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CONGENITAL EPULIDIS: A LITERATURE REVIEW - FROM DIAGNOSIS
TO TREATMENT
Anne Caroline Ribeiro Lacerda1
Kádja Alves Freitas Cruz 2
Edithe Helena de Brito Santos Lima 3
Isabela Luzia Coelho Bezerra de Carvalho4
Isabella Santos Souza 5
Nicole Rodrigues Silva6
Lívia Jordania Lino Figueredo7
Mariana Meira Soares8
Malvina de Souza Pereira9
Ana Jessica Dos Santos Nascimento 10
1 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
2 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
3 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
4 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
5 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
6 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
7 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
8 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
9 Master in Pediatric Dentistry from São Leopoldo Mandic – 13045-755, Campinas – SP, Bra-
zil.
10 Undergraduate student in Dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina-PE, Brazil.
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Abstract: Introduction: Congenital epulis is a rare condition characterized by the growth of benign
tumors in the oral cavity of newborns or young children. Although it is an uncommon disorder, it is
important due to its impact on oral health and child development. Objective: This literature review
aims to address the specicities of the diagnosis and treatment of Congenital Epulis. Methodology:
The databases used were: National Center for Biotechnology Information, U.S. National Library
of Medicine (PubMed), Scientic Electronic Library Online (SciELO) and Virtual Health Library
(BVS), in English, Spanish and Portuguese. Fifty-three articles published between 2014 and 2024 were
selected, and those that did not meet the inclusion criteria were excluded; only xx scientic articles
were included in this work. Results: The studies show that ECGC is a rare condition, predominantly
identied in female patients, reinforcing hypotheses related to hormonal factors. Surgical treatment
has demonstrated high efcacy, with favorable prognosis and low incidence of recurrence. Discussion:
Diagnosis is usually made through clinical examination, associated with imaging tests and biopsy,
when necessary, to conrm the benign nature of the lesion. Even so, early diagnosis is limited in
contexts with restricted access to resources, therefore, diagnosis tends to occur only after birth,
through clinical and visual evaluation of the lesion. Conclusion: Congenital epulis requires an accurate
diagnosis to ensure the exclusion of other more serious oral conditions. With uncertain etiology of the
lesion, surgical treatment, in many cases, is curative and effective, and the prognosis for the child is
generally positive.
Keywords: Congenital epulis, Pediatric dentistry, Differential Diagnoses.
INTRODUCTION
Congenital granular cell epulid (ECGC) is a rare/uncommon benign tumor that affects
the oral mucosa of neonates. Despite being benign, this lesion can reach a large size and directly
compromise weight gain, breathing and the development of the stomatognathic system, thus requiring
surgical intervention. (Deus et al. 2021)
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As for its etiology, the exact cause of this injury has not yet been elucidated, although
several theories have been suggested. Among them, the origin of epithelial remains, undifferentiated
mesenchymal cells, pericytes, broblasts, smooth muscle cells, nerve-related cells, and odontocytes
have been proposed. In addition, an unproven theory proposes the involvement of endogenous
hormonal stimulation, given the predominance of cases in female patients. (Jain et al. 2020)
With regard to clinical diagnosis, it can be made during intrauterine life, from the 27th
gestational week, through imaging tests, such as three-dimensional ultrasonography and magnetic
resonance imaging. Alternatively, it can be detected only at the time of birth, depending on the size of
the lesion. (Aparna et al. 2014, Bianchi et al. 2015)
Clinically, GCEC presents, in most cases, as a rm nodule on palpation, pink in color and
with a predilection for the anterior region of the maxilla. (Kokubun et al. 2018)
Regarding the therapeutic approach, the literature recommends the complete removal of the
lesion in order to remedy the problems associated with its presence. Thus, after excision, the prognosis
is favorable, since there are no signicant rates of recurrence of the lesion. (Torresani et al. 2021)
This study is relevant due to the scarcity of discussions about Congenital Epiplid among
students and dentists, in addition to the limited availability of current research in databases. The
objective of this study is to deepen the understanding of this condition, ranging from diagnosis to
treatment, and thus contribute to the expansion of knowledge and improvement of clinical practices
related to this theme.
METHODOLOGY
The systematization of this integrative literature review was based on a bibliographic search
in the following databases: National Center for Biotechnology Information, U.S. National of Medicine
(PubMed), Scientic Electronic Library Online (SciELO) and Virtual Health Library (VHL). The
following descriptors were used to perform the DeCS/MeSH descriptors: “Gingival Diseases”,
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“Granular Cell Tumor” and “Differential Diagnoses”.
A total of 53 articles published between 2014 and 2024 were selected, considering the
following inclusion criteria: literature reviews and clinical case reports written in Portuguese, English,
and Spanish, which addressed the diagnosis and treatment of congenital epulids in pediatric patients.
