the term is derived from a greek word meaning  on the gum  or gum boil .
this gingival overgrowth was first described by neumann in 1871 . to date , fewer than 200 cases have been described in the literature .
fuhr and krogh in an excellent centennial review of congenital epulis ( ce ) noted that tumor occurred 8 times more frequently in females than males and 3 times more often on the maxilla than the mandible .
the histogenesis is mostly uncertain , but several theories like origin from epithelial , undifferentiated mesenchymal cells , pericytes , fibroblasts , smooth muscle cells , and nerve - related cells have been proposed .
the lesion clinically presents in the form of a pedunculated , non - ulcerated reddish pink mass of varying sizes .
we report here a unique case of congenital granular cell epulis ( cgce ) in a newborn baby causing feeding problems .
this case report is unique due to the fact that the patient was referred to us within an hour of the delivery of a baby girl weighing 2.3 kg who was a product of normal full - term pregnancy having a single , large , oblong , lobulated swelling on the mandibular anterior alveolar ridge .
a clinical diagnosis of ce was made by the maxillofacial surgery team [ figure 1 ] .
further consultations with the treating gynecologist , pediatrician and an anesthesiologist were done and the patient was operated under conscious sedation within the next few hours .
general anesthesia was placed in spare to manage intra - operative complications like blood asphyxiation and other airway related problems .
hence a transfixion suture had to be placed slightly away from the lesion on the alveolar ridge so as to achieve pre - excision hemostasis and minimize the chances of intra - operative bleeding which could have endangered the airway .
h and e stained section shows lesional tissue comprising of large , rounded and polyhedral , histiocyte - like cells with small , dark oval eccentrically placed nuclei and abundant eosinophilic granular cytoplasm .
lesional cells are usually rounded but may be somewhat spindled . numerous vascular spaces and extravasated rbcs are seen in between granular cells .
final diagnosis of cgce was made based on clinical and histopathological features [ figures 2 and 3 ] .
further we did immunohistochemical staining of the section with vimentin to differentiate whether it is of mesenchymal origin or epithelial origin .
lesional cells are compactly arranged with indistinct cytoplasmic outline ( 10 ) lesional cells are large , rounded and polyhedral in shape with small , dark oval eccentrically placed nuclei and abundant eosinophilic granular cytoplasm ( 40 ) vimentin positivity on immunohistochemical staining
it is a rare , benign soft tissue tumor seen only in the newborn and is a different entity from other granular cell tumors as the lesion shows no propensity towards malignancy or recurrence .
it appears as a mass arising in the mouth and originates from the alveolar ridge .
the tumor is usually solitary , but occasionally multiple tumors are found and they may interfere with respiration or feeding .
there is no tenderness or surface change and the lesion does not increase in size after birth .
the mucosal mass is comprised almost entirely of large , rounded and polyhedral , histiocyte - like cells with small , dark , oval nuclei and abundant eosinophilic granular cytoplasm .
there are vascular channels between granular cells , but fibrous stroma is minimally present and often appears to be completely lacking .
the tumor cells extend to the overlying epithelium , which is atrophic and never demonstrates the pseudoepitheliomatous hyperplasia so commonly seen in the granular cell tumor of adults .
the fact that ce arises in the newborn may lead to the hypothesis that maternal hormonal influence is an important factor in the growth of the lesion .
it is not yet clear if ce of the newborn represents a neoplastic or reactive lesion .
the absence of local recurrence even after incomplete excision , the possibility of a spontaneous regression , and the lack of a malignant counterpart all favor a non - neoplastic origin .
ultrastructural studies have suggested that ce originates from primitive mesenchymal cells with myofibroblastic differentiation . in the present case vimentin
this is exclusively absent in granular cell tumor which shows positivity for s-100 protein , neuronal - specific enolase , and carcinoembryonic antigen ( cea ) . recommended management for epulis is surgical excision , although some opt to wait for spontaneous regression if the mass is small and is not interfering with respiration or feeding .
in addition to simple excision , undermining and advancing gingivo - periosteal flaps , and suturing them over the bony defect , thus extrapolating the techniques used by millard and latham for cleft alveolar management have also been reported .
cgce is a simple yet uncommon entity that manifests as an aberration in an otherwise healthy child .
it leads to concern or even cause hysteria in the parents who often require proper counseling .
the management of this lesion is a team effort by the maxillofacial surgeon , gynecologist , pediatrician and anesthesiologist .
 the congenital granular cell epulis ( cgce ) is a rare tumor , which is apparent at birth . 
 the histogenesis is still uncertain , but several theories , including origin from epithelial , undifferentiated mesenchymal cells , pericytes , fibroblasts , smooth muscle cells , and nerve - related cells have been proposed . 
 this case report describes management of a 2-day - old baby girl having a large , round , soft , single 3  4 cm , pedunculated swelling , on the lower anterior ridge , which was causing difficulty in feeding 
 . clinical diagnosis of congenital epulis ( ce ) was made and lesion was excised under conscious sedation . 
 a vessel running over the surface of the lesion was continuous on the alveolar ridge . to reduce intra - operative hemorrhage transfixion suture 
 was passed around the vessel on the alveolar ridge . 
 then the lesion was excised from the base of peduncle with a scalpel . 
 histopathologically , the diagnosis of a congenital granular cell lesion of the jaw was given . 
 follow up of 3 months shows no signs of recurrence . 
 cgce may interfere with feeding , requiring a conservative excision as soon as the child is fit to undergo surgery . 
 tendency for recurrence and malignant transformation has not been documented . 
INTRODUCTION
CASE REPORT
HISTOPATHOLOGY
DISCUSSION
CONCLUSION