The congenital epulis

THE

CONGENITAL

Report

EPULIS

of a Case

Hcwold S. Pirf er, D.D.X.,” Chicago, Ill. L)epartment

of

Oral

Surgery,

and

Cook

Orion H. Shtezdle,

County

D.D.S., M.D.,**

Ifospitnl

COSGENITAL EPULIY has long been a subject of controversy as regards both its exact classification and its histogenesis. In this article a case is being reported to provide more information concerning the nature and frequency of the congenital epulis. This tumor’s marked resemblance to the granular-cell myoblastoma has been noted by many,“, is B and some consider the two lesions to be identical.“. 4 This has been challenged by others, however, on the basis of the lesion’s presence at birth, the absence of an anatomic relationship to striated muscle fibers, and other significant factors.6, 7,9 Other investigators have tried to relate this entity to a malformation of the odontogenic apparatnqi but none have directly connected it to odontogenic fibrous connective tissue.“. g, I0 Some have attempted to relate it to derivatives of neural elements8or fibroblasts of the oral mucosa,l, j but so far a definite connection has eluded them. The exact cause is then essentially unknown, although reports of more cases may help shed some light on the subject. Age is of distinct significance, in that all lesions of this type are present from birth.; The tumor’s disposition as to sex is variable; although some studies have shown a higher incidence in femaleq7’ 9 no definite trend can be established at this time. The tumor is usually slow in growth, and generally asymptomatic. It may vary in diameter from a few millimeters to 1 cm. More commonly seen on t,he maxilla than on the mandible, it arises as a pedunculated mass from the crest of the alveolar ridge. Ristologically, it is similar to the granular-cell myoblastoma, with sheets of large polyhedral cells packed closely together.3y 9 The cells, which vary in size from 20 to 60 micra, have a fine pale-staining granular eosinophilic cytoplasm and small uniform nuclei pushed to one side.“>lo Cross-striations and mitosis are not seen. Small strands of fibrous connective tissue are found between the cells and separate the tumor from a thin overlying layer of squamous

T

HE

*Resident **Attending

in

Oral Staff,

Surgery. Cook County

Hospital.

781

Fig

3

CONGENITAL

Fig.

3.--N&e

Fig.

4.-High-power

the

flattening

view

of the epithelial overlying

revealing

the

EPULIS

papillae and the tumor.

large within

granular them.

the

narrow

polygonal

rim

cells

of connective

with

small

tis

nuclei

Jianer,

It-. MED.

Herder, Remier,

H.,

and

Baucr,

CT. I).:

ThC! SO-(‘Nll~tl

“(‘Oll@Witi~l

Xplllis,‘!

OR.41.

SCKG.,

ORAl.

& ORAL PATH. 6: 1065, 1953.

J. L.: J. I,.: (‘ompan~-. Hernier, .J. I,., Hhaskar, 8. N., ljlastoma), C’uster, R. P., blastoma, (‘uster, B. I?., Fcprtrr, F. : lS1, 1949.

Myoblastoma, Am. .J. Orthodont,ics The Management of Oral Wsessr, ant1 Thompson, and Akamine,

H. (:.: Xyot~lastoma, R.: Congenital Epulis

6: Oral Surg. 33: $:t. I,ouis, 195.5,

548, 1~1-1;. The C. I’. Mosby

.I. I). Hes. 25: 253, 1946. (( ‘ongenital Granular C!ell Fibro-

ORAL SAG., ORAL Mm. & ORAL PATIC. 8: 517, 1955.

and Fnst, .1. A.: On the Neurogenwis Am. .T. Clin. Patll. 19: 632y 1949. and Fust, J. A.: Congenital Epulis. i’her die grannlarcw G~v:~c~l~w, Iieitr.

of So-called

Granul;tl,-tell

:1n1. ,I. Clin. Path. 22: path. Annt. u. al&.

JIyo-

11111, 193Z. Path. 110: