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Case of the Week # 167

Novakov Mikic A, MD, Ivanovic Lj, MD, Lucic M, MD, Kiralj A, MD, Dobric Lj, MD, Koprivšek , MD, Vuckovic N, MD, Kacanski M, MD

May 12 - 25, 2006

Novakov Mikic A, MD1, Ivanovic Lj, MD1, Lucic M, MD2, Kiralj A, MD3, Dobric Lj, MD1, Koprivšek , MD2, Vuckovic N, MD4, Kacanski M, MD4

1 Klinika za ginekologiju i akušerstvo, Klinicki centar Novi Sad, Serbia 3 Klinika za maksilofacijalnu hirurgiju, Klinicki centar Novi Sad, Serbia 4 Institut za patologiju i histologiju, Klinicki centar Novi Sad, Serbia, 2 Dijagnosticki imidžing centar. Institut za onkologiju, Sremska Kamenica, Serbia

This is a case referred to our unit at 28 weeks. There was no relevant obstetrical history.

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Answer

This is a fetus referred to our unit at 28 weeks. There was no relevant past obstetrical history.  A 2D scan revealed an oral cavity tumor. A 3D scan confirmed the diagnosis and revealed the peduncle at the upper border of maxilla. Magnetic resonance examination was performed and the site of the tumor was visualized. Karyotype was performed with a normal result. Regular three-week scans were arranged to follow the growth of the tumor as well as the amniotic fluid. No tumor growth was seen. The amniotic fluid volume was normal until 39 weeks. A cesarean section was scheduled to avoid a rupture of the tumor during a vaginal delivery. A pediatric surgeon was present during the delivery. A complete surgical excision was done immediately after the baby was extracted. The histological diagnosis was Granular cell tumor (Epulis).

The differential diagnosis includes Epignathus which typically are larger, more irregular and contain calcifications.

The female newborn has been developing without complications.

2D and 3D views showing the tumor coming from the mouth

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MRI showing the tumor

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Postnatal view

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Anatomopathological examination (Granular cell tumor)

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References

Shaw L, Al-Malt A, Carlan SJ, Plumley D, Greenbaum L, Kosko J. Congenital epulis: three-dimensional ultrasonographic findings and clinical implications. Ultrasound Med. 2004 Aug;23(8):1121-4.

Charrier JB, Droulle P, Vignaud JM, Chassagne JF, Stricker M.Obstructive congenital gingival granular cell tumor. Ann Otol Rhinol Laryngol. 2003 Apr;112(4):388-91.

Nakata M, Anno K, Matsumori LT, Sumie M, Sase M, Nakano T, Hara H, Imate Y, Nakamura Y, Kato H.Prenatal diagnosis of congenital epulis: a case report. Ultrasound Obstet Gynecol. 2002;20(6):627-9.

Lopez de Lacalle JM, Aguirre I, Irizabal JC, Nogues A.Congenital epulis: prenatal diagnosis by ultrasound. Pediatr Radiol. 2001 Jun;31(6):453-4.

Bilen BT, Alaybeyoglu N, Arslan A, Turkmen E, Aslan S, Celik M.Obstructive congenital gingival granular cell tumour. Int J Pediatr Otorhinolaryngol. 2004 Dec;68(12):1567-71.

Merrett SJ, Crawford PJ.Congenital epulis of the newborn: a case report. Int J Paediatr Dent. 2003 Mar;13(2):127-9.

Kumar P, Kim HH, Zahtz GD, Valderrama E, Steele AM.Obstructive congenital epulis: prenatal diagnosis and perinatal management. Laryngoscope. 2002 Nov;112(11):1935-9.

M. Echevarria, A. Muñoz, N. Maiz, M. Torrents, B. Serra, J. MallafreCongenital epulis: prenatal diagnosis with ultrasound and MRI. Ultrasound Obstet Gynecol 2004; 26 (4): 372. Leocata P, Bifaretti G, Saltarelli S, Corbacelli A, Ventura L. Congenital (granular cell) epulis of the newborn: A case report with immunohