Traumatic Ulcerative Granuloma — ORE Part 1 MCQ

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ModerateOral PathologyTraumatic Ulcerative GranulomaORE Part 1

A 46-year-old patient reports a painful lesion on the lower labial mucosa that developed rapidly over 3 days after accidentally biting the lip. Examination shows a solitary 8 mm shallow ulcer with an erythematous base and firm, slightly raised margins. There is no fluctuation, discharge or regional lymphadenopathy. What is the most likely diagnosis?

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Correct answer: D — Traumatic ulcerative granuloma

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

A is correct. TUGSE (eosinophilic ulcer) is a benign reactive lesion that may follow local trauma and presents as a solitary painful ulcer with an indurated or raised margin. The short history, clear traumatic trigger and ulcerative morphology favour this diagnosis. Oral squamous cell carcinoma can also be indurated and ulcerated, but is less consistent with an acute, clearly trauma-associated lesion; persistent or unexplained ulceration requires urgent assessment in UK practice. A mucocoele is usually a dome-shaped, fluctuant or bluish swelling rather than an ulcer. Minor salivary gland tumours are generally persistent submucosal masses, not acute painful ulcers. A soft-tissue abscess would be expected to show fluctuation, purulence and/or features of spreading infection rather than a discrete traumatic ulcer.

Reference: Chandra S, Raju S, Sah K, Anand P. Traumatic Ulcerative Granuloma with Stromal Eosinophila: A Case Report and Review of Pathogenesis. 2016. https://pubmed.ncbi.nlm.nih.gov/27891480/