Congenital Epulis

Introduction:

“Epulis” is a Greek term meaning Gums. This term is used to denote a wide variety of lesions involving the gums regardless of their pathology. This is a rare congenital growth affecting the gingival mucosa of neonates. It is also known as Neumann’s tumor. It is truly a benign condition affecting predominantly female infants. It may even be multiple. This tumor was first described in 1871 by Neumann and hence the name.

These tumors are commonly present at birth arising from the gingival mucosa of maxilla / mandible. These infants may have feeding and breathing difficulties because of the mass effect. Ultrasound studies have shown that this tumor can arise as early as 26th week of gestation.

Clinical features:

1. Affects commonly female neonates.

2. Commonly arises over the incision canine region of maxilla

3. It can also involve the gingiva over the mandible. Involvement of gingiva of maxilla / mandible is 3:1.

4. These lesions when large can interfere in breathing and feeding of the neonate

Histology:

Histologically congenital Epulis resembles granular cell tumors. Its differentiating features from granular cell tumors include:

1. Plexiform arrangement of capillaries

2. Lack of pesudoepitheliomatous hyperplasia

3. Immunohistochemistry shows no reactivity to S-100 protein and laminin.

It should also be borne in mind that granular cell tumors involve almost all age groups and they rarely affect gingiva. Granular cell tumors arise from Schwann cells and hence positive for S-100 protein.

Theories of origin of congenital Epulis:

1. Myoblastic theory

2. Neurogenic theory

3. Odontogenic theory

4. Fibroblastic theory

5. Histiocytic theory

6. Lake theory – Is the most accepted theory. He attributed development of Epulis in neonates to reactive hyperplasia due to oestrogen changes. This explains the female preponderance of the lesion.

Management:

If the lesion is small and asymptomatic it can be left alone. Spontaneous regression has been documented. If the mass is large and symptomatic surgical excision can be resorted to. After resection it is not known to recur.