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LETTER TO THE EDITOR |
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Year : 2013 | Volume
: 6
| Issue : 2 | Page : 213-214 |
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A case of congenital epulis
Vineeta Pande, Renuka Jadhav, Sharad Agarkhedkar, Vishal Jain
Department of Pediatrics, Padmshree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
Date of Web Publication | 10-Apr-2013 |
Correspondence Address: Vineeta Pande Department of Pediatrics, Padmshree Dr. D. Y. Patil Medical College,Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.110321
How to cite this article: Pande V, Jadhav R, Agarkhedkar S, Jain V. A case of congenital epulis. Med J DY Patil Univ 2013;6:213-4 |
Sir,
A newborn infant with congenital epulis can be a conspicuous sight, both for the parents as well as the health care professionals involved in neonatal care. These tumors of the infant's mouth can be extraordinarily large, occupying much of the oral cavity coupled with posing a risk of airway obstruction or interfering with feeding.
A newborn girl was referred immediately after delivery for examination of a mass sticking out of her mouth [Figure 1] and [Figure 2]. Antenatal, natal and immediate postnatal history was uneventful. No abnormalities were observed in the ultrasound performed in the 29 th week of gestation. The newborn was a full term normal vaginal delivery at 38 weeks. The family history did not suggest any of the hereditary diseases. Clinical examination showed a midline, pedunculated, 5 cm diameter round soft tissue mass exhibiting a smooth erythematous surface. The color of the mucosa was normal. Hemangioma, reddish to purple in color was ruled out; gingival cyst which has a whitish color and melanotic neuroectodermal tumor of infancy, bluish to black in color, were also ruled out. Peripheral giant cell granuloma and pyogenic granuloma were excluded, as both conditions usually display a reddish color and an ulcerated surface. Clinical diagnosis of congenital epulis was made. This article presents an unusual case of large congenital epulis.
Such lesions being rare enough to justify reporting any case in which they occur, the presence of an unusually large lesion interfering with feeding renders significance to the present case.
Congenital epulis is a rare, benign lesion that appears on the alveolar mucosa of newborn infants. Congenital granular cell tumor (Newmann's tumor) or congenital epulis was first described by Newmann's in 1871. [1] It most commonly occurs along the alveolar ridge of the maxilla, usually without associated abnormalities of the teeth or additional congenital malformations. The usual clinical appearance of this condition is a pedunculated (may be sessile) mass with a normal to reddish colour, non-ulcerated, pink, as large as 9.0 cm in diameter, with a surface that may be either smooth or multilobular. [2]
The lesion usually appears late in utero as it is often not detected on antenatal ultrasound. While the lesion is visually impressive and equally distressing, it is ultimately a benign lesion. If there is any fear of airway obstruction or difficulty with feeding, then prompt surgical treatment is necessary. Dentists may be consulted initially to rule out any abnormality in dental development. [3]
The lesion is most common in females, with a female-to-male ratio of 8:1, and is more common in the maxilla than in the mandible with ratio 3:1. Mostly they are single, may be multiple. The histogenesis is uncertain and cells of origin include odontogenic epithelium, undifferentiated mesenchymal cells, pericytes, fibroblasts, smooth muscle cells, nerve related cells, and histiocytes. [4]
The diagnosis is usually clinical, although difficulties may occur when the index of suspicion is low or when the origin of the tumor is hard to determine. In such cases, the differential diagnosis is wide and imaging has a contributing role to play. Antenatal ultrasonographic features of congenital epulis have been described at irregular intervals, but postnatal ultrasonographic findings have seldom been described. Correlative prenatal ultrasound and postnatal magnetic resonance imaging (MRI) findings have been reported. [5] Congenital epulis may be confirmed histologically. Congenital epulis, although stops growing after birth, the lesion usually is removed surgically within a child's first days or weeks of life to provide the newborn with adequate room for breathing and feeding. [6] Colour and power Doppler ultrasound examination may show marked blood flow within the tumor. 3D ultrasound helps in antenatal diagnosis.
References | | |
1. | O'Brian FV, Pielou WD. Congenital epulis: Its natural history. Arch Dis Child 1971;46:559-60. |
2. | Olson JL, Marcus JR, Zuker RM. Congenital epulis. J Craniofac Surg 2005;16:161-4. |
3. | Merrett SJ, Crawford PJ. Congenital epulis of the newborn: A case report. Int J Paediatr Dent 2003;13:127-9. |
4. | Kanotra S, Kanotra SP, Paul J. Congenital epulis. J Laryngol Otol 2006;120:148-50. |
5. | Lapid O, Shaco-Levy R, Krieger Y, Kachko L, Sagi A. Congenital epulis. Pediatrics 2001;107:E22. |
6. | Jenkins HR, Hill CM. Spontaneous regression of congenital epulis of the newborn. Arch Dis Child 1989;64:145-7. |
[Figure 1], [Figure 2]
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