Figure 1. Mass obstructing the mouth space nearly completely
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Diagnosis: Congenital epulisThe mass which had a short handle, erythematous, punctate minimally hemorrhagic areas and a moderately firm consistency was sent for histopathological examination. On macroscopic examination, a creambrown lesion covered with mucosa with dimensions of 2.5 x 2.1 cm was observed and hemorrhage was observed on the surface. The cross sections were solid, brown and elastic. On microscopic examination, a nodular lesion covered with stratified squamous epithelium with diffuse ulcers on the surface which was characterized with small monotonous poligonal cells with large, granular, eozinophilic cytoplasms was observed. These histopathological findings were compatible with congenital epulis (CE).
DiscussionCongenital epulis is a rare, benign soft tissue lesion of the newborn generally originating from the alveolar prominence of the maxilla or mandible. CE which is also called congenital granular cell tumor (GCT) was described by Neumann (1) in 1871 for the first time and hundreds of cases have been reported until the present time. Its characteristic property is that it generally originates from the upper chin and has a single, polypoid structure. However, multiple masses have been reported in 10% of the cases (2). Its etiology has not been elucidated yet. It is observed in girls with a higher rate compared to boys (3). The maxilla/mandible ratio is 3:1 and the female/male ratio is 8:1 or 10:1. Although its higher prevalence in girls suggested hormonal impact, the fact that estrogen and progesteron receptors could not be found on tumor cells confuted this assumption. Although malign forms of other GCTs have been observed, no malignancy related with CE has been reported in the literature so far (2, 4). Although spontaneous reduction has been reported in the literature, its treatment generally consists of complete excision of the mass. No recurrence or metastasis has been reported after surgery. The prognosis is excellent (2, 5, 6).Premature delivery has been reported very rarely in hundreds of patients with congenital epulis in the literature (7,8). The fact that our patient was delivered prematurely is the speciality of our case.Con genital epulis for which the biological origin has not been elucidated yet is histologically observed as cell groups in diffuse layers. These cell groups contain round, intense small nuclei and rough granular cytoplasms. Fine vascular plexus is found between the granular cells. This predisposes to hemorrhage in the lesion (9). It is thought that congenital epulis originates from undifferentiated mesenchymal cells, fibroblasts, myofibroblasts, Schwann cells or odontogenix epithelial cells (10).Congenital epulis causes to problems which require urgent intervention related with respiration and nutrition and severe parental anxiety because of the region of origin. Congenital epulis may render feeding impossible by preventing closure of the mouth and swallowing. This swallowing disorder leads to polyhydramnio...