Parameter | Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) | Squamous cell carcinoma (SCC) | CD30 positive lymphoprolipherative disorder (LPD) | Lues (syn. Syphilis) | Epstein-Barr virus (EBV) mucocutaneous ulcer | Aphthous stomatitis |
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Location in the oral cavity | Tongue, buccal and vestibular mucosa, palatal mucosa, retromolar area, gingiva, floor of the mouth | Bottom of the oral cavity, lateral side and tip of the tongue, lower lip, retromolar area | Rarely in the oral cavity, often recurring lesions | Lips, tongue, pharynx | Oropharyngeal mucosa | Non-keratinizing epithelial surfaces in the mouth (labial and buccal mucosa, soft palate, lower side of the tongue); in patients with Severe aphthous stomatitis, the keratinized mucosa can also be affected |
Etiopathogenesis | Unknown, causal connection with repeated trauma | Causal connection with chronic tobacco and alcohol consumption and poor oral hygiene | Typically in patients with an impaired immune system | Most commonly spread through unprotected (oral) sexual intercourse or congenital infection | Associated with immunosuppression | Stress, trauma, hormonal fluctuations, allergic reaction (certain foods, drinks, toothpastes and mouth rinses) |
Peak age | Two peaks of life incidence: one during the first two years of life and another between the 5th and 7th decade | Most commonly after the 5th decade of life (men more frequently affected than women) | Elderly (> 75 years) | Most commonly between the 3rd and the 4th decade of life (men more frequently affected than women) | Primarily elderly (> 75 y), any age | Any age but the frequency increases later in life |
Clinical features | Ulcer with elevated and indurated margins and yellowish fibrinous base | Endophytic growth, nodose and shallow ulcer with elevated margins, often covered by a non-strippable reddish, whitish or mixed focus growing infiltrative and destructive | Nodules or ulceration, indolent clinical behavior, primary cutaneous manifestation possible | Stage I (primary syphilis): after an incubation period of 2–3 weeks, the papule at the portal of entry converts into a indolent and superficial ulcers with indurated margins (also called primary chancre) multifocal, aphthous enanthema | Sharply circumscribed indolent ulceration | Nonspecific shallow round or oval painful ulcer, covered by a grayish-white fibrin pseudomembrane with a sharply defined erythematous border |
Histopathology | Granulomatous tissue with a dense, diffuse, polymorphic, inflammatory infiltrate predominately of eosinophils and histiocytes, often extending into the submucosa, deeper muscle fibers and salivary glands | Epithelial differentiated structures with cornification (hyperkeratosis, parakeratosis, horn beads and multiple dyskeratotic keratinocytes) and peritumoral inflammatory reaction composed of a mixed cellular infiltrate, which is rich in plasma cells | Infiltrate of atypical lymphoid cells admixed with eosinophils involving the oral epithelium and the deep soft tissues | Significant plasmacytosis, plasmacell phlebitis, vague granulomas, detectable spirochetes (Warthin-Starry, immunohistochemistry) | Polymorphous infiltrate with inflammatory cells and atypical large B-cells blasts often with Hodgkin/Reed-Sternberg (HRS) cell-like morphology, sharply demarcated towards deeper structures (assessible only on excisional biopsies) | Nonspecific ulcer, inflammatory cells, predominately T-cells, with high local levels of TNF-α |
Immunohistochemistry | Mixture of phenotypically regular T-lymphocytes, occasionally CD30+ | CK5/6+, CK19+, p63+, p40+ | MUM1p+, MYC+, CD30+ T-cells with antigenic loss of T-cell markers | Detection of Treponema pallidum by the following tests: TPPA test (Treponema pallidum particle agglutination assay test), FTA-ABS test (fluorescent treponemal antibody absorption test) | EBER+ (EBV encoded small nuclear RNA), CD30+ | Nonspecific |