Multiple Congenital Epulis in Alveolar Ridges of Maxilla and Mandible in a Newborn: A Rare Case Report

Congenital granular cell lesion (CGCL) or congenital epulis is an uncommon benign of the oral cavity tumor appearing at birth with typical clinical and pathologic features. It predominately affects females, mainly on the anterior maxillary alveolar ridge, and occurs usually as a single mass, although sometimes as multiple. The left side incisor area is the most common site. The etiology and histogenesis of the lesion remain obscure. Though it is a benign lesion, the tumor may cause feeding and respiratory problems if there are too large or multiple tumors. We report a case of a three-day-old, female newborn, who was referred to our hospital with multiple congenital oral swellings arising from the maxilla and mandible. The tumors caused a feeding problem and, hence, they were resected by surgical excision under general anesthesia. 1. Introduction Congenital epulis (CE) is an uncommon benign tumor. This condition clinically appears as a protuberant mass in a round or ovoid shape, pedunculated, or sessile [1]. The CE normally arises from the anterior part of the maxillary alveolar ridge of the newborn and frequently laterals to the midline in the area of the developing primary lateral incisor and canine [1, 2]. Other than gingiva, a few cases of congenital epulis have been reported on the tongue [3, 4]. Congenital granular cell epulis (CGCE) typically presents as a tan-pink polypoid mass with a smooth nonulcerated surface. The CGCE is composed of large, polygonal granular cells, characterized by an abundance of eosinophilic granular cytoplasm and round or oval basophilic nuclei. These distinctive cells grow in a sheet-like pattern supported by delicate fibrovascular septa. Incorporation of odontogenic epithelium is occasionally seen. The overlying surface epithelium is usually intact and atrophic. The cut surface is homogeneous, firm, and tan to yellow [5]. In this case report we report a rare case of CE, a newborn with multiple CE in both maxillary and mandibular alveolar ridge that interfered with feeding. 2. Case Report A female newborn was referred from a pediatric hospital for the treatment of soft tissue masses on the alveolar ridges of the maxillary and mandibular noticed at birth (Figure 1). She was a three-day-old infant, term, from a cesarean section delivery with 3200？gr birth weight, 48？cm birth height, and 34？cm head circumference. Her mother was a 30-year-old G2P1Ab0 woman. All prenatal evaluations such as sonographic findings were normal and no abnormality was reported. The family history of congenital disorders was negative and three soft