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07-02-2013 | Internal medicine | Article

Oral eosinophilic ulcers ‘a self-limiting, reactive condition’

Abstract

Free abstract

medwireNews: A review of patients with oral eosinophilic ulcers suggests that the lesions should be considered a reactive, local condition rather than a CD30+ lymphoproliferative disorder.

The study was undertaken by Alan Santos-Silva (Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil) with the aim of characterizing the clinicopathologic and immunohistochemical features of eosinophilic ulcers of the oral mucosa.

From hospital records, the researchers identified 19 patients with oral eosinophilic ulcers between 1998 and 2012. Their mean age was 58.6 years (range 35-84), just over half were men, and the tongue was involved in 14 cases. Other sites included the palate, floor of the mouth, gingiva, and lip.

The most common symptom was a single painful ulcer, with a duration varying from 2 to 48 months. Trauma was a potential cause in seven (36.8%) cases and no patient reported skin lesions or recurrences - indicative of systemic disease - during follow up.

Microscopically, most cases had a superficial fibrinopurulent membrane covering the ulcerated areas. There was also an intense inflammatory infiltrate composed mainly of lymphocytes and scattered plasma cells, mast cells, and macrophages.

All cases had a "significant" population of eosinophils, frequently surrounding the deeply situated muscular fibers.

Immunohistochemical analysis revealed that the inflammatory infiltrate was mostly composed of cytotoxic T-lymphocytes. Interestingly, CD30 expression was not restricted to the large atypical cells but also stained small reactive lymphocytes.

Taken together, these observations do not support the hypothesis that oral eosinophilic ulcers are part of the spectrum of CD30 lymphoproliferative disorders, Santos-Silva and co-authors write.

"Cases with histopathological and clinical features consistent with this diagnosis behaved in a benign, reactive way, with no tendency for recurrence and no specific staining pattern for CD30," they state in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.

The team concludes: "In the absence of more distinct clinical (multiple oral lesions, disseminated skin lesions), histopathological (significant cellular pleomorphism, increased atypical mitotic figures, extensive areas of necrosis), and genetic features (monoclonal rearrangements of the T-cell receptor that could support a diagnosis of lymphoproliferative disorder, eosinophilic ulcers of the oral mucosa should be considered a reactive condition."

By Joanna Lyford, Senior medwireNews Reporter

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