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Twin congenital epulis in the alveolar ridge of the maxilla and mandible in a newborn: a rare and interesting case
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  1. Deepak Sharma1,
  2. Srinivas Murki1,
  3. Tejo Pratap1,
  4. Vallamsetty Leelakumar2
  1. 1Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
  2. 2Department of Pediatric Surgery, Suraksha Children's Hospital, Tarnaka, Hyderabad, India
  1. Correspondence to Dr Deepak Sharma, dr.deepak.rohtak{at}gmail.com

https://doi.org/10.1136/bcr-2014-206490

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    Description

    Case

    A term female with birth weight of 2.9 kg was born to a primi mother through normal vaginal delivery. The infant had apgar scores of 8/9/9. At birth the infant was diagnosed with two masses originating from the left maxilla and mandible. The upper maxillary mass was pedunculated and 2×2×1.5 cm in size and the mandibular mass was 1.5×1.5×1 cm in size (figures 1⇓–3). The infant was evaluated with head ultrasound, whole body X-ray and echocardiography for other malformations; all reports were normal. The infant was diagnosed as a case of congenital epulis and was operated on. Both the masses were removed and the postoperative course was uneventful; the infant was discharged. The histopathology report confirmed the diagnosis of epulis.

    Figure 1
    Figure 1

    Two large pedunculated masses on the maxillary and mandibular alveolar ridges in a neonate female. Maxillary mass 2×2×1.5 cm in size and mandibular mass 1.5×1.5×1 cm in size.

    Figure 2
    Figure 2

    Two large pedunculated masses on the maxillary and mandibular alveolar ridges in a neonate female. Maxillary mass 2×2×1.5 cm in size and mandibular mass 1.5×1.5×1 cm in size.

    Figure 3
    Figure 3

    Two large pedunculated masses on the maxillary and mandibular alveolar ridges in a neonate female. Maxillary mass 2×2×1.5 cm in size and mandibular mass 1.5×1.5×1 cm in size.

    Discussion

    Congenital epulis is also known as Neumann’s tumour, granular cell tumour or congenital gingival granular cell tumour.1 The incidence of congenital epulis has been reported to be about 0.0006%. The size of the lesion can vary from a few mm to 8 cm.2 This tumour is more common in women, with female-to-male ratio being 8:1.3 This tumour arises from the mucosa of the gingiva, usually from the anterior part of the maxillary alveolar ridge. On examination, infants with congenital epulis clinically present with a mass protruding from the mouth, which may produce difficulty in feeding or breathing if it is large.4 These tumours are uniformly benign in nature.

    Differential diagnosis includes5

    • Hemangioma

    • Lymphangioma

    • Fibroma

    • Granuloma

    • Rhabdomyosarcoma

    • Osteogenic sarcoma

    • Chondrogenic sarcoma

    • Schwannoma

    • Heterotopic gastrointestinal cyst

    Histology shows polygonal cells with pink, PAS-positive granular cytoplasm and regular, round, dark basophilic-staining nuclei.6 The recommended treatment is prompt surgical resection. These tumours have very good prognosis.7

    Key messages

    • Twin congenital epulis are very rare tumours seen at birth.

    • Prompt surgical excisison is the treatment of choice.

    • These tumours should be confirmed with histopathology as other conditions can also present in similar fashion.

    References

    1. ↵
      1. Neumann E
      . Elin fall von congaliter epulis. Arch Helik 1871;12:189.
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    2. ↵
      1. Zuker RM,
      2. Buenecha R
      . Congenital epulis: review of the literature and case report. J Oral Maxillofac Surg 1993;51:1040–3.
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    3. ↵
      1. Mueller DT,
      2. Callanan VP
      . Congenital malformations of the oral cavity. Otolaryngol Clin North Am 2007;40:141–60, vii.
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      1. Merrett SJ,
      2. Crawford PJ
      . Congenital epulis of the newborn: a case report. Int J Paedi Dent 2003;13:127–9.
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      1. Lapid O,
      2. Shaco-Levy R,
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      4. et al
      . Congenital epulis. Pediatrics 2001;107:E22.
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    6. ↵
      1. Lack EE,
      2. Worsham GF,
      3. Callihan MD,
      4. et al
      . Gingival granular cell tumors of the newborn (congenital“epulis”): a clinical and pathologic study of 21 patients. Am J Surg Pathol 1981;5:37.
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    7. ↵
      1. Kumar Dutta H
      . Jaw and gum tumours in children. Pediatr Surg Int 2009;25: 781–4.
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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.