Clonal T-Cell Receptor Gene Rearrangements in Traumatic Ulcerative Granuloma with Stromal Eosinophilia
CL Kossover, S Budnick, S Li. Emory University, Atlanta, GA
Background: T-cell monoclonality is not confined to lymphoproliferative disorders but additionally has been described in benign reactive conditions. Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a typically self-limited lesion of the oral mucosa with unclear pathogenesis. Morphologically these lesions consist of dense and deeply infiltrative mixed inflammatory cells with a prominent eosinophilic component as well as occasional large atypical mononuclear cells. Although largely regarded as clinically benign lesions, recently a few case reports have demonstrated molecular evidence of T-cell clonality within these lesions, suggesting that a subset of TUGSE might be a low-grade T-cell lymphoproliferative disorder. However, to date a large study examining the prevalence and clinical significance of T-cell clonality in TUGSE's has not been conducted.
Design: To evaluate by molecular methods the presence of T-cell clonality in TUGSE's and to investigate the clinical significance of these findings.
Results: We performed polymerase chain reaction (PCR) analysis for T-cell receptor (TCR) gene rearrangements on 37 cases of TUGSE selected from the 2002-2008 files of the Department of Pathology at Emory University. Clonal TCR gene rearrangements were demonstrated in 7 of the 37 cases. After blind review of the morphology of all 37 cases, two of the clonal cases were diagnosed as atypical lymphoid proliferations based on the findings of cohesive clusters and sheets of atypical large mononuclear cells with abundant mitoses. The remaining 5 clonal cases were morphologically benign. Clinical follow-up was available for 5 of the 7 clonal cases for an average period of 1 year and 9 months after the initial biopsy/excision, with no evidence of local recurrence or development of systemic T cell lymphoma.
Conclusions: The majority of TUGSE's demonstrating a clonal TCR gene rearrangement are morphologically and clinically benign. Without morphologic and/or clinical evidence of a lymphoproliferative process, T cell clonality in these lesions is not an indication of malignancy. More experience is needed with these lesions for a conclusive statement regarding their long-term biologic behavior and the best overall clinical management.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 188, Wednesday Morning