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Peripheral giant cell granuloma (PGCG) is a non-neoplastic lesion representing a local hyperplastic reaction to injury or inflammation. Lesions vary in appearance from smooth, regularly outlined masses to irregularly shaped, multilobulated protuberances with surface indentations. Ulcerations of the margin is occasionally seen. The lesions are painless, vary in size, and may cover several teeth. This article reports a case of PGCG arising at the mandibular anterior region in a 45-year-old man. The biopsy specimen revealed features consistent with PGCG. The clinical follow-up revealed uneventful soft tissue healing.

A newborn infant with congenital epulis (CE) can be a striking miserable sight for both parents and health care professionals involved in neonatal care. These tumours of the infant mouth can be remarkably large, occupying much of the oral cavity and posing a risk of airway obstruction or interfering with feeding with marked facial deformity. Neumann first described congenital epulis of newborn in 1871. It is most frequently located on the anterior maxillary alveolar ridge with slight female predilection. It 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 Congenital epulis shows characteristic large cells with granular cytoplasm and spindle cells resembling fibroblasts. The exact histogenesis is still uncertain, various theories of origin are epithelial, undifferentiated mesenchymal cells, pericytes, fibroblast, smooth muscle cells and nerve related cells. Herein we report a newborn female child with Multiple Congenital epulis arising from maxilla and mandible with investigation, management and follow-up.

Arteriovenous malformations (AVM) are usually observed on the skin, but they can also rarely affect the visceral organs and the maxillofacial area. In the maxillofacial area, these lesions can spread and they are potentially dangerous, as a biopsy or even a simple tooth extraction can lead to a catastrophic haemorrhage that may eventually cause death. There are several indications for the treatment, including age, size and type of vascular malformation. The purpose of this report is to describe an AVM on the maxilla, first diagnosed as an epulis, which has been treated for several years as a chronic local periodontitis. The lesion was finally stabilised after an antibiotic therapy. Improved knowledge of the development of these lesions and collaboration between dentists, radiologists and surgeons are necessary to improve the diagnosis and treatment of vascular malformations.

Objectives. Although it is now reasonably certain that granular cell tumors derive from Schwann cells, the histogenesis of congenital epulis, which is largely isomorphic with granular cell tumor, remains unclear. A study was undertaken to compare the immunophenotype of these tumors with particular emphasis on the expression of matrix proteins and macrophage markers because such information is not available in the literature. Study design. Four granular cell tumors and two congenital epulis were immunostained with a panel of 29 antibodies. Two congenital epulis and one granular cell tumor were investigated by electron microscopy, the latter also by immunoelectron microscopy. Results. Many similarities in immunostaining were found, for example, both tumor types were CD68+, Ki-M1P+, lysozyme-, vimentin+, fibronectin+, laminin+, lectin PHAE+, and lectin WGA+. However, differences were also noted, for example, granular cell tumor was always S100 protein+, but only one congenital epulis case was reactive (weak reactivity after microwave treatment), and staining with the proliferation markers anti-proliferating cell nuclear antigen and MIB 1 was found only in congenital epulis. Both tumor types exhibited pericellular and diffuse cytoplasmic staining for fibronectin and laminin. Conclusions. The hypothesis that congenital epulis and granular cell tumor would exhibit similar reactivity for macrophage markers was confirmed: both were reactive with anti-CD68 and Ki-M1P and nonreactive with MAC387, anti-lysozyme, and 3A5. Intracytoplasmic staining for fibronectin and laminin, which has not been described previously in these tumors, appears to be a characteristic feature common to both tumors. This finding suggests that there could be a disturbance of synthesis and secretion of extracellular matrix proteins or a derangement of their receptor systems. This theory could be supported by the finding of intracytoplasmic CD49e-positive material in two cases.

Clinico-histopathological analysis was made of 87 cases diagnosed as epulis in the Second Department of Oral and Maxillofacial Surgery of Niigata University Dental Hospital during the 21 years from 1973 to 1994. The results were as follows : 1. They were classified histopathologically into 50 cases of epulis granulomatosa (57.5%), 16 cases of epulis fibrosa (18.4%), 15 cases of epulis osteoplastica (17.2%) and 6 cases of epulis hemangiomatosa (6.9%), according to Ishikawa Classification(1982). 2. Epulis was evident in the fourth and fifth decades of age and the mean age was 42.6 years. Females were affected more frequently than males by a ratio of 2.6:1. 3. Their chief complaints were tumor of the gingiva. 4. Fifty-three cases occurred in the maxilla and 34 cases in the mandible. Forty-one cases were located in the anterior segments of the jaws. 5. All cases were surgically excised. The cases accompanied with tooth extraction were 39.1%. Four cases recurred and were reoperated. 6. The pregnancy epulis was observed in 13 females. Their chief complaint was tumor of the gingival with gingival bleeding. Most of the tumors appeared by middle of pregnant period and had tendency to stop growing after delivery. They were composed of 6 cases of epulis granulomatosa (46.1%), 4 cases of epulis hemangiomatosa (30.8%), 2 cases of epulis osteoplastica (15.4%) and one case of epulis fibrosa (7.7%)., 過去21年間に当科を受診し,病理組織学的にエプーリスと診断された87例について検討した。組織学的分類は石川の分類に準じ,肉芽腫性エプーリス50例,線維性エプーリス16例,骨形成性エプーリス15例,血管腫性エプーリス6例であった。男女比は1:2.6で女性に多く,好発年齢は30歳台,40歳台であったが,血管腫性エプーリスは20歳台に多かった。主訴は歯肉の腫脹･腫瘤であったが,妊娠性エプーリスでは出血を自覚している症例を多く認めた｡病悩期間は比較的短く,半年以内が過半数を占めていたが,血管腫性エプーリスでは短く,線維性エプーリスでは長い傾向を認めた｡好発部位は上顎前歯部であった｡大きさは雀卵大から示指頭大で,粘膜色,有茎性のものが多くみられた｡処置は全例摘出であったが,摘出時に抜歯を併用した症例は39.1%であった｡妊娠性エプーリスは妊娠中期までに自覚することが多く,出産後,腫瘤の増大は停止する傾向を認め,組織学的には一般のエプーリスに比し,血管成分を多く認めた｡

This article describes the acanthomatous epulis in dogs, a quite common lesion that appears to be the counterpartof human ameloblastoma. Histologically, it resembles closely the acanthomatous pattern of human ameloblastoma and like ameloblastomas in human beings, it infiltrates cancellous bone; moreover, it has no tendency to metastasize. Veterinarians have sometimes treated the acanthomatous epulis with therapeutic irradiation, providing one example when this tumor served as an animal model for human ameloblastoma. Although this treatment has cured some animals, others have developed postirradiation malignancies.

The epulis gravidarum, or granuloma of pregnancy, represents a vascular lesion observed during gravidism. While histologic features may mimic those of generic pyogenic granulomas, the management may differ. Remarkably, the plastic surgical literature is conspicuously void of information concerning this common entity, with approximately 40 new cases being diagnosed and treated annually at our institution. With a review of the literature, we offer four typical and representative case reports that serve to highlight the pertinent physiology and treatment options. Guidelines are proposed to assist in the management of this disease process.

Sonographic prenatal diagnosis of congenital anomalies has been proven to be an invaluable tool in the management of pregnancy, delivery, and postnatal treatment of affected newborns. Congenital gingival granular cell tumor, or epulis, is a rare intraoral tumor that may cause polyhydramnios and possibly severe respiratory and feeding complications at birth. Sonographic diagnosis of this tumor provides the opportunity to plan the mode of delivery, the presence of support teams to assist in airway maintenance, and surgical correction.

Epulis, a discrete sessile or pedunculated mass of fibrous tissue on the gingiva caused by chronic inflammation, is a common lesion. However, other lesions may occasionally exhibit exophytic growth and they must be differentiated from epulis. A 38-year-old Japanese female noticed a pedunculated soft mass on the alveolar ridge of the right maxillary third molar shortly after extraction of the tooth. The mass, which had periods of exacerbation and quiescence, was excised under a tentative diagnosis of epulis. Because histopathology revealed edematous, inflamed antral mucosa with a covering of ciliated columnar epithelium, a final diagnosis of herniation of antral polyp through an oro-antral fistula was established. Although a rare occurrence, herniation of antral polyp should be included in the differential diagnosis of exophytic lesions on the maxillary molar alveolar ridge if there is a history of dental extraction at the concerned area.

The Schwannoma is a benign tumor that originates from Schwann cells of peripheral motor and sensory nerves. It presents as a solitary, slow growing, smooth-surfaced and asymptomatic firm mass. The pre-operative diagnosis is often difficult, and in majority of cases it can only be made during the surgery and the definitive diagnosis obtained by histological study when cells test positive for S-100 protein. In this report, a case of a 20-year-old female patient with a Schwannoma located in the upper gingival mucosa is discussed. The patient was referred to the department of oral and maxillofacial surgery with chief complaint of enlargement of the upper gingival mucosa at the level of upper right premolar. Clinical findings showed characteristics of connective tissue tumor including epulis; however, histologic and immunohistochemical studies revealed it to be a Schwannoma. There has been no sign of recurrence 1 year and 8 months after surgery.

Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federalde Minas Gerais, Belo Horizonte, BrazilBACKGROUND: Theglucosetransportertype1(GLUT-1)protein is a useful marker for perineurial cells. Because ofthe possible neuroectodermal histogenesis of the granu-lar cell tumour and congenital granular cell epulis, theaim of this study was to assess the immunoexpression ofGLUT-1 protein in granular cell tumour and congenitalgranular cell epulis to aid in clarifying their histogenesis.METHODS: The protocol of this study was approved bythe Committee of Bioethics in Research at UniversidadeFederal Minas Gerais. Six cases of granular cell tumourand three cases of congenital granular cell epulis weresubmitted to immunohistochemistry for GLUT-1 and S-100 using the streptavidin-biotin standard protocol.RESULTS: Five cases of granular cell tumour werelocated on the tongue and one case on the upper lip.All cases of congenital granular cell epulis were observedin the alveolar ridge of newborns. All lesions evaluatedproved to be immunonegative for GLUT-1. S-100 wasfound to be positive in all granular cell tumours andnegative in congenital granular cell epulis.CONCLUSIONS: Neither granular cell tumour nor con-genital granular cell epulis is directly related to perineur-ial cells.J Oral Pathol Med (2013) 42: 450–453Keywords: congenital epulis; GLUT-1 protein; granular celltumour; immunohistochemistry

Congenital epulis is a rare benign oral cavity tumor that usually arises from the maxillary alveolar mucosa. It is also known as congenital gingival granular cell tumor. Prenatal diagnosis is uncommon and mostly confined to the third trimester. We report a case of congenital epulis, which was referred to our department at 35 weeks of gestation. Both images from our prenatal 2D/3D ultrasound (including Doppler technique) and magnetic resonance examination are presented. A baby girl weighing 2,800 g was delivered spontaneously at 36 weeks and 1 day. The newborn had to be intubated immediately after delivery. A simple excision of the mass was performed on the first day of neonatal life after clinical examination by our pediatric stomatologists confirmed the presence of a tumor resembling epulis. The correctness of this diagnosis was subsequently confirmed by histogenesis. Photographs from the operating room show the postnatal appearance of the tumor. The baby was discharged at the age of 19 days and has remained well at follow-up controls.

Neoplasms metastatic to the oral cavity are rare, accounting for less than 1% of all malignancies found there. When they do occur, they are usually found in the soft tissue or mandible. Metastatic malignancies involving the gingival, alveolar, or buccal mucosa are very rare. We present a case of what appeared to be a benign epulis in a 25-year-old man. Biopsy revealed that the lesion represented metastatic testicular cancer.

A total of 138 surgical excision specimens from 120 patients presenting clinically with epulis was classified by histopathological criteria into giant cell-, granulomatous- and fibromatous-type lesions. Clinical data suggest that local irritants are an important pathogenetic factor. Histopathological analysis revealed that epulides represented self-limiting, reactive gingival overgrowths of granulation tissue displaying common morphologic features in all three histologic types. The transition of a given histologic type of epulis into another, as observed in recurrent lesions, is consistent with the concept of a common histogenetic entity.

Congenital epulis or congenital granular cell tumor, is a benign tumor that has rarely been diagnosed prenatally. We report a case of a large congenital epulis diagnosed at 26 weeks of gestation that increased in size during gestation. Color and power Doppler ultrasound examination showed marked blood flow in the tumor. The tumor could be resected completely following Cesarean section and histologically examined. We discuss the prenatal diagnosis and histogenesis of congenital epulis.

El fibroma osificante periférico (FOP) es una entidad benigna que se incluye en el grupo de las lesiones gingivales reactivas, denominadas con el término genérico de épulis, y se origina, según la teoría más aceptada, en las células del ligamento periodontal. Se manifiesta en forma de tumoración de consistencia firme, bien circunscrita, de color rosado o rojizo y está situada normalmente en la zona incisivo-canina del maxilar superior, siendo rara su aparición en crestas edéntulas. Aparece a cualquier edad, con una mayor incidencia entre la segunda y tercera décadas de la vida, con una ligera predilección por el sexo femenino. Es una lesión de partes blandas, que en ocasiones puede estar asociada a una ligera erosión superficial del hueso subyacente. Se han revisado 3 casos de FOP que afectaban a 2 hombres y 1 mujer de edades comprendidas entre los 39 y los 73 años, presentándose uno de ellos en una cresta alveolar edéntula. En dos casos se observaba radiográficamente una ligera erosión del hueso subyacente y el tercer caso presentaba puntos radioopacos difusos intralesionales. El tratamiento consistió en realizar la exéresis-biopsia de las lesiones, efectuándose dos casos mediante bisturí frío y uno con láser de CO2. Uno de los casos presentó tres episodios de recidiva en el seguimiento postoperatorio. The peripheral ossifying fibroma (POF) is a reactive gingival disorder known under the generic term of epulis and is widely considered to originate from the cells of the periodontal ligament. It manifests as a tumor of firm consistency, well circumscribed, pink or red and is usually located in the incisor-canine area of the maxilla, being uncommon occurrence in edentulous alveolar ridges. Appears without ages difference, with a higher incidence between the second and third decades of life, with a slight predilection for females. It is a soft tissue injury, which can sometimes be associated with a slight erosion of the underlying bone surface. We have reviewed 3 cases of POF involving 2 men and 1 woman aged between 39 and 73 years, presenting one of them in edentulous alveolar ridge. In two cases showed radiological slight erosion of the underlying bone and the third case showed diffuse intralesional radiopaque points. Treatment consisted on resection of the lesions and biopsy of them, two cases to be carried out by cold scalpel and a CO2 laser. One case presented three episodes of recurrence in the postoperative follow.

Epulis is a relapsable lesion in gingiva without specific treatment for its unexplained pathogenesis. Nowadays, surgical excision is the most popular method of treatment. To prevent recurrence, it is necessary to resect diseased tissues thoroughly, and even to remove the involved teeth. However, this may cause functional and cosmetic deformities. Therefore, it is urgent to find a new therapy without severe side effects. Infantile hemangioma is a common benign pediatric tumor which shares many features with epulis, such as rich vascularity, high incidence of female patients, high hormone level and similar treatments. A recent study showed that propranolol, a beta adrenergic receptor (β-AR) antagonist, was effective as treatment for infantile hemangioma. Our preliminary work showed that mRNA and protein levels of β2-AR were higher in epulis than in adjacent tissue. Therefore, we hypothesize that intralesional injection of propranolol may be useful as epulis treatment. Further work need to be done to confirm the safety and therapeutic effect of the treatment. After that, this specific β2-AR antagonist may be the first choice for epulis treatment.

espanolEl fibroma osificante periferico (FOP) es una entidad benigna que se incluye en el grupo de las lesiones gingivales reactivas, denominadas con el termino generico de epulis, y se origina, segun la teoria mas aceptada, en las celulas del ligamento periodontal. Se manifiesta en forma de tumoracion de consistencia firme, bien circunscrita, de color rosado o rojizo y esta situada normalmente en la zona incisivo-canina del maxilar superior, siendo rara su aparicion en crestas edentulas. Aparece a cualquier edad, con una mayor incidencia entre la segunda y tercera decadas de la vida, con una ligera predileccion por el sexo femenino. Es una lesion de partes blandas, que en ocasiones puede estar asociada a una ligera erosion superficial del hueso subyacente. Se han revisado 3 casos de FOP que afectaban a 2 hombres y 1 mujer de edades comprendidas entre los 39 y los 73 anos, presentandose uno de ellos en una cresta alveolar edentula. En dos casos se observaba radiograficamente una ligera erosion del hueso subyacente y el tercer caso presentaba puntos radioopacos difusos intralesionales. El tratamiento consistio en realizar la exeresis-biopsia de las lesiones, efectuandose dos casos mediante bisturi frio y uno con laser de CO2. Uno de los casos presento tres episodios de recidiva en el seguimiento postoperatorio. EnglishThe peripheral ossifying fibroma (POF) is a reactive gingival disorder known under the generic term of epulis and is widely considered to originate from the cells of the periodontal ligament. It manifests as a tumor of firm consistency, well circumscribed, pink or red and is usually located in the incisorcanine area of the maxilla, being uncommon occurrence in edentulous alveolar ridges. Appears without ages difference, with a higher incidence between the second and third decades of life, with a slight predilection for females. It is a soft tissue injury, which can sometimes be associated with a slight erosion traof the underlying bone surface. We have reviewed 3 cases of POF involving 2 men and 1 woman aged between 39 and 73 years, presenting one of them in edentulous alveolar ridge. In two cases showed radiological slight erosion of the underlying bone and the third case showed diffuse intralesional radiopaque points. Treatment consisted on resection of the lesions and biopsy of them, two cases to be carried out by cold scalpel and a CO2 laser. One case presented three episodes of recurrence in the postoperative follow.

Epulis (grč. ͑επί – na ; ο͗ῦλον-ου, τ̀ο-gingiva) je širok pojam koji klinički označava benignu izraslinu na gingivi (1). Vanjskim izgledom djeluje kao tumor, a iza kliničke dijagnoze se mogu skrivati razne promjene. Klinički većina epulisa izgleda podjednako i ono što predstavlja problem jest razlikovanje tih tvorbi. Diferencijalno dijagnostički postoje mnoge tvorbe koje makroskopski izgledaju gotovo identično epulisu i zbog toga jedinstvena podjela epulisa u svijetskoj literaturi ne postoji. Iz razloga što je takvih bolesti mnogo, u diferencijalnoj dijagnozi obuhvatit će se samo najčešće i najzanimljivije tvorbe. Cilj ovog rada jest napraviti što jednostavniju i logičniju podjelu epulisa, približiti njihov izgled i ponašanje, te obuhvatiti što širi aspekt diferencijalno dijagnostičkih bolesti.

This paper compares the microscopic features and clinical behaviour of the acanthomatous epulis in dogs with those of ameloblastoma in human beings. The acanthomatous epulis has similar microscopic features to one histological variant of human ameloblastoma, the acanthomatous ameloblastoma. Moreover, its clinical behaviour is equivalent to that of intraosseous ameloblastoma in human beings, not of the human peripheral (extraosseous) ameloblastoma, as has been suggested. The stroma of acanthomatous epulides varies and does not always resemble periodontal ligament, a feature that in dogs has been used to distinguish them from ameloblastomas. It is concluded that the acanthomatous epulis (1) is an ameloblastoma, (2) arises from the gingival epithelium in some cases, but (3) may also arise intraosseously and then break out of bone. We recommend the term canine acanthomatous ameloblastoma as being appropriate for this lesion.

Epulides account for 0-7.8% of tumors in surveys of feline oral neoplasms. A review of the literature revealed no reports of multiple epulides in cats. Multiple, concurrent epulides were diagnosed microscopically in 13 cats. Fibromatous and ossifying epulides were diagnosed in 11 of 13 cats and fibromatous epulides were diagnosed in 2 of 13 cats. Microscopically, these epulides were nonencapsulated, well-vascularized, infiltrative, highly cellular neoplasms that expanded the gingiva and were composed of haphazardly arranged, spindle-shaped to stellate cells amid a dense, collagenous stroma. Osseous foci were a feature in the fibromatous and ossifying epulides. The mitotic rate was low and there was marked hyperplasia of the overlying gingiva with a prominent downgrowth of epithelial cords. These tumors recurred in 8 of 13 cats following surgical excision. While uncommon, multiple epulides in cats have a high incidence of recurrence but do not appear to have metastatic potential.

