Journal of Advanced Clinical & Research Insights (2014), 1, 102–105 102 Journal of Advanced Clinical & Research Insights ● Vol. 1:3 ● Nov-Dec 2014 CASE REPORT Traumatic ulcerative granuloma with stromal eosinophilia: A diagnostic dilemma? Tejavathi Nagaraj, Durga Okade, Pooja Sinha, I. P. Mahalakshmi Department of Oral Medicine and Radiology, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India Abstract Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a slow growing reactive lesion that commonly affects the tongue. The pathogenesis of this lesion is obscure. Chronic irritation from traumatic agents is considered to be one of the contributing factors in most of the cases. It usually presents as an ulcer or an indurated submucosal mass. Histopathologically, it is characterized by eosinophilic inflammatory infiltrate penetrating into the submucosal layers degenerating the underlying muscle. It is important to recognize this mucosal entity as it has a close resemblance with malignancy of the oral cavity. The pathognomonic feature of TUGSE is that it resolves on its own after excisional biopsy. A 25-year-old Sudanese boy had reported to us with an ulceroproliferative growth in the left side of the mouth. Keywords Biopsy, eosinophils, trauma, traumatic ulcerative granuloma with stromal eosinophilia Correspondence Dr. Durga Okade, Department of Oral Medicine and Radiology, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru - 560 032, Karnataka, India. Mobile: +91-9632680474, Email: dr_durga@hotmail.com Received 8 July 2014; Accepted 2 September 2014 doi: 10.15713/ins.jcri.26 Introduction Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a unique and relatively recently delineated entity also called as traumatic granuloma and eosinophilic granuloma. [1] It is a benign lesion, possibly a lymphoproliferative disorder, which typically follows trauma. [1] The rapid growth, large ulceration and indurated borders resemble early squamous cell carcinoma; hence biopsy is performed to rule out that possibility. [1,2] Interestingly, many of these traumatic granulomas undergo resolution after incisional biopsy. [2] Here, we report a case of 25-year-old Sudanese boy who presented to our department with a swelling on the left side of the lower 1/3 rd of the face. Case Report A 25-year-old Sudanese boy had come to the hospital with the chief complaint of pain in the lower left back teeth region and asymmetry on one side of the face since 1½ months. In the history of presenting illness, pain was insidious in onset, severe in intensity since 1 week, intermittent in nature, aggravated on chewing food on the affected side and relieved on taking medications. Swelling was noticed by the patient in the lower aspect of the jaw 1½ months back which was the size of a peanut and has gradually increased to its present size, associated with severe pain since 1 week. The medical and allergic history was not significant. Patient revealed the habit of smoking 3-4 cigarettes/day since 6 years and has stopped the habit since 1 month. Occasionally, a patient would take to hookah smoking. Extraoral examination revealed presence of a solitary swelling on the lower left side of the face roughly oval in shape measuring about 3 cm × 3 cm in size. It extended anteriorly 1 cm from the angle of mouth, posteriorly from the posterior border of the ramus of the mandible, superiorly 0.5 cm below the infraorbital margin and inferiorly till lower border of the mandible. It had well-defined margins, color over the swelling was normal, and no effect on surrounding structures [Figure 1]. On palpation, inspectory findings were confirmed. Swelling was tender, firm to hard in consistency. A solitary left submandibular lymph node was palpable, tender, 1 cm in size roughly, soft in consistency and freely movable. On biting, tenderness was elicited over the area of the left temporomandibular joint and mouth opening was restricted. Intraoral soft tissue examination revealed presence of an ulceroproliferative growth on the left side of the oral cavity on