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Congenital epulis is a rare benign tumour arising from the gum of neonates. We report the antenatal diagnosis and neonatal surgical treatment of a large congenital epulis of the mandible associat

Congenital epulis of the newborn is a rare lesion whose histogenesis and natural clinical history have remained obscure. Even with the advent of modern histopathological techniques, it has not been possible to depict specific cellular features unique to this lesion. However, it is important that new cases are reported from all populations so that their occurrence and frequency may be easily noted. Furthermore, the lesion is important as a differential diagnosis of other aggressive lesions early in life. This report presents two Kenyan cases.

Dear Editor, A 6-month-old male, healthy baby brought along with their parents to our department complaining of soft tissue mass in the upper anterior region of the alveolar ridge [Figure 1]. History revealed that the swelling was of pea nut size when the baby was born and gradually increased to reach the present size. There was no history of ulceration, bleeding, pain or pus discharge associated with the swelling. Pregnancy and delivery were uneventful. Mother complained that there was a problem with feeding due to a huge mass of the soft tissue. Intra oral examination showed a single, large, irregular, pendunculated, pinkish white, firm, soft tissue growth with rough outer surface attached to the upper anterior part of the alveolar ridge at the canine region. The swelling measured about 12 mm × 10 mm in diameter and was fibrous in consistency. A clinical diagnosis of soft tissue benign tumor was made, and surgical excision was planned as it caused discomfort to the baby. Neuman’s tumor also known as congenital granular cell tumor (CGCT) or congenital epulis is an uncommon, rare, benign soft tissue tumor, described for the first time in 1891 by Neuman.[1] This tumor is usually diagnosed at birth with three times more predilection for anterior alveolar ridge of the maxilla than the mandible. It is more frequently encountered in females with a ratio of 10:1.[2] Until date, 200 cases have been reported in the literature with 10% of multiple lesions in the same patient. Clinically, the size of the lesion varies from a few millimeters to 15 cm in diameter on gross and usually appears as a protuberant, pedunculated mass. CGCT normally arises from the anterior part of the maxillary alveolar ridge lateral to the midline in the area of the developing primary lateral incisor and canine. The clinical problems encountered are interferences with feeding, respiration, or adequate closure of the mouth.[3] This entity is not found with any other dental malformations or congenital abnormalities. Huge lesions can cause prenatal hydramnios because of ineffective deglutition and postnatal breathing and feeding difficulties. The recommended treatment of choice is surgical excision under local or general anesthesia. However, spontaneous regression has also been reported in very few patients.[4] Literature shows no reports of recurrence, even when the excision has been incomplete, malignant change or future disruption to gums or teeth. Radical resection is not recommended as it is likely to damage the underlying alveolar bone and developing tooth buds.[2,3]

Congenital epulis, a benign tumor of the oral cavity, is an extremely rare condition in newborn. It may lead to mechanical obstruction, therefore resulting in respiratory distress and difficulty in feeding. Addressing the problem may need a multidisciplinary team approach at the time of birth. Antenatal ultrasonography and perinatal magnetic resonance imaging are an adjunct to treatment planning. Prenatal diagnosis remains difficult as the findings are nonspecific due to the late development of the tumor. Surgical excision is, therefore, the treatment of choice. Our report discusses this condition and the treatment thereafter on a newborn, with an epulis originating from the upper alveolar ridge discovered at birth. Histological examination confirmed the diagnosis of large polygonal granular cells. The mass was excised under general anesthesia, and the outcome was good after surgery allowing regular feeds on the second postoperative day.

Congenital epulis is an uncommon benign tumor that originates from the alveolar ridge in newborns. It is also known as congenital gingival granular cell tumor. Although there have been around 200 reports of its postnatal diagnosis, this oral tumor has rarely been diagnosed prenatally. We present fetal MRI and Doppler prenatal imaging of an infant with two congenital epulides (simultaneous involvement of superior and inferior maxillas).