Congenital epulis of the newborn (CEN) is a rare benign lesion that exclusively occurs in the oral and maxillofacial regions of newborns. The clinicopathologic features of CEN were examined and reviewed from the files of the Armed Forces Institute of Pathology from 1970 to 2000. Ten cases were included. Patient lesions were all present at birth but were surgically excised between 2 days and 6 weeks (median, 5.5 days). Nine lesions were in females; 1 case did not designate patient sex. Locations included 6 on the maxilla, 2 on the mandible, 1 on the designated maxillary lip, and 1 unknown. The cases included a patient with 2 lesions: 1 on mandibular and 1 on maxillary alveolar ridges, respectively. All other lesions were solitary and polypoid. Microscopically, these were pedunculated and nodular, composed of sheets to grouped clusters of medium-sized, ovoid-to-polygonal cells with abundant granular cytoplasm, distinct cell membranes, vascular-rich stroma, and attenuated overlying mucosa. Two cases also demonstrated spindled cells. The nuclei were vesicular and focally stippled, with distinct and slightly convoluted nuclear membranes; nucleoli were visible but not prominent. Mitotic activity was not observed. The vascular channels ranged from capillary-sized to venous, some staghorn-like with rare perivascular long-term inflammation. The venules exhibited a perivascular pericytic proliferation. Odontogenic epithelial rests were present in 2 cases. No cases demonstrated cytoplasmic hyaline globules. The lesional cells in all cases were negative for S-100 protein, CD68, CD34, CD31, keratins, desmin, calponin, and smooth muscle actin. Perivenular pericytes were positive for smooth muscle actin. Congenital epulis of the newborn is a rare oral entity with characteristic clinicopathologic features. It predominately affects girls, mainly on the maxillary alveolar ridge. It may be separated from "granular cell tumor" by location, patient age, absence of cytoplasmic hyaline globules, solid growth pattern, pericytic proliferation, attenuated overlying epithelium, and negativity for S-100 protein.

Nerve sheath myxoma (NSM) is a benign peripheral nerve sheath tumor that rarely occurs in the oral cavity. Among the 23 reported intraoral cases, no lesion has previously been reported on the gingiva. In this report, we describe the first gingival case of oral neurothekeoma with histopathologic and immunohistochemical characteristics. The patient, a 32 year old female presented with a slowly growing gingival mass diagnosed clinically as an epulis. The lesion was surgically excised. Histopathologically, the lesion presented as a submucosal multinodular mass composed of spindle and stellate-shaped cells with a myxoid background. Immunohistochemically, the tumor cells were sporadically positive for S-100 and NSE and negative for GFAP, EMA, SMA, CD68 and HMB45. The immunoprofile of this lesion confirmed a Schwann cell origin. The lesion was followed up for 10 months with no reports of recurrence.

This study reviews rim excision as a treatment for canine acanthomatous ameloblastomas (CAA) in dogs with

Dentinogenic ghost cell tumor (DGCT) is an uncommon locally invasive odontogenic tumor regarded by many as a variant of calcifying odontogenic cyst. The peripheral variant of this clinical rarity appears as a well-circumscribed mass mimicking a nonspecific gingival enlargement. Microscopic appearance of odontogenic epithelium admixed with focal areas of dentinoid formation and sheets of ghost cells giving the definitive diagnosis of dentinogenic ghost cell tumor imply that microscopic examination is compulsory for any gingival mass. Van Gieson histochemical stain further confirmed the nature of dentinoid-like material. A complete workup of a case of peripheral dentinogenic ghost cell tumor is presented in this paper and the current concept as well as the appraisal of literature is presented.

This article presents the descriptive epidemiology, risk factors, and clinical highlights of the oral mucosal lesions that are most common or of greatest concern among the elderly. Leukoplakia, oral cancer, candidiasis, lichen planus, and RAU have not been studied extensively among the elderly. Recent efforts to standardize definitions and research methods should greatly enhance future information. The paucity of research on oral lesions such as herpes zoster, epulis, and oral medication reactions is surprising, given that these are common problems among the elderly.

As we experienced a rare case of large epulis fibrosa osteoplastica which arose from the upper jaw of a 35 year-old male, we studied biologically and morphologically using this epulis.The tumor, 30×20×20 mm in size, located in the muco-gingival region of the bridge (765) and connected with a stalk to alveolar gingiva under the dummy of the bridge.Radiograph revealed radiopaque spots which indicated the existence of calcified substances.The tumor was surgically removed and investigated both morphologically and biochemically.The histopathological findings showed that there were immature woven bones surrounded by osteoblasts and prominant proliferation of fibrous connective tissue between epithelium and woven bones.Biochemical studies demonstrated that acid soluble calcium and phosphorus contents were relatively high corresponding with the region of bone formation. At this region alkaline phosphatase activity and inorganic phosphorus ion were also increased.These results suggest that the woven bones in epulis are calcified, and that both the increases of alkaline phosphatase activities and inorganic phosphorus ion contents may contribute to the onset of calcification.

A peripheral calcifying odontogenic cyst (PCOC) was observed in a 9 year-old Japanese boy. The patient visited our hospital with a chief complaint of swelling on the palatal aspect of the oral mucosa. He had felt the slowly growing lesion without pain for 3 months. Physical examination showed a firm submucosal mass approximately 1 cm in diameter in the palatal mucosa between the maxillary right central and lateral incisors. Based on clinical data, the lesion was thought to be an epulis; however, histological examination revealed a calcifying odontogenic cyst (COC). Follow-up examinations for over 1 year indicated no recurrence of the tumor. Although many cases of COC have been reported, this is the first case of PCOC in Japan suggesting racial differences in the incidence.

The jaw bones may develop the same types of tumors as the other bones of the body but may also develop tumors arising from the alveolar processes (epulis) and the developing teeth (odontomes). They are usually benign in nature and can affect the functions of mastication, swallowing and cause facial deformity. They make about 3% of all bone tumors with a tendency for a local recurrence if a wide excision is not contemplated at the first attempt. Local destruction caused by the tumor can mimic a malignancy; however with imaging we can get a fair idea about the treatment planning. We present a series of 6 cases of such nature for their variety, diagnostic challenge they posed and different reconstruction methods used for better cosmesis.

