CASE REPORT Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 52-53

Congenital mandibular granular cell tumor in a male neonate: A rare case report

Ananta Rattan1, Kamal Nain Rattan2
1 Department of Paediatrics, Safdarjung Hospital, New Delhi, India
2 Department of Paediatric Surgery, PGIMS, Rohtak, Haryana, India

Date of Submission19-Jun-2020Date of Decision10-Jul-2020Date of Acceptance15-Sep-2020Date of Web Publication08-Feb-2021

Correspondence Address:
Dr. Ananta Rattan
Department of Paediatrics, VMMC and Safdarjung Hospital, New Delhi
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jcn.JCN_93_20

Congenital epulis or granular cell tumors are rare neonatal oral tumors. We report the case scenario of a male neonate presenting with congenital epulis on day 2 of life on the mandibular alveolar ridge. It was successfully treated with surgical resection under general anesthesia. During our wide review of the literature, we could not find a single case reporting a mandibular granular cell tumor in a male neonate.

Keywords: Congenital epulis, male neonate, mandibular

How to cite this article:
Rattan A, Rattan KN. Congenital mandibular granular cell tumor in a male neonate: A rare case report. J Clin Neonatol 2021;10:52-3
  Introduction 

Congenital epulis is also known as congenital granular cell tumor or congenital granular cell myoblastoma or fibroblastoma.[1] These tumors are generally benign.[2] They usually present as a mass protruding from the oral cavity at birth. Most commonly, it leads to feeding difficulties. In some cases, it may lead to fast breathing due to respiratory tract obstruction or even perinatal asphyxia.[2] They are ten times more common in females. They most commonly arise from the gingival mucosa of maxilla with maxilla/mandible ratio being 3:1.[3] They are mostly solitary, pedunculated, fleshy pink color with smooth surface. They can be unilobed or multilobed. It is mostly diagnosed clinically, although prenatal Ultrasonography or perinatal magnetic resonance imaging (MRI) can also be used.[4] Its management is surgical excision under anesthesia. Here, we have reported an extremely rare case of a male neonate presenting with a solitary congenital granular cell tumour arising from the mandibular ridge.

  Case Report 

A full term male neonate weighing 2.68 kg at birth presented at 30 h of life with complaint of a mass protruding from the oral cavity [Figure 1]. On examination, it was a solitary, nontender smooth, and firm mass measuring 3.5 cm × 2.6 cm. It was fleshy pink, sessile, lobulated smooth surface arising from the lower mandibular alveolar ridge. The adjacent skin and tissue appeared normal. The child had no respiratory distress but was having feeding difficulties.

Figure 1: Congenital granular cell tumor protruding from the oral cavity

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In consultation with the pediatrician, the baby was prepped for the surgery. Surgical excision was done under general anesthesia on day 3 of life [Figure 2].

The postoperative period was uneventful with breast feeding initiated on the next day. Baby was discharged the following day.

The diagnosis was confirmed on the histological examination which showed “stratified epithelium covered soft tissue revealing monotonous population of round polygonal large sized cells with abundant granular well-defined cytoplasm, round-to-oval nucleus with vesicular chromatin, and small nucleus. Sheets of cells are intersected with small congested vessels with pericytic arrangement of cells suggestive of granular cell tumor” [Figure 3].

  Discussion 

Congenital granular cell tumor was first reported in 1871 by Neumann; hence, it is also known as Neumann tumor.[5] It is most commonly found in female neonates as opposed to the index case, where it is a male neonate. It is benign in nature with etiology still unclear.[5] Diagnosis is mostly clinical at birth. Antenatal diagnosis is possible with prenatal USG as early as 26 weeks of gestation.[5] Perinatal MRI is also helpful for the diagnosis in order to rule out multiple tumors in the oral cavity.[4] It usually presents at birth with an obvious mass in the oral cavity. In severe cases, it may be responsible for perinatal asphyxia or severe respiratory distress due to mechanical obstruction. In most of the cases, it presents with feeding problems as in the present case.

It most often arises from the maxillary ridge. In some cases, multiple tumors arising from the maxilla and mandibular ridge are also reported. In the index case, it was a solitary tumor arising from the mandibular ridge. The treatment of choice is surgical excision. The surgical excision can be done under local as well as general anesthesia by using cautery. There is no postoperative recurrence noted again proving the benign nature.[4] There has been no reports of delayed eruption of teeth at the site of resection. In cases where the tumor is small in size and not causing any symptoms, conservative approach of wait and watch can be followed. In few cases, spontaneous regression is also noted.[6]

However, benign it is, immediate surgical resection is advised in almost all cases due to difficult feeding, respiratory distress, and cosmetic reasons. Histological examination shows granular cells with abundant granular eosinophilic cytoplasm predominantly eccentrically located vesicular nuclei with conspicuous nucleoli.[5]

  Conclusion 

Congenital granular cell tumor although rare needs early management as it can lead to respiratory distress, feeding problems, and cosmetic reasons.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Costas JB, Di Piramo S. Congenital epulis (congenital granular-cell myoblastoma). Report of two cases. Oral Surg Oral Med Oral Pathol 1968;26:497-504.  
    2.Bhaskar SN, Akamine R. Congenital epulis (congenital granular cell fibroblastoma); report of a case. Oral Surg Oral Med Oral Pathol 1955;8:517-23.  
    3.Tatli U, Abayli C, Kisa HI, Uguz HA Congenital granular cell epulis: A case report of an unexpected feature with histopathological and immunohistochemical examination. J Cranio Maxillary Dis 2014;3:51-5.  
    4.Mahesh KR, Radhika BM, Umashankar ND, Rashi S. Congenital epulis of the newborn. J Oral Maxillofac Pathol 2015;19:407.  
    5.Singh M, Rattan KN, Rani B. Congenital epulis: A rare benign jaw tumour of newborn. J Neonatal Surg 2012;1:31.  
    6.Ritwik P, Brannon RB, Musselman RJ. Spontaneous regression of congenital epulis: A case report and review of the literature. J Med Case Rep 2010;4:331.  
    
  [Figure 1], [Figure 2], [Figure 3]