The exclusion criteria were: articles published before 2014, congress abstracts, book chapters, studies
with restricted access to full content, those involving other age groups, and those that were not related
to the central theme of the research. Only xx scientic articles were included in this work.
Source: Developed by the authors
Title Authors and year Goal Methodology/ Main ndings
Extensive congenital
epullide in a newborn:
diagnosis and treatment
of a rare lesion
Ciro Borges Duailibe de
Deus, João Victor Uchôa
Silva, André Hergesel de
Oliva, Wellington José
Alves Nunes.( 2021)
Report a case of diagnosis
and treatment of a
newborn with congenital
epullid of large
proportions.
Congenital epullid, as it is
a rare condition, is often
underdiagnosed and confused
with vascular lesions, therefore,
the multidisciplinary approach
directs the diagnosis and
treatment of Properly.
Large Congenital Epulid
in Newborns: Diagnosis
and Treatment
Neha Jain , Pallavi Sinha,
Lavleen Singh. (2020)
A case of large epulid in a
newborn causing feeding
and breathing difculties
that were treated with
immediate surgical
intervention.
Epulid is a benign mass and no
metastasis has been reported
to date. Due to its location and
size, it can cause mechanical
obstruction, leading to feeding
difculty, cyanosis, dyspnea, and
has the potential to cause death of
the child by asphyxiation during
the perinatal and postnatal
period.
Congenital epullide in
newborns: case report,
immunoproling and
literature review
H G Aparna, B S
Jayanth, R Shashidara, P
Jaishankar (2014)
It reports a case of
congenital epullide in a
female newborn in the right
alveolar crest, along with
an extensive review of the
literature and discussing
immunoproling.
Early diagnosis of CAC in
a newborn is of paramount
importance in the successful
treatment of these rare cases.
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FINDINGS
In view of the careful review, the nal set of studies had a total of 9 articles that met the
readability criteria. Studies show that GCEC is a rare condition, predominantly identied in female
patients, reinforcing hypotheses related to hormonal factors. Prenatal diagnosis was reported in part
of the publications, while other cases were identied at birth. Surgical treatment demonstrated high
efcacy, with a favorable prognosis and low occurrence of recurrences.
These results highlight the importance of further investigations on the etiology and clinical
impact of the lesion, since, although rare, its proper identication and management can prevent
complications that affect the development of the stomatognathic system in newborns.
Title Authors and year Goal Methodology/ Main ndings
Extensive congenital
epullide in a newborn:
diagnosis and treatment
of a rare lesion
Ciro Borges Duailibe de
Deus, João Victor Uchôa
Silva, André Hergesel de
Oliva, Wellington José
Alves Nunes.( 2021)
Report a case of diagnosis
and treatment of a
newborn with congenital
epullid of large
proportions.
Congenital epullid, as it is
a rare condition, is often
underdiagnosed and confused
with vascular lesions, therefore,
the multidisciplinary approach
directs the diagnosis and
treatment of Properly.
Large Congenital Epulid
in Newborns: Diagnosis
and Treatment
Neha Jain , Pallavi Sinha,
Lavleen Singh. (2020)
A case of large epulid in a
newborn causing feeding
and breathing difculties
that were treated with
immediate surgical
intervention.
Epulid is a benign mass and no
metastasis has been reported
to date. Due to its location and
size, it can cause mechanical
obstruction, leading to feeding
difculty, cyanosis, dyspnea, and
has the potential to cause death of
the child by asphyxiation during
the perinatal and postnatal
period.
Congenital epullide in
newborns: case report,
immunoproling and
literature review
H G Aparna, B S
Jayanth, R Shashidara, P
Jaishankar (2014)
It reports a case of
congenital epullide in a
female newborn in the right
alveolar crest, along with
an extensive review of the
literature and discussing
immunoproling.
Early diagnosis of CAC in
a newborn is of paramount
importance in the successful
treatment of these rare cases.
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Multiple congenital
granular cell epulids:
case report and
immunohistochemical
prole with emphasis on
vascularization
Patrícia Roccon Bianchi,
Vera Cavalcanti de
Araujo, José Wagner
Banterli Ribeiro, Fabricio
Passador-Santos, Ney
Soares de Araujo,
Andresa Borges Soares
(2015)
A rare case report of a
female newborn presented
with two exophytic
pedunculated red nodules
located on the alveolar
crest between the future
eruption sites of the
incisors and canines of the
mandible and maxilla.
Understanding this lesion is
essential for the correct diagnosis
and appropriate treatment. The
immunohistochemical prole
conrmed the increase in
vascularization, proving that
these lesions are composed not
only of new and preexisting blood
vessels, but also of lymphatic
vessels.
Congenital epulid: a case
and literature review
Katsutoshi Kokubun,
Kenichi Matsuzaka,
Yoshihiko Akashi,
Masami Sumi, Kei
Nakajima, Satoshi
Murakami, Masato
Narita, Takahiko
Shibahara, Takashi Inoue
(2018).
A case of congenital
epullide (20×10 mm) in the
mandibular gingiva of a
newborn. The mass, with a
smooth and pedunculated
surface with a healthy
color, was surgically
removed 5 months after
birth.
Histologically, the tumor
consisted mainly of large
eosinophilic granule cells.
Immunohistochemical studies
revealed intense staining for
vimentin, STRO-1 and CD44,
suggesting that it was derived
from mesenchymal cells.
Epulis of congenital
granule cells of the
newborn: importance of
prenatal diagnosis.
Torresani E, Girolami
I, Marletta S, Eccher A,
Ghimenton C. (2021)
This paper analyzes a case
of multiple CGCE in a
female newborn discovered
at birth, along with a brief
review of the pathogenesis,
differential diagnoses, and
treatment implications of
early diagnosis.
This entity should be suspected
before birth because of the
important implications for
delivery management choices
and to avoid excessive surgical
treatment, keeping in mind that
the nal diagnosis depends on
histopathological examination
after surgery.
Congenital epulide The Lapid, R Shaco-Levy,
and Krieger , L Kachko ,
A Sagi (2001).
Epulis is seen only in the
newborn and is a different
entity from other granular
cell tumors.
The recommended treatment is
immediate surgical resection.
Tumor recurrences and damage
to future dentition have not been
reported, suggesting that radical
excision is not warranted.
Congenital granular cell
epulis: a rare pediatric
tumor of newborn
Xavier, Arun Mamachan
et al. (2022)
The diagnosis of
GCCE in a child is
discussed, including its
clinical presentation,
histopathological ndings,
and surgical management.
The CGCE is composed of large,
granular cells, with an abundant
amount of cytoplasm, and is lined
with epithelium of oral origin.
Histology is typical, with cells
that appear to originate from the
cells of the gum tissue.
Congenital Epulis: A
Case and Review of the
Literature
KOKUBUN, K.;
MATSUZAKA, K.;
AKASHI, Y.; SUMI,
M.; NAKAJIMA,
K.; MURAKAMI,
S.; NARITA, M.;
SHIBAHARA, T.;
INOUE, T. (2018)
To present a clinical case
of congenital epullide
and to review the existing
literature on this rare
condition, with emphasis
on the clinical and
histopathological aspects
and treatment of the
disease.
The literature review conrms
that congenital epulide is rare,
with most cases being diagnosed
at birth or in the rst days of life.
Although it is a benign condition,
early resection is essential to
avoid complications.
Congenital granular cell
tumor of the newborn-
Spontaneous regression
or early surgical
intervention.
DHAREULA, A.;
JAISWALL, M.; FOYAL,
A.; GARUBA, K. (2018)
Explore the diagnosis,
clinical course, and
treatment options, and
discuss whether early
surgical treatment is
necessary or whether
the tumor may undergo
spontaneous regression.
This study contributes to the
understanding of the management
of congenital granular cell tumor,
highlighting the possibility
of spontaneous regression
and providing information on
when surgical intervention is
necessary.
Prenatal diagnosis of
congenital epullid using
three-dimensional
ultrasonography.
Davidson TM, Gibbons
MD. (2008)
Listen to the use of
three-dimensional
ultrasonography (3D USG)
for the prenatal diagnosis
of congenital epiplid.
This article contributes to the
eld of prenatal diagnosis by
showing how three-dimensional
ultrasound can be an effective
tool in the identication of oral
anomalies such as congenital
epullid.
Congenital epullide of the
newborn: A systematic
review of 174 cases
reported in the literature.
Chrcanovic BR,
Guimarães LM, Gomes
CC, Gomez RS. (2010)
It conducts a systematic
review of 174 cases
of congenital epullide
published in the literature,
with the aim of providing a
comprehensive analysis of
the condition.
This study provides a complete
view of congenital epullid,
highlighting its frequency,
clinical and histological
characteristics.
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DISCUSSION
GCEC, although a rare lesion, has clinical and histological characteristics that make its
diagnosis and management essential for the maintenance of neonatal health. According to the studies
included, the predominance of female neonates reinforces the hypotheses of hormonal inuence on
the pathogenesis of the lesion, even though the exact etiology remains uncertain. The proposal is
that endogenous hormonal stimuli can act as triggers and reinforced by high frequency in female
Congenital Epulis: A
Case and Review of the
Literature
KOKUBUN, K.;
MATSUZAKA, K.;
AKASHI, Y.; SUMI,
M.; NAKAJIMA,
K.; MURAKAMI,
S.; NARITA, M.;
SHIBAHARA, T.;
INOUE, T. (2018)
To present a clinical case
of congenital epullide
and to review the existing
literature on this rare
condition, with emphasis
on the clinical and
histopathological aspects
and treatment of the
disease.
The literature review conrms
that congenital epulide is rare,
with most cases being diagnosed
at birth or in the rst days of life.
Although it is a benign condition,
early resection is essential to
avoid complications.
Congenital granular cell
tumor of the newborn-
Spontaneous regression
or early surgical
intervention.
DHAREULA, A.;
JAISWALL, M.; FOYAL,
A.; GARUBA, K. (2018)
Explore the diagnosis,
clinical course, and
treatment options, and
discuss whether early
surgical treatment is
necessary or whether
the tumor may undergo
spontaneous regression.
This study contributes to the
understanding of the management
of congenital granular cell tumor,
highlighting the possibility
of spontaneous regression
and providing information on
when surgical intervention is
necessary.
Prenatal diagnosis of
congenital epullid using
three-dimensional
ultrasonography.
Davidson TM, Gibbons
MD. (2008)
Listen to the use of
three-dimensional
ultrasonography (3D USG)
for the prenatal diagnosis
of congenital epiplid.
This article contributes to the
eld of prenatal diagnosis by
showing how three-dimensional
ultrasound can be an effective
tool in the identication of oral
anomalies such as congenital
epullid.
Congenital epullide of the
newborn: A systematic
review of 174 cases
reported in the literature.
Chrcanovic BR,
Guimarães LM, Gomes
CC, Gomez RS. (2010)
It conducts a systematic
review of 174 cases
of congenital epullide
published in the literature,
with the aim of providing a
comprehensive analysis of
the condition.
This study provides a complete
view of congenital epullid,
highlighting its frequency,
clinical and histological
characteristics.
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individuals, but there are no robust studies that conrm this relationship. (Lapid et al. 2001)
Clinically, the epulid manifests as a single nodule with a sessile or pedicled base, with an
elastic-brous consistency and a reddish hue. It is usually parallel to the midline, in the region of growth
of the lateral incisor and canines, recurrently located in the alveolar rim of the maxilla, although it can
also occur in other sites such as the mandibular alveolar ridge and on the tongue. (Xavier et al. 2022)
Regarding size, it can present variations from 0.8 cm to 0.20 cm, according to the cases reported in
the literature. Although rare/unusual, multiple ECCG lesions may present in approximately 10% of
cases. (Torresani et al. 2021, Kokubun et al. 2018, Dhareula et al. 2018)
Technological advances, such as the use of three-dimensional ultrasonography and magnetic
resonance imaging, have expanded the possibilities of prenatal diagnosis, allowing the identication
of lesions as early as the 27th week of gestation. Despite this, there are limitations to early diagnosis,
especially in scenarios with restricted access to these resources. In these cases, the diagnosis tends to
occur only after birth, through clinical and visual evaluation of the lesion. This temporal variability
of the diagnosis can directly impact the therapeutic planning and the approach to the cases. Surgical
management was reiterated as the best therapeutic approach, given the benign nature of the lesion and
its low probability of recurrence. (Davidson and Gibbons 2008)
Complete excision, in addition to resolving the specic potential complications related to
tumor growth, such as breathing and feeding difculties, also contributes to improving the quality of
life of the newborn and his family. The positive prognosis reported in the reviewed studies reinforces
the efcacy of this intervention. In addition, the reviewed literature emphasizes the need for greater
awareness among health professionals, especially dentists and pediatricians, about the GCEC. The
scarcity of epidemiological data and longitudinal studies limits the comprehensive understanding
of the condition, which tends to occur only after birth, through clinical and visual evaluation of the
lesion. (Chrcanovic et al.2010)
Finally, this study highlights the relevance of research on GCS, contributing to the
improvement of technical-scientic knowledge and to the reduction of gaps in pediatric dentistry and
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neonatal surgical practice.
FINAL CONSIDERATIONS
Congenital epullid, although a rare condition, is a benign lesion that affects the oral mucosa.
Although it is benign, it can end up affecting weight gain, breathing, and stomatognathic development,
requiring surgical intervention. The etiology of the lesion remains uncertain, and the role of endogenous
hormonal stimulation is considered unproven, due to the higher incidence in female patients. GCEC
usually presents as a rm, pink nodule with a predilection for the anterior region of the maxilla. The
indicated treatment is complete removal of the lesion, with a favorable prognosis and low chance of
recurrence. This article contributes signicantly to the eld of health, as it addresses a rare and little-
discussed condition and results in a lack of knowledge that can negatively impact the prognosis of
patients.
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