Jaw and gum tumours are rare conditions in children. Children presenting with jaw tumours during 2001 till 2007 are presented. Their modes of presentation, operative procedures and findings, histology and post operative results have been described. Fourteen children presenting with jaw and gum tumours are retrospectively analysed. Acute inflammatory and developmental cyst are excluded from the study. Relevant literature of three rare tumours noted in our series are reviewed. Eight patients had epulis, two of them had rare congenital epulis. Two patients had aneurysmal bone cyst. Melanotic neuroectodermal tumour of infancy was noted in two patients. Ameloblastic fibrosis, another rare tumour in children, and non-osseus fibroma were noted in one patient each. Excision of the mass was done in all except two patients with aneurysmal bone cyst, in whom curettage of the cyst was done. Patients were followed up from 3 months to 6 years. Jaw and gum tumours in children are usually benign. Excision of the tumour or curettage is curative in most of them.

Congenital epulis (CE) is a rare tumor of the newborn, also known as granular cell tumor or congenital gingival granular cell tumor because of its histologic features. Neumann first described CE in 1871. Epulis is seen only in the newborn and is a different entity from other granular cell tumors. CE has a female predilection with 8:1 ratio. Epulis is most frequently located on the anterior maxillary alveolar ridge and usually occurs as a single mass although 10% cases occur as multiple. CE clinically appears as a pedunculated protuberant mass, which may interfere with respiration or feeding. 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. The exact histiogenesis is still uncertain. The recommended treatment is prompt surgical resection. Recurrences of the tumor and damage to future dentition have not been reported. Spontaneous regression of congenital epulis has been reported in a few cases. However, surgical excision is generally indicated due to interference with feeding or respiration. We report a female neonate with congenital multiple tumors in the anterior maxillary alveolar ridge and review the relevant literature. The tumors were resected by surgical excision. The intraoperative and postoperative course was uneventful. Follow-up for 6 months did not show recurrence.

There is some disagreement about the validity of the clinical term “pregnancy tumor.” On the basis of its clinical presentation and histologic appearance, some authors believe that it simply represents a pyogenic granuloma (PG), whereas others believe that the lesion is unique because of the apparent influence of female sex hormones. In an attempt to resolve this problem, a study was undertaken to determine whether a significant correlation exists between PG and pregnancy, and whether the clinical term applies to the other epulides. The study involved 42 epulides diagnosed clinically as pregnancy tumors. A chi-square analysis comparing 32 of these lesions with 757 epulides occurring in women revealed a significant disproportion in the number of PGs, whereas the number of peripheral ossifying fibromas and peripheral giant cell granulomas were within the expected range. Very few focal fibrous hyperplasias (fibromas) were diagnosed as pregnancy tumors. Clinical and behavioral features of pregnancy tumors diagnosed microscopically as PGs were also analyzed. The results indicated that the diagnosis of pregnancy tumor is valid clinically in describing a PG occurring in pregnancy, because it describes a distinct lesion not on the basis of histologic features but on etiology, biologic behavior, and treatment protocol.

From analysis of the epulis patient population for 40 years, it could be established that of 1019 lesions, 12.8% relapsed, in 40% of surgical interventions, with the extraction of the tooth involved. For the removal of epulis, we have developed our own method. As a first step, the tumor is excised by CO2 laser. Thereafter, excochleation and bone decortication are performed, followed, as a third step, by evaporation. In each case, an attempt is made at preserving the teeth. When necessary, radicular treatment and fixation are performed. Postoperatively, minimal edema and pain occurred, and the majority of the patients were able to work on the first postoperative day. Following laser removal of 63 epulides, recurrence was seen in 5 cases (7.9%) without intraoperative tooth extraction. The combined method was applied successfully also in a hemophilic patient. Besides the conventional laser surgical handpiece, an endoscope of own construction was used on surfaces untreatable by direct sight.

This article compares the clinical and histopathologic features of the peripheral odontogenic fibroma in human beings and the fibromatous epulis in dogs. They are apparently equivalent lesions. Both are odontogenic tumors of limited growth potential that do not recur if adequately excised; both occur in middle and late adulthood of the species concerned. The one difference is that the peripheral odontogenic fibroma is a rare condition, whereas the canine fibromatous epulis is common.

A case of congenital epulis in a triple X infant, whose intra-oral mass was first detected on a 33-week prenatal ultrasound, is described. Two previous ultrasound studies performed at 21 and 28 weeks' gestation showed normal facial anatomy, suggesting accelerated tumour growth during the third trimester. Genetic amniocentesis also showed the infant to possess a 47, XXX karyotype.

Congenital granular cell epulis (CGCE), a rare benign lesion arising from the mucosa of the alveolar ridges of the jaws in newborns, has a clinical course characterized by lack of further growth after birth. Histomorphologically, it resembles a granular cell tumor (GCT) of the adult. The histogenesis of this lesion is unclear. We submitted a series of five CGCEs to a large panel of antibodies in order to trace the origin of the constituent granular cells. The resultant immunohistochemical profile showed positivity of these cells to vimentin, NKI/C3, and PGP9.5. This does not confirm any particular cell type for the histogenetic origin of CGCE but may rather reflect a local metabolic or reactive change, providing supporting evidence that the lesion is of a non-neoplastic nature. In addition, the granular cells were non-reactive for S-100, NGFR/p75, and inhibin-alpha, which further contributes to the distinction between a CGCE and the adult GCT.

