Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)-A precursor of oral squamous cell carcinoma?

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a benign, chronic, reactive and self-healing lesion. It is composed of abundant eosinophils and small lymphocytes. Several studies have shown varying observations on the relation of tissue eosinophilia with the prognosis of oral cancer. Here, we present a case of a 65-year-old male who presented with a non-healing ulcer on the lateral border of the tongue, which was suggestive of TUGSE on histopathological examination. The patient was kept on strict monthly follow up and the second re-biopsy was suggestive of moderately differentiated squamous cell carcinoma. Literature does not support the transformation of TUGSE to oral squamous cell carcinoma; however, our experience suggests a close vigilance of such lesions due to its high clinical resemblance to malignancy. Hence, repeat biopsies on a regular basis are mandatory in cases where the clinical picture is highly suspicious.