Objective To describe a multidisciplinary approach for delivery room management of congenital epulis. Study Design Case reports. Methods Reporting of two cases of congenital epulis and review of the literature. Results Antepartum ultrasonography demonstrated massive intraoral masses in two fetuses whereby concerns regarding the patency of the airway at birth necessitated development of a multidisciplinary team of maternal–fetal medicine, neonatal–perinatal medicine, anesthesiology, and otolaryngology. Surgical excision was performed before delivery in one infant and after complete delivery in the other without a need for endotracheal intubation and general anesthesia. Feeding was started early, and both infants were discharged after brief hospital stays. Pathological findings were consistent with congenital epulis. Differential diagnosis and options for surgical intervention are discussed, including ex utero intrapartum treatment. Conclusions A multidisciplinary approach to antenatally identified congenital intraoral masses facilitates care at birth. Surgical treatment in this milieu may be simple and complete at the time of delivery.

Congenital fibrous epulis is an extremely rare tumor of infancy. It is a benign gingival tumor and generally seen in maxillary alveolar crest and its etiology remains the subject of debate. Congenital fibrous epulis could be considered a hamartomatous lesion. Histologically it does not show the closely packed large granular cells necessary for the diagnosis of an ordinary congenital epulis. Instead, it consists of irregular bundles of collagenous connective tissue, varying numbers of fusiform cells with oval or fusiform shaped nuclei and mild subepithelial inflammatory infiltration with tiny blood vessels and in this case a woven bone spicule in the deep area. Recommended treatment for this tumor is simple excision. We report upon a case of congenital fibrous epulis in a male infant and discuss the clinical features, histopathologic findings, and surgical treatment.

Melanotic Neuroectodermal Tumour of Infancy (MNTI) is an uncommon neoplasm found predominantly in infants, with around 220 cases reported so far in world literature. 92% of the reported cases have been found in children less than one year of age and 82% of cases have been within the first 6 months of infancy [1, 2, 3]. This tumour has a predilection for the craniofacial region and is most frequently found in the maxilla (72%) followed by cranial vault (12%), mandible (5%) and brain (4%) [4, 5]. The remainder of the sites where the lesion has been reported are epididymis, mediastinum, ovaries and few isolated cases in the thigh, foot, scapula, cheek and zygoma. The earlier uncertainty on the origin of the tumour resulted in a variety of terms [6, 7] for the lesion. Krompecher (1918) who first reported this neoplasm referred to it as congenital melanocarcinoma. The other names proposed have been melanotic progonoma, pigmented ameloblastoma, retinal anlage tumour, melanotic epithelial odontoma, and pigmented congenital epulis [8]. Borello and Gorlin in 1966 referred to the tumour as melanotic neuroectodermal tumour of infancy and suggested neural crest origin on the basis of high excretion of vanillyl mandelic acid [9] by the patients which is characteristic of tumours of neural crest origin, namely pheochromocytoma, neuroblastoma and ganglioneuroblastoma [10, 11]. The neural crest origin has further been established from the support received on the basis of immunohistochemical, ultrastructural and biochemical analysis. MNTI is a locally aggressive benign lesion with a recurrence rate of 15%. About 16 cases of malignant variants (6-7%) reported, have been from CNS. Keeping in mind the locally aggressive behaviour of this neoplasm, its tendency for recurrence and the highly proliferative nature of its constituent cells, the management proposed for this lesion is early surgery in the form of either enucleation with aggressive curettage or enbloc resection, depending upon the extent, proximity of the lesion to vital anatomic structures and the histopathological report.

Congenital epulis of the newborn is a rare tumour which is usually benign. The first description of a case is attributed to Neumann in 1871. The word "epulis" is derived from Greek and means "on the gum" or "gum boil". Epulis is also known as a congenital gingival granular cell tumour because of its histological features. Since 1871, 216 cases have been reported. Female babies are affected 8-10 times more often than males. Epulis is located on the maxillary ridge twice as often as on the mandible, mostly as single tumours but rarely as multiple tumours. Macroscopically, epulis is a pedunculated tumour with a smooth or lobulated surface. The basis of the tumour is the alveolar mucosa. The size varies from a few millimetres to 9 cm in diameter. After birth, the tumour normally does not increase in size. Microscopic examination shows a central mass of granular cells. This mass is surrounded by a stratified squamous mucosa. The histogenesis of the tumour is unknown. Spontaneous regression of congenital epulis has been reported in four cases. However, surgical excision is generally indicated due to interference with feeding or respiration. Recurrence of the tumour after surgery has not been reported yet.

