Congenital epulis of the newborn: difficult to diagnose but easy to treat. A case of unusual size

Abstract

The epulis or giant cell granuloma is a benign tumor of the connective tissue of the gingival mucosa frequent in an advanced period of life but much more rare in its congenital form.  We present the case of a female newborn, otherwise healthy, presenting with a giant swelling protruding from her mouth and originating from upper left alveolar ridge. The size of the mass has created great anxiety in parents and pediatricians,  however this clinical presentation suggested us a diagnosis of congenital epulis with a differential diagnosis of teratoma.
We perform surgical resection of the mass under general anesthesia, through diathermy. There wasn’t blood loss and postoperative  recovery was uneventful. A definite diagnosis of giant congenital epulis was disclosed by histopathological and immunohistochemical analysis.
Although it has not been yet clarified the etiology of this tumor and the role of hormonal influences on its appearance and development and despite have been reported cases of spontaneous regression, the treatment of choice is the early surgical  excision.
Nevertheless, particularly in the small centers, due to the rarity and large size of presentation, the diagnosis is often delayed or wrong, exposing so the newborn parents to useless days of waiting and anxiety In our opinion all pediatricians and surgeons should be aware of this malformation and of its simple, safe and effective  surgical treatment, considering the excellent prognosis of this rare disease.