DDx
Diagnostic Considerations
Also consider noma (necrotizing stomatitis), Epstein-Barr virus infection, and atypical herpes stomatitis (in patients who are immunocompromised).
Occasionally, lesions may demonstrate atypical histologic features. These lesions have been misdiagnosed as non-Hodgkin lymphoma and squamous cell carcinoma, and unnecessary radical treatment may result. Conversely, CD30-positive anaplastic lymphomas have been misdiagnosed as eosinophilic ulcers; therefore, immunohistochemical studies may be needed to confirm the diagnosis. [13]
Differential Diagnoses
Media Gallery
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A 47-year-old African American woman with an eosinophilic ulcer on the lateral surface of the tongue. The anterior border of the lesion is raised. Courtesy of Dr Paul D. Freedman.
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Raised, indurated, nonhealing ulcer on the lateral surface of the tongue. The lesion was related to an adjacent fractured tooth. Courtesy of Dr Paul D. Freedman.
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Ulcer on the ventrolateral surface of the tongue. The differential diagnosis should include squamous cell carcinoma or an infectious etiology. Courtesy of Dr Paul D. Freedman.
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Lesion on the lateral surface of the tongue. Courtesy of Dr Paul D. Freedman.
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Low-power view showing an ulcerated surface epithelium with a dense cellular inflammatory infiltrate underlying the mucosal surface (original magnification X40). Courtesy of Dr Paul D. Freedman.
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Cellular infiltrate composed mainly of large mononuclear cells, including histiocytes and submucosal dendrocytes, eosinophils, and scattered T lymphocytes (original magnification X400). Courtesy of Dr Paul D. Freedman.
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Inflammatory infiltrate extending through and between muscle bundles (original magnification X400). Courtesy of Dr Paul D. Freedman.
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