Congenital granular cell tumour is usually diagnosed at birth and is a rare, benign tumour that presents as a nonpulsatile, pedunculated lesion arising from the gingival mucosa of the maxilla. It can cause difficulty to the newborn in terms of feeding and breathing. The pathogenesis of the tumour is unknown; histologically, it resembles a granular cell myoblastoma, but is different on immunohistochemical staining. This study presents a case involving a newborn with a large congenital granular cell tumour protruding from the mouth, and discusses its management.

Background : Congenital epulis is a rare lesion of the newborn, presenting as mass in the oral cavity which can interfere with respiration and feeding. It should be distinguished from other lesions which can occur in newborns, both clinically and histopathologically. Case details : Here, we report a case of congenital epulis in a newborn female on the right alveolar ridge, along with an extensive review of literature and discuss the immunoprofiling. Conclusion : Early diagnosis of CE in a newborn is of paramount importance in the successful management of these rare cases. Keywords : congenital epulis, congenital granular cell lesion, Neumann’s tumor

Congenital granular cell tumor, also known as congenital epulis, is a very rare lesion seen in newborns. The typical presentation is a solitary nodule occurring on the gingiva of the anterior alveolar ridge of either jaw. Multiple-site involvement is seen very seldom but has been noted on the same or different alveolar ridges. However, tongue involvement is exceptional, and there have been only three cases reported involving both the alveolus and the tongue. A female newborn with multiple congenital epulis on the mandibular alveolar ridge and tongue is presented, and her preferred treatment and histopathological diagnosis are discussed.

Congenital epulis or neonatal granular cell tumor is a tumor whose histogenesis has long been debated. It is dissimilar to other granular cell tumors; the latter having derivation from Schwann cells and hence being S-100 positive. We report a case of congenital granular cell tumor in a newborn female child that was uneventfully operated. The case is reported here because of its rarity.

The histologic and immunohistochemical findings of an extremely rare case of congenital soft tissue mass on the alveolar ridge in an infant are reported. The lesion clinically mimicked an ordinary congenital epulis (congenital granular cell epulis, granular cell tumor of the newborn); however, histologically it consisted of a conglomerate of spindle-shaped cells, akin to smooth muscle cells, which formed interlacing and whorled fasciculi. Nerve fibers with myxoid degeneration, capillaries and muscle walled small vessels intermingled with fasciculi of spindle-shaped cells. The border between the conglomerate of spindle-shaped cells and the surrounding connective tissue was not evident. Immunohistochemically, most of the spindle-shaped cells were intensely positive for antibodies to alpha-smooth muscle actin, HHF-35 and desmin. These findings suggest that the lesion was composed of mature smooth muscle cells that were of hamartomatous or choristomatous nature. The term ‘congenital leiomyomatous epulis’ is proposed.

Objective To describe a clinical approach to the differential diagnosis of oral lesions in neonates. Design Case report. Setting Academic ambulatory care center. Participants Male infant. Results A gingival mass in a male infant appeared clinically consistent with a congenital epulis. Following excision and histologic examination, the diagnosis was determined to be a pyogenic granuloma. Careful attention to alternative diagnoses led to the correct etiology. Conclusions Primary care pediatricians encounter neonatal oral lesions infrequently. The most common oral lesions in the newborn period are Epstein pearls and Bohn nodules. This case illustrates the importance of formulating a more extensive differential diagnosis on discovery of a neonatal oral mass.

Congenital granular cell tumor or congenital epulis is a rare benign soft tissue lesion in newborns. It usually arises from the mucosa of the gingiva, either from the maxillary or mandibular alveolar ridge, and may cause respiratory or feeding problems. We reported a case of a 1-hour-old female newborn with a congenital granular cell tumor in the anterior maxillary alveolar ridge. The lesion was causing a feeding problem and was excised under general anesthesia when the newborn was 1 day old.

