T-Cell Receptor Gene Rearrangement and CD30 Immunoreactivity in Traumatic Ulcerative Granuloma With Stromal Eosinophilia of the Oral Cavity

Abstract

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an ulcerative lesion of the oral mucosa with unknown pathogenesis. A few recent case reports have demonstrated molecular evidence of T-cell clonality in TUGSE and CD30 immunoreactivity in the large atypical mononuclear cells, raising the possibility that a TUGSE subset may represent the oral counterpart of primary cutaneous CD30+ T-cell lymphoproliferative disorders. We examined the immunoreactivity for CD30 and T-cell receptor (TCR) gamma gene rearrangement in 37 TUGSE cases. Clonal TCR gene rearrangements were demonstrated in 7 (24%) of 29 cases with amplifiable DNA, and the morphologic features and CD30 immunoreactivity of these cases did not differ from those with polyclonal TCR gene rearrangements. Clinical follow-up was available for 5 of 7 TUGSE cases with clonal TCR gene rearrangement for an average period of 1.75 years after the initial biopsy or excision, and there was no evidence of local recurrence or development of systemic T-cell lymphoproliferative disorder. Without morphologic and/or clinical evidence of lymphoma, T-cell clonality and/or CD30 positivity in these lesions is not indicative of malignancy and should be interpreted with caution.

Mucosal CD30-positive T-cell lymphoproliferations of the head and neck show a clinicopathologic spectrum similar to cutaneous CD30-positive T-cell lymphoproliferative disorders

“…Clonal T-cell receptor gene rearrangements may be present. 19 These general features fit our cases 4-7, although eosinophila was not prominent in case 4.…”

“…Indolent CD30-positive T-cell lymphoproliferations have been reported previously in the oral cavity, especially the tongue, and variably designated traumatic ulcerative granuloma with stromal eosinophila, traumatic eosinophilic granuloma, eosinophilic ulcer of the oral mucosa and Riga (or Riga-Fede) disease. [11][12][13][14][15][16][17][18][19][20] These terms connote a reactive process. 17,19 Reports of seemingly similar processes have been described as lymphomatoid papulosis (in the absence of co-existing cutaneous disease) 21 or as T-cell lymphoma.…”

“…[11][12][13][14][15][16][17][18][19][20] These terms connote a reactive process. 17,19 Reports of seemingly similar processes have been described as lymphomatoid papulosis (in the absence of co-existing cutaneous disease) 21 or as T-cell lymphoma. 14 Some investigators have used the term CD30-positive T-cell lymphoproliferative disorder and have suggested this spectrum of lesions represents the oral counterpart of cutaneous CD30-positive T-cell lymphoproliferative disorder.…”

Mimics of Cutaneous Lymphoma

“…82 In fact, subsequent molecular studies often demonstrate a clonal proliferation, which may further confound the diagnosis or lead to an erroneous "confirmation" of malignancy. 82,83 Submitted cases ultimately labeled consistent with TUGSE by the expert panel shared similar clinical CD68+ histiocytes. Subsequent lymph node biopsy specimens showed changes most consistent with KFD, including a CD8-predominant T-cell infiltrate with numerous CD68+ histiocytes.…”

Eosinophilic Ulcer of the Oral Mucosa

“…4 Likewise, in the current case, there was no previous trauma. 7,12 To our knowledge, this is the first reported case of EUOM with 4 synchronous lesions of the tongue. 3 Velez et al 2 have suggested that in some predisposed individuals, trauma is only a contributing factor in the development of EUOM.…”