Congenital epulis of the newborn is a rare tumour which is usually benign. The first description of a case is attributed to Neumann in 1871. The word "epulis" is derived from Greek and means "on the gum" or "gum boil". Epulis is also known as a congenital gingival granular cell tumour because of its histological features. Since 1871, 216 cases have been reported. Female babies are affected 8-10 times more often than males. Epulis is located on the maxillary ridge twice as often as on the mandible, mostly as single tumours but rarely as multiple tumours. Macroscopically, epulis is a pedunculated tumour with a smooth or lobulated surface. The basis of the tumour is the alveolar mucosa. The size varies from a few millimetres to 9 cm in diameter. After birth, the tumour normally does not increase in size. Microscopic examination shows a central mass of granular cells. This mass is surrounded by a stratified squamous mucosa. The histogenesis of the tumour is unknown. Spontaneous regression of congenital epulis has been reported in four cases. However, surgical excision is generally indicated due to interference with feeding or respiration. Recurrence of the tumour after surgery has not been reported yet.

Epulis in a newborn. histogenetic comparison with a granular cell tumor in adults.Pathologe. 2002 Mar;23(2):145-8.

The congenital granular cell tumor is a rare lesion of newborns located on the alveolar ridge with a marked predilection for female infants. Histologically these tumors are characterized by large eosinophilic granular cells, similar to granular cell tumors in adults which are often seen as Abrikossoff tumors. Immunohistochemical studies revealed the different histogenesis and evolution of both these tumor entities. We report on a female newborn infant with a congenital epulis of the left anterior maxillary alveolar ridge. This case demonstrates a rare congenital tumor of newborns and reveals the histogenetic differences to granular cell tumors in adults.

Congenital epulis: an ultrastructural and immunohistochemical case study.Adv Clin Path. 2000 Oct;4(4):159-63.

We report a case of an otherwise healthy, two days old, female with a a mass derived from the mandible. Light microscopy findings were compatible with the diagnosis of congenital epulis. The lesion showed negative staining for S-100 protein, which is a characteristic finding in cases of epulis and distinguishes it from granular cell tumor. The characteristic electron microscopy findings, as well as other features of epulis in relation to the theories for its possible origin are also reviewed.