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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Behçet's syndrome
• Aphthous ulcer
• Drug-induced oral ulcer
• Oral traumatic ulcer – Generally the routine traumatic ulcer is not as chronic as the traumatic granuloma, although candidal infection of the periphery of a traumatic ulcer may cause it to persist.
• Squamous cell carcinoma – This malignancy may appear to be very similar clinically, and biopsy is often necessary to distinguish between these two entities.
• Non-Hodgkin's lymphoma – This malignancy, when secondarily ulcerated, can also appear clinically very similar to traumatic granuloma. Recent reports have suggested that a small percentage of lesions that may have been categorized as traumatic granuloma in the past could represent an indolent CD-30-positive T-cell lymphoma.
• Histoplasmosis or other deep fungal infection – Biopsy reveals Histoplasma capsulatum or other causative organisms in tissue sections stained with PAS or GMS method.
• Tuberculous ulcer – Biopsy shows necrotizing granulomatous inflammation and acid-fast bacilli.

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