Eosinophilic Ulcer of the Oral Mucosa

Abstract

Eosinophilic ulcer of the oral mucosa is considered to be a benign, reactive, and self-limiting lesion, with unclear pathogenesis, manifesting as a rapidly developing solitary ulcer. We report the case of a 52-year-old man who presented with 4 synchronous ulcerations of the tongue. Histopathological examination showed polymorphic inflammatory infiltrate, rich in eosinophils, involving the superficial mucosa and the deeper muscle layer. Immunohistochemical analysis revealed single CD30 cells scattered within an inflammatory infiltrate. All the lesions began to regress spontaneously within 1 week after biopsy. A 4-year follow-up showed no recurrence.

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“…EU is considered a reactive, benign, self-limiting disease of poorly understood pathogenesis. Many etiologic hypotheses have been proposed, emphasizing mainly trauma (Damevska et al, 2014). Most authors suggest that the lesions are caused by accidental biting or repetitive trauma against sharp, misaligned or fractured teeth (Shen et al, 2015;Neville et al, 2016;Woo, 2017).…”

“…On the other hand, the frequency of injuries to the oral mucosa is much higher than the prevalence of EU, and the occurrence of multiple lesions also weakens the theory of traumatic origin (Damevska et al, 2014;Gonçales et al, 2007). Therefore, it is likely that although trauma is important, other factors are involved in the pathogenesis of this entity (Gonçales et al, 2007;Vélez et al, 1997).…”

“…Clinically, an ulcer with hardened and elevated margins is observed, with a white or yellowish base, an erythematous periphery and a surface covered by a fibrinous membrane (Damevska et al, 2014;Song et al, 2011). Pain or tenderness may be present in about 30% of cases (Didona et al, 2015).…”

“…Although the tongue is the most common location, the lips, the buccal mucosa, the palate, the gums, the floor of the mouth and the retromolar region can also be affected (Damevska et al, 2014;Didona et al, 2015;Neville et al, 2016;Vélez et al, 1997;Woo, 2017). A solitary painful ulcer is the main clinical presentation of this entity, as in the four cases reported.…”

Oral eosinophilic or traumatic ulcer: A case report and brief review

“…This type of lesion is unusual in oral mucosa but does have a predilection for the bones of the jaw, more often the mandible, where it may cause a localized ragged zone of destruction. [ 4 18 19 20 ] The disease may be localized to a single site (then called “eosinophilic granuloma”) or may manifest as a part of a systemic histiocytosis involving several different organs, such as bone (as above), skin, lymph nodes, spleen, lungs, gastrointestinal tract, and other areas. Histologically these lesions show diffuse interstitial infiltration by large atypical histiocytes with accompanying eosinophils.…”