apparent in our case.

Discussion

As Traumatic Ulcerative Granuloma may mimic malignancy or infectious diseases, biopsy is mandatory and should be combined with thorough clinical examination. A screening for infectious diseases (mainly syphilis, Epstein-Barr virus, and HIV infections) must be performed routinely. In most cases, the lesions resolve spontaneously, obviating the need of further actions other than clinical follow-up. The pathogenesis of these lesions is still under debate, although local traumatic events and an immune response have been suggested to be major contributing factors.

Conclusion

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