Congenital granular cell tumors of the gingiva (synonyms: congenital myoblastoma, congenital epulis) originate from the alveolar ridge in newborns. They are rare granular-cell tumors with benign histology. The main differential diagnosis is epignathus (oral teratoma). Early surgical excision is recommended due to a risk of airway obstruction and difficulty feeding.

Congenital epulis, a rare benign soft tissue tumour from the alveolar crest is smooth-surfaced, pedunculated and lobulated. It is almost always located on the gingiva and is found predominantly on the maxilla. It can obstruct the oral passage by its size and induce airway obstruction and feeding problems. Spontaneous involution after birth is rare. Newborns with a diagnosis of congenital epulis should be immediately subjected to the simple conservative surgical excision to restore vital functions, improve quality-of-life and decrease parental anxiety. Wide radical excision is not recommended as no recurrences have been described even after incomplete excision. The parents of the newborn with congenital epulis should be assured of this benign pathology and the simple treatment. This report documents the presentation and management of a congenital epulis of the maxillary alveolar ridge found in a newborn female and treated with simple conservative surgical excision.

The congenital granular cell epulis is a very rare benign tumor arising from the alveolar ridges of newborns. Although several etiologic theories, like myoblastic, odontogenic, neurogenic, fibroblastic, histologic and endocrinologic possibilities have been proposed; the exact mechanism in the development of such a lesion remains elusive. In the present article, a slowly growing congenital granular cell epulis of a 50-day-old male newborn encountered in the mandible was reported in the light of histopathologic and immunohistochemical examination. Presence of congenital epulis (CE) in the mandible and in male is a very rare entity. Furthermore, growth of CE after birth was an unexpected feature. In conclusion, it is important to allow the pediatric and general dentists to be aware of this congenital tumor and its presentation with the underlined unexpected feature, so that this entity will be more easily recognized and relevant information given to patients.

The granular cell tumour (myoblastoma, Abrikosoff's tumour) and the congenital epulis in newborns (Neumann tumour) are two lesions rarely found in the oral cavity, whose histogenetic origin is highly controversial. This work analyses using immunohistochemical techniques 15 cases of myoblastomas and two of congenital epulis with different mono- and poly-clonal antibodies. Positive immunostaining was found for S-100 protein and neuron-specific enolase in all the cases of myoblastoma, and for vimentin and carcinoembryonic antigen in some cases. No immunoreactivity was observed for any of the other 13 antibodies used in congenital epulis.

Congenital granular cell lesion (CGCL) is a rare non-neoplastic lesion found in newborns also known as Neumann’s tumor. This benign lesion occurs predominantly in females mostly as a single mass. The histogenesis and natural history of the lesion remains obscure. It arises from the mucosa of the gingiva, either from the maxillary or mandibular alveolar ridge. The lesion is more common in the maxillary alveolar ridge than the mandibular.The present report describes a case of congenital granular cell lesion in an eight-day-old female child who was born with a mass on the anterior mandibular alveolar ridge. The mass was protruding from her mouth and compromised feeding. A clinical diagnosis of teratoma was suggested. Histologically, cells of this lesion are identical to granular cell tumor (neuroectodermal type) and show intense diastase-resistant Periodic Acid Schiff positivity. Immunohistochemically, cells are positive for vimentin but negative for S-100 and desmin, thus suggesting that CGCL is possibly derived from primitive gingival mesenchymal cells rather than having schwannian origin.Key words: Congenital epulis, congenital granular cell lesion, immunohistochemistry

A newborn baby boy weighing 3100 g was found to have a pinky red solid mass 3 × 2.5 × 2 cm arising from the anterior ridge of the maxilla. This caused difficulty in feeding, and looked ugly. The mass was excised under local anaesthetic when he was 2 days old and histological examination showed congenital epulis. He also had a stage II congenital goitre. His hypothyroidism was treated with L-thyroxine sodium and he was well with no sign of recurrence of the tumour at the age of 1 year.

