|Year : 2014 | Volume
| Issue : 2 | Page : 117-119
Neumann's tumor in new born: A case requiring surgical intervention
Murali Nirupama1, Ganesh Pai2, Anand Pai2, Reshma Pai3
1 Department of Pathology KMC, Manipal University, Mangalore, Karnataka, India
2 Department of Paediatric Surgery, KMC, Manipal University, Mangalore, Karnataka, India
3 Department of Oral Surgery, Kshema Institute of Medical Sciences, Mangalore, Karnataka, India
|Date of Web Publication||12-Aug-2014|
Dr. Murali Nirupama
Department of Pathology KMC, Manipal University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Congenital epulis (CE) also known as granular cell tumor of new born was first described by Neumann in the year 1871. Most frequent location includes maxillary alveolar ridge with a female preponderance up to 8 times more than males. These tumors are usually small and can be solitary or multiple, pedunculated or protuberant mucosa covered nodules presenting at birth. Multiple theories have been proposed for their origin. Though, it may cause panic at birth they are indolent and regress spontaneously. Rare cases require surgical intervention in the neonatal period when symptomatic, causing difficulties in respiration or deglutition. We describe a case of CE in a 2-day-old female neonate, who presented with pink protuberant mass in the anterior alveolar ridge of maxilla. The mass was symptomatic and surgery was indicated. The mass was excised and the benign nature was confirmed by histopathology.
Keywords: Benign, congenital, gingiva, granular cell tumor
|How to cite this article:|
Nirupama M, Pai G, Pai A, Pai R. Neumann's tumor in new born: A case requiring surgical intervention. Saudi J Oral Sci 2014;1:117-9
| Introduction|| |
Congenital epulis (CE) also called as granular cell tumor (GCT) is a rare benign tumor of new borns arising from the alveolar ridges and is usually self-regressive. It was first described by Neumann in 1871. ,,, In case of large lesions, it can interfere with fetal deglutition or feeding. Occasionally, it can also present as polyhydramnios or regress spontaneously in postnatal life. ,, The incidence is very rare and accounts for 0.0006%.  The size of the mass varies from few mm to 9 cm. They are usually soft pink nodular mass, which can be solitary or multiple and at times very large and can interfere with feeding and respiration. Surgical excision is the treatment of choice for symptomatic lesions. There is no documented incidence of recurrence malignant transformation or disruption of teeth or gums. The lesion is 8 times more common in the anterior maxillary region than mandibular region. Simultaneous involvement of both maxillary and mandibular alveolar ridges occurs in approximately 10% of reported cases.
| Case Report|| |
A 2-day-old otherwise healthy female neonate was brought to the hospital with a nodular pink mass in the anterior gingival margin of the maxilla at the incisor region. On examination, the nodule was well-circumscribed and non-tender. It interfered with feeding. Excision biopsy was done and sent for histopathological evaluation.
Postoperative period was uneventful. Further follow-up showed normal development of alveolar ridges.
Grossly, a single pale pink, well-circumscribed nodule measuring 3 cm × 3.5 cm was received. It was covered by mucosa [Figure 1]. The cut surface was homogenous pale white, without any areas of hemorrhage or necrosis. On microscopy, the sections showed tumor tissue composed of uniformly arranged cells in large sheets admixed with delicate branching and arborizing blood vessels. The cells had abundant pink granular cytoplasm with centrally placed round nuclei with bland chromatin [Figure 2]. Mitosis was absent confirming low proliferation and surgical margins were free. The surrounding tissue showed mild fibrosis and lymphocytic infiltrate.
|Figure 2: Microscopy showing tumor cells with abundant granular pink cytoplasm and a centrally placed nucleus|
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A diagnosis of GCT was made. A follow-up after 6 months showed no recurrence of the tumor with normal development of alveolar ridges.
| Discussion|| |
Congenital Epulis was first described by Neumann hence acquiring the name Neumann's tumor. It has a predilection for females and has a very low incidence accounting for 0.0006%. , It is 8 times more common in maxillary than mandibular region, although simultaneous involvement can be seen in 10% of cases.  Most often when asymptomatic and small they are left alone for spontaneous regression.  They can be solitary or multiple.  They are commonly associated with the new born although they have been detected as early as 26 weeks of gestation. , There are reports describing associated hydramnios and maxillary hypoplasia. They can arise in adults at the base of the tongue, oral, gastrointestinal mucosa and so on, where it is called as adult GCT.
The precise origin of CE is unclear. Various theories of origin include myoblastic, neurogenic, odontogenic, fibroblastic etc.  The hormonal role in the development of CE has been implied, but there is no definite evidence as these receptors are absent in the tumor.
The differential diagnosis include neuroectodermal tumor, rhabdomyoma, gingival cyst, fibromatosis gingivae, and teratoma. , Histopathology is confirmative.
The present tumor showed intact mucosa with collagen rich dense connective tissue stroma. The cells were closely packed and had abundant granular cytoplasm, with single bland, central to slightly eccentric nucleus. Necrosis, atypical mitosis or elements from other germ cell layers are unusual findings. They are usually well-circumscribed lesions without infiltrative margins.
These lesions are CD68, S-100, vimentin positive. Fibronectin and laminin show diffuse and pericellular cytoplasmic staining. 
| Conclusion|| |
Congenital epulis of new born is a widely accepted term, although many have called it as GCT of new born, whereas others opine it as just hamartoma of gingiva. Whatever the term used, these are very indolent tumors, which regress spontaneously on its own. Surgical excision is indicated if large and symptomatic, interfering with feeding or respiration. No report of tumor recurrence is documented in the literature. Histopathology is diagnostic and assures the treating surgeon and parents about the benign course despite ruling out other congenital anomalies.
| Acknowledgment|| |
We acknowledge all our departmental staff for the support and encouragement.
| References|| |
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[Figure 1], [Figure 2]