Purpose: To describe a case of congenital epulis with multiple lesions, which was treated combining surgical resection of the largest tumor and monitoring of the smaller lesions. Case description: A white female newborn showed a large (2.4x1.8x1.1cm), pinkish-red, nodular formation on the left side of the maxillary alveolar ridge, which was preventing mouth closure and causing feeding difficulties. Other small polyps were present on the left side of the mandibular ridge. Excisional biopsy under general anesthesia allowed for the complete removal of the irregular, bilobed maxillary tumor. The diagnostic hypothesis of congenital epulis of the newborn was confirmed based on both the anatomic details and immunohistochemical profile of the lesion. The smaller mandibular tumors were not resected; complete spontaneous remission occurred within 6 months. After surgery, the patient showed substantial clinical improvement, with complete functional and esthetic rehabilitation. No recurrence was observed. Conclusion: Treatment allowed the reestablishment of vital functions and normal neonatal development. The surgical approach improved the infant’s quality of life and restored the parents’ confidence and emotional stability. Key words: Gingival neoplasms; epulis, congenital; surgery Objetivo: Descrever um caso de epúlide congênita com lesões múltiplas, onde foi realizada a exérese total do tumor maior e o monitoramento dos tumores menores. Descrição do caso: Um sujeito neonato do gênero feminino apresentava uma formação nodular grande (2,4x1,8x1,1cm), vermelha-rosada, no lado esquerdo do rebordo alveolar superior, a qual estava dificultando o fechamento bucal e causando dificuldades de alimentação. Outros pólipos menores estavam presentes no lado esquerdo do rebordo mandibular. A biópsia excisional sob anestesia geral permitiu a remoção complete do tumor superior, com aspecto irregular e bilobulado. A hipótese diagnóstica de épulis congênita do recém-nascido foi confirmada com base nos detalhes anatômicos e no perfil imunoistoquímico da lesão. Os tumores mandibulares menores não foram excisionados; a remissão espontânea completa ocorreu dentro de seis meses. Após a cirurgia, a paciente mostrou melhora clínica significativa com completa reabilitação funcional e estética. Não houve recorrência nas visitas subseqüentes. Conclusão: O tratamento permitiu o restabelecimento das funções vitais e do desenvolvimento normal do neonato. A abordagem cirúrgica melhorou a qualidade de vida da criança e devolveu confiança e estabilidade emocional aos pais. Palavras-chave: Neoplasias gengivais; epúlide congênito; cirurgia

We report the case of a 4-month-old Caucasian male baby who presented an uncommon mass in the anterior mandibular ridge. The patient was born with two natal mandibular incisors, which exfoliated some weeks after birth, followed by a growth of nodular lesion in the same region. Based on the clinical and histopathological features, the diagnosis was of myxoid calcified hamartoma. Immunohistochemical and scanning electron microscopic analysis of the lesion were performed. Hamartomas in the mandibular ridges associated with natal teeth are rare, but they must be considered in the differential diagnosis of common lesions, such as congenital granular cell epulis.

The oral cavity contains many organs and tissues compressed in a small area. Accordingly oral tumors have a wide variety of appearances. Reactive hyper-plastic lesions include epulis,morsicatio,traumatic ulcer or palatal hyperplasia. These benign lesions must be separated clinically and histologically from precancerous and neoplastic lesions. In leukoplakia,the individual risk can be estimated by clinical signs. Nevertheless histopathology is mandatory because precancerous lesions usually precede or accompany most oral cancers. Amalgam tattoo,oral nevi and melanoacanthoma have to be considered as differential diagnoses of oral melanoma. Accurate clinico-pathological diagnosis is mandatory to insure appropriate therapy. Oral soft tissue tumors such as Kaposi sarcoma and multiple mucosal neuromas in MEN 2b require interdisciplinary management. Diseases affecting the minor salivary glands which may be encountered by dermatologists include mucocele, necrotizing sialometa-plasia,and tumors such as pleomorphic adenoma.

An 11-year-old neutered male domestic shorthair cat was presented with an epulis. A hemispherical mass, 8 mm in maximum diameter, without a peduncle and bright reddish in colour, was observed on the gingiva of the left mandible. Radiography failed to show any infiltrating osteolysis. The epulis was surgically removed via gingival incision around the margin to the depth of connective tissue layer. Histopathological examination indicated that the epulis contained a large number of multinucleated giant cells (MGCs) intermixed with mononuclear mesenchymal cells in a loose fibrovascular stroma. Mitotic cells were found, mainly in the centre of the mass. MGCs were stained positive by the tartrase resistant acid phosphatase (TRAP) staining, indicating osteoclasts activity. Immunohistochemical staining for proliferating-cell nuclear antigen (PCNA) was observed within the majority of mononucleated cells, whereas multinucleated cells did not stain. An osteoclast-like giant cell tumour was concluded in this case. The origin of epulis is likely from the periosteal tissue. The cat recovered uneventfully and no recurrence has been noted for 3 years thereafter.

The peripheral giant cell granuloma (PGCG) is a relatively common tumor-like growth of the oral cavity. It is also known as giant cell epulis. PGCG is an oral, nonneoplastic, tumor-like growth that occurs exclusively on the gingiva and the alveolar mucosa. It affects both sexes, with a slight predilection for females, especially after puberty. It is not a true neoplasm but rather benign hyperplasic lesion. It is probably caused by local irritation or trauma which resulted in gingival or mucosal hemorrhage.

