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TUGSE — MFDS Part 1 MCQ

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HardOral PathologyTUGSEMFDS Part 1

A 58-year-old immunocompetent patient has an 8-week history of a solitary, painless, indurated ulcer on the lateral border of the tongue. Biopsy shows surface ulceration with a polymorphous inflammatory infiltrate extending between skeletal muscle fibres. Numerous eosinophils and scattered large CD30-positive mononuclear cells are present. There is no epithelial dysplasia or invasive epithelial malignancy, and in-situ hybridisation for Epstein–Barr virus is negative. What is the most likely diagnosis?

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Correct answer: E — Traumatic ulcerative granuloma with stromal eosinophilia

The diagnosis is traumatic ulcerative granuloma with stromal eosinophilia (TUGSE). The discriminating combination is a persistent, indurated tongue ulcer with a deep polymorphous infiltrate rich in eosinophils extending between skeletal muscle fibres. Scattered atypical CD30-positive cells may occur in TUGSE and do not alone establish lymphoma. Squamous cell carcinoma is an important clinical mimic but would show invasive malignant squamous epithelium. An Epstein–Barr virus-positive mucocutaneous ulcer requires demonstration of EBV-associated atypical cells, typically by positive EBER testing. Major aphthous ulceration lacks this characteristic deep eosinophil-rich infiltrate. Necrotising sialometaplasia predominantly affects minor salivary gland sites, especially the palate, and shows lobular salivary necrosis and squamous metaplasia.

Reference: Wolk R, Trochesset D. Traumatic Ulcerative Granuloma with Stromal Eosinophilia: From Reactive Process to Low Grade CD30+ Lymphoproliferative Disorder. Head and Neck Pathology. 2025;19(1):70. https://pubmed.ncbi.nlm.nih.gov/40419719/