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      Congenital epulis with auto-resolution: case report Translated title: Epúlide congênita com auto-resolução: relato de caso

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          Abstract

          Congenital epulis is an uncommon benign lesion that affects the oral cavity of newborns, and presents histological features which are similar to those of granular cell tumor. The origin of this lesion has not been fully elucidated, and many hypotheses are considered due to the large variety of cell types observed in histological sections. Epulis development occurs further in the prenatal period, and is more common in newborn females, frequently in the maxilla. This lesion usually is presentend as a nodule covered by normal oral mucosa, which in some cases, interferes with baby's breathing and feeding. This report describes the case of a two-month-old male baby who presented a pedunculated intraoral lesion in the mandibular alveolar ridge. Histological sections revealed presence of mucosal fragments with atrophic squamous stratified epithelium, and fibrous connective tissue composed of cells with granular and eosinophilic cytoplasm. A few days after initial exam, the lesion detached from alveolar ridge, and healed spontaneously.

          Translated abstract

          A epúlide congênita é uma lesão benigna rara que acomete a cavidade oral de recém-nascidos e apresenta características histológicas semelhantes às do tumor de células granulares. A origem da lesão ainda não foi completamente elucidada, e as muitas hipóteses a respeito de sua histogênese baseiam-se na grande variedade de tipos celulares observados nos cortes histológicos. A epúlide desenvolve-se ainda no período pré-natal, e é mais comum em recém-nascidos do sexo feminino, ocorrendo com mais freqüência na maxila. Esta lesão costuma apresentar-se como um nódulo coberto por mucosa oral normal que, em alguns casos, interfere na respiração e na alimentação do bebê. Esse artigo descreve o caso de um bebê do gênero masculino, leucoderma, de dois meses de idade, que apresentava lesão intra-oral pediculada com implantação débil na região alveolar da mandíbula. Cortes histológicos revelaram a presença de fragmento de mucosa revestido por epitélio pavimentoso estratificado atrófico, e de tecido conjuntivo fibroso composto de células com citoplasma granular e eosinofílico abundante. Alguns dias após o exame inicial, a lesão desprendeu-se do rebordo alveolar, sofrendo resolução espontânea.

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          Congenital epulis of the newborn: a case report.

          This paper describes the case of a day old baby who was admitted to hospital because of the presence of a large intraoral swelling that was preventing her from breast feeding. Clinical examination showed a firm, pedunculated, lobulated nodule protruding from the mouth and attached to the maxillary alveolus to the left of the midline. The mucosa was normal in appearance. The growth was excised under local anaesthesia and showed a histological appearance consistent with a congenital epulis of the newborn. Healing was complete and no recurrence was seen at review after two weeks. Conservative treatment of congenital epulis is often sufficient but in this case, the nodule prevented feeding. Excision was incomplete but, as in other cases treated in the same way, there has been no obvious tendency to recur.
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            Congenital epulis in the newborn, review of the literature and a case report.

            Congenital epulis (CE) is a rare tumor of the newborn, also known as granular cell tumor or congenital gingival granular cell tumor because of its histologic features. Neumann first described CE in 1871. Epulis is seen only in the newborn and is a different entity from other granular cell tumors. CE has a female predilection with 8:1 ratio. Epulis is most frequently located on the anterior maxillary alveolar ridge and usually occurs as a single mass although 10% cases occur as multiple. CE clinically appears as a pedunculated protuberant mass, which may interfere with respiration or feeding. In cases with large lesions mechanical oral and nasal obstruction can impair fetal deglutition and neonatal respiratory efforts resulting in polyhydramnios prenatally or respiratory impairment postnatally. The exact histiogenesis is still uncertain. The recommended treatment is prompt surgical resection. Recurrences of the tumor and damage to future dentition have not been reported. Spontaneous regression of congenital epulis has been reported in a few cases. However, surgical excision is generally indicated due to interference with feeding or respiration. We report a female neonate with congenital multiple tumors in the anterior maxillary alveolar ridge and review the relevant literature. The tumors were resected by surgical excision. The intraoperative and postoperative course was uneventful. Follow-up for 6 months did not show recurrence.
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              Congenital epulis and granular cell tumor: a histologic and immunohistochemical study.

              Although it is now reasonably certain that granular cell tumors derive from Schwann cells, the histogenesis of congenital epulis, which is largely isomorphic with granular cell tumor, remains unclear. A study was undertaken to compare the immunophenotype of these tumors with particular emphasis on the expression of matrix proteins and macrophage markers because such information is not available in the literature. Four granular cell tumors and two congenital epulis were immunostained with a panel of 29 antibodies. Two congenital epulis and one granular cell tumor were investigated by electron microscopy, the latter also by immunoelectron microscopy. Many similarities in immunostaining were found, for example, both tumor types were CD68+, Ki-M1P+, lysozyme-, vimentin+, fibronectin+, laminin+, lectin PHAE+, and lectin WGA+. However, differences were also noted, for example, granular cell tumor was always S100 protein+, but only one congenital epulis case was reactive (weak reactivity after microwave treatment), and staining with the proliferation markers anti-proliferating cell nuclear antigen and MIB 1 was found only in congenital epulis. Both tumor types exhibited pericellular and diffuse cytoplasmic staining for fibronectin and laminin. The hypothesis that congenital epulis and granular cell tumor would exhibit similar reactivity for macrophage markers was confirmed: both were reactive with anti-CD68 and Ki-M1P and nonreactive with MAC387, anti-lysozyme, and 3A5. Intracytoplasmic staining for fibronectin and laminin, which has not been described previously in these tumors, appears to be a characteristic feature common to both tumors. This finding suggests that there could be a disturbance of synthesis and secretion of extracellular matrix proteins or a derangement of their receptor systems. This theory could be supported by the finding of intracytoplasmic CD49e-positive material in two cases.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rgo
                RGO - Revista Gaúcha de Odontologia
                RGO, Rev. Gaúch. Odontol.
                Faculdade São Leopoldo Mandic (Campinas )
                1981-8637
                September 2014
                : 62
                : 3
                : 315-318
                Affiliations
                [1 ] Universidade Federal do Pará Brazil
                [2 ] Centro Universitário do Estado do Pará Brazil
                [3 ] Universidade de São Paulo Brazil
                Article
                S1981-86372014000300315
                10.1590/1981-86372014000300000131891
                e5e835a3-9809-4a8e-9fc3-5964703d7cdb

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1981-8637&lng=en
                Categories
                DENTISTRY, ORAL SURGERY & MEDICINE

                Dentistry
                Gingival diseases,Gingival neoplasms,Infant newborn,Doenças da gengiva,Neoplasias gengivais,Recém-nascido

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