Periodontics deals with surgeries of the gingiva and soft tissues in the vicinity of teeth. In Periodontics, the amount of gingiva is a critical factor in maintaining the health of periodontium. A very minimal loss of gingiva can at times produce esthetic problems or can be difficult to maintain for the patient. So any periodontal surgical procedure should be directed towards minimal loss of soft tissues. Periodontal procedures conducted with scalpel cause pain, post operative edema, scaring and would lead to soft tissue loss postoperatively. Hence, a tool which can efficiently conduct periodontal surgeries with minimal loss of soft tissue is required. In this facet, a soft tissue diode laser is the most appropriate tool. It can be very conveniently used for frenectomy, gingivectomy, vestibuloplasty, epulis excision, gingival depigmentation and second stage implant surgery. This article emphasizes that a diode laser is a suitable instrument for oral soft tissue surgeries.

Pyogenic granuloma is the non-neoplastic reactive soft tissue growth. It is inflammatory hyperplasia commonly affects the oral cavity. It predominantly occurs in second decade of life and commonly affects the females. It usually has asymptomatic clinical course with rarely causing resorption of underlying bone. Complete excision of lesion is the treatment of choice with removal of local etiological factors. We present a case report of pyogenic granuloma affecting mandibular gingival in 32year old female patient. Total excision of the lesion was done with no reported recurrence following a month follow up. Keywords: Pyogenic granuloma, Epulis, Reactive, Gingiva, Mandible

Focal gingival enlargements are a diverse group of lesions with almost similar clinical presentation but varied etiology and histopathology. The actual cause of peripheral ossifying fibroma (POF) has been debated over many years. POFs are usually seen in childhood and younger ages. There is a slight female predilection. It is usually localized, rarely generalized. Usually, the treatment option is only surgical excision with minimal chances of recurrence. Here, we report a case of POF of the right maxillary posterior region with a review of literature.

Pyogenic granuloma occurs in the skin and the mucous membranes. The most characteristic features of the lesion are endothelial proliferation and formation of numerous vascular spaces. However criteria to differenciate the lesion from capillary hemangioma or epulis hemangiomatosa has never been established.We examined the histopathological, histochemical and immunohistochemical features in 5 cases of pyogenic granuloma, 6 cases of epulis hemangiomatosa and 2 cases of capillary hemangioma.1) Histopathological study by hematoxylin-eosin staining: In every cases of pyogenic granuoma and 2 out of 6 cases of epulis hemangiomatosa, ulcer formation and superficial inflammation were seen. Every cases of pyogenic granuloma and epulis hemangiomatosa revealed small lobules of proliferated endothelial cells with many vascular spaces in deeper portion of the tumor. These lobules were quite simillar to that of ordinary capillary hemangioma.2) Histochemical study by Ulex europaeus agglutinin I (UEA-I) lectin: UEA-I lectin has been known as the marker for endothelial cell of blood vessel. Endothelial cells in small lobules showed specific and strongly positive reaction to UEA-I lectin.3) Immunohistochemical study by Factor Via related antigen (F VI-RAG): Endothelial cells of lobules revealed no specific reaction to F Via-RAG.In conclusion, it is suggested that pyogenic granuloma and epulis hemangiomatosa are capillary hemangioma with granulation tissue induced by irritations such as repeated trauma or infection.

Epulis is generally classified histopathologically into several subtypes, e. g. epulis fibrosa, epulis granulomatosa, epulis fibromatosa, etc. among them epulis fibrosa and epulis granulomatosa are common in Japan, while epulis with a formation of hard tissue is relatively rare. A case of epulis fibro-osteomatosa cementoplastica is reported.The patient was a 32-year-old female who had noticed a small lump on the gingiva in the left mandibular molar region. Clinical examination revealed a mass of the thumb tip in size in the region between teeth numbered 35 and 37. Radiographic examination showed i cloudy irregular radioopacity in the mass region. The lesion was diagnosed clinically as epulis osteoplastica, and surgical operation was carried out under local anesthesia. On gross examination, the mass was mesured 19 × 13 × 11.5 mm and the/cross section showed a firm milky white mass with scattered areas of hard bony tissue. Histopathological examination was performed and the lesion was diagnosed as epulis fibro-osteomatosa cementoplastica.The postoperative course was uneventful and there is no evidence of recurrence after 6 years.

Peripheral ameloblastoma is a rare tumor of the oral cavity. A case of peripheral ameloblastoma appeared in the lower right mandibular gingiva of a 71-year-old male was presented. The tumor was a semi-spherical mass measuring 25×15×12mm which was clinically diagnosised as a fibroma or an epulis. Histologic examination of the lesion revealed an ameloblastoma of plexiform type. The tumor was excised with a rim of normal tissue. After 18 months, there was no evidence of recurrence. The clinical and histopathologic characteristics, surgical treatment and prognosis of the lesion of 63 cases documented in the literatures concerned were also analysed and summerized.

The primary focus of this experiment was on the investigation of localizations of alpha 1-antitrypsin (alpha 1-AT), alpha 1-antichymotrypsin (alpha 1-ACT), fibronectin (FN) and lysozyme (LY) in tumor cells of experimental malignant fibrous histiocytoma (MFH). The induction of MFH was conducted by injecting Fischer 344 rats with 4-hydroxyaminoquinoline 1-oxide (4-HAQO). In 46 out of 50 rats, tumors were generated, all of which were diagnosed as MFH and classified into 5 subtypes, according to their histological properties. The presence of alpha 1-AT, alpha 1-ACT and FN in all MFH tumor cells was observed in the tumor cells of various types. Especially, fibroblast-like, histiocyte-like and Touton and/or Epulis type giant cells showed strong reactivity. However, positive reaction of LY in MHF tumor cells was very weak, or the reaction was negative. These findings are consistent with those of human MFH.