Congenital epulis is a rare, soft-tissue benign condition that presents at birth. It arises from the alveolar mucosa and occurs more frequently in the maxilla, mainly in the frontal region. This condition may interfere with respiration, feeding or lip closure. Surgical excision is the only possible treatment, although spontaneous regression has been reported. This article presents the case of a female infant with a solid ovoid mass protruding from the oral cavity. Treatment of this lesion was surgical, and histopathological examination confirmed the clinical diagnosis of congenital epulis. Postsurgical follow-up was without complications; examination of the infant 5 months later has revealed only mild left frontal alveolar ridge hypoplasia without any sign of recurrence.

A rare case of leiomyomatous hamartoma of the gingiva is reported and the immunohistochemical and ultrastructural features described. A polypoid mass which presented with the appearance of a congenital epulis was located in the midline of the maxillary alveolar ridge of a two-year-old boy. Histologically, the mass was without a capsule and was composed mainly of irregularly arranged fasciculi of large spindle cells resembling smooth muscle cells. The immunohistochemical staining for desmin was strongly positive in these cells. Many nerve fibers were intermingled with them. Ultrastructurally, the cytoplasm was filled with thin filaments associated with dense patches. Numerous pinocytotic vesicles were present on the cytoplasmic membrane. These findings indicated that the mass consisted mainly of mature smooth muscle cells. The clinical and histological features suggest that the smooth muscle cells in the lesion are of hamartomatous or choristomatous origin, in contrast to true leiomyoma or granular cell congenital epulis.

Five previously unreported cases of congenital epulis of the newborn are presented. All five cases were on the anterior maxillary alveolar ridge. Four were removed at 2 days of age and one at 7 weeks. Light microscopy demonstrated large eosinophilic granular cells within vascular fibrous connective tissue. Immunohistochemical studies revealed a positivity for vimentin and neuron specific enolase. Cytogenetic evaluation performed on one case was normal. Estrogen and progesterone receptors were absent in the one case so studied. Electron microscopy demonstrated tumor cells that were filled with autophagosomes. Cellular organelles were significantly reduced and inversely related to the number of cytoplasmic autophagosomes. Many of the autophagosomes contained collagen precursors. Poorly formed junctional complexes were seen. Occasional tumor cells demonstrated long processes that contained contractile microfilaments, pinocytosis, and areas of exocytosis. These studies suggest the tumor cells represent early mesodermal cells that express pericytic and myofibroblastic features that undergo cytoplasmic autophagocytosis.

Congenital gingival granular cell tumor is a rare benign lesion of uncertain origin, which has been found only in newborn infants. This article describes one such case. Our immunohistochemical study employing antibodies against S-100 protein, epithelial membrane antigen, carcinoembryonic antigen, wide-spectrum keratin, desmin and vimentin yielded data supporting the theory of a mesenchymal cell origin for this lesion.

We present a case of congenital epulis, diagnosed prenatally with US. Congenital epulis is a benign gingival tumour whose differential diagnosis includes other oral-facial masses such as haemangioma, granular cell myoblastoma and cystic hygroma. This tumour can cause obstruction of the airway or feeding problems in the newborn child. Surgical excision is the treatment of choice.

Congenital epulis, a kind of hamartoma, is a very rare tumor, which appears in front of maxillary alveolar ridge in most cases, and accompanies no malformations. As the tumor protrudes from the oral cavity, it may lead to respiratory difficulties and feeding problems. Therefore it is important for pregnant women to receive comprehensive prenatal counseling with accurate diagnosis of the fetal oral tumor. We report a rare case of prenatal detection of oral tumor with a brief review of literatures, which was confirmed to be a congenital epulis or granular cell tumor after birth.

A newborn infant with multiple congenital oral swellings can be a striking sight for both parents and healthcare professionals involved in neonatal care. Neumann first described congenital epulis of a newborn in 1871, hence it is also known as Neumann's tumor. Congenital epulis occurs at birth and has a predilection for females. Congenital epulis clinically appears as a pedunculated protuberant mass. In cases with large lesions, mechanical, oral, and nasal obstruction can impair fetal deglutition or interfering with feeding and / or respiratory impairment. We are reporting a case of a six-day-old, 3.5 kg newborn female, who had reported to our institution with multiple congenital oral swellings arising from the maxilla and mandible.

A neonate, with a rare, large, congenital epulis of the anterior maxilla, which resulted in oral feeding obstruction, is presented. Due to its easy accessibility, narrow pedicle to the alveolus, and benign clinical behavior, permanent eradication of the tumor by simple excision under local anesthesia was performed.

Two cases of congenital epulis occurring in the gingiva at the site where the lower deciduous incisors were to erupt are described. The first patient was a 7 day-old female infant. Her epulis was diagnosed, histopathologically, as a granular cell tumor. Electron microscopy revealed that the tumor cells were large with small eccentric nuclei. The cells were filled with granular structures. These granular substances varied in size and electron density. Case 2 involved a 37 day-old male infant. A histopathological diagnosis of fibromatosis was made. Electron micrographs showed a proliferation of cells which resembled fibroblasts. These cells varied in shape, including some with thin, long processes. Abundant reticular and collagen fibers were present in the stroma. In both cases, the postoperative course was uneventful without recurrence.

Neumann first described congenital epulis (CE) of newborn in 1871. CE occurs at birth and has a striking predilection for females. It is most frequently located on the anterior maxillary alveolar ridge. CE clinically appears as a pedunculated protuberant mass. In cases with large lesions mechanical oral and nasal obstruction can impair fetal deglutition and neonatal respiratory efforts resulting in polyhydramnios prenatally or respiratory impairment postnatally. Histologically CE shows characteristic large cells with granular cytoplasm and spindle cells resembling fibroblasts. The exact histiogenesis is still uncertain, various theories of origin are epithelial, undifferentiated mesenchymal cells, pericytes, fibroblast, smooth muscle cells and nerve related cells. A newborn female child with CE in the maxillary alveolar ridge reported to our institution is presented with investigation, management and follow-up.

A rare case of congenital epulis is presented. The tumor growth, as a result of intrauterine hormonal stimuli, is discussed along with evidence against the intrauterine estrogen stimulus theory.

We observed, under the scanning and transmission electron microscope, the case of a bean-size tumor which developed from the moment of his birth in the front tooth area of the lower jaw of a male new-born baby of 37 days. Clinically it was diagnosed as a case of congenital epulis and histopathologically confirmed the congenital fibromatosis. The observation under the scanning electron microscope revealed that the tumor consisted of basically fibrous connective tissue and partly of osseous formation structure. Transmission electron microscope served to observe the variety of fibroblast patterns such as fusiform, stellated and plane one etc., as well as the existence of abundant reticular and collagenous fibrils in its stroma. These findings under both electron microscopes suggest to consider on the hamartoma character of the tumor from mesenchymal tissue.

Tumor cells of the congenital granular cell epulis (GCE), unlike those of the granular cell tumor (GCT), did not stain with antiserum to S-100 protein. Based on immunohistochemical findings it is concluded that the GCE and GCT differ in histogenesis; furthermore, ultrastructural studies of the authors are in agreement with others in supporting a mesenchymal origin of the GCE.

A rare case of congenital epulis with natal tooth in a 6-month-old girl is presented. The lesion was excised under general anesthesia. Histological examination revealed that the tooth had scanty root formation and was directly connected to the soft tissue without periodontal membrane. The epulis consisted of fibrous connective tissue covered by layers of stratified squamous epithelium. According to these findings, it was considered that the epulis was formed by the response to irritation of the natal tooth as a result of the upward transposition of germs.

A case of gigantic congenital epulis of a new born baby was reported. The tumor measured 42×33×29 mm and was arising from B region on the alveolar gingiva.The tumor was removed 3 hours after birth without anesthesia. After extirpation, the baby was able to nurse satisfactorily. There has been no problem of recurrence. The tumor was diagnosed histopathologically as a benign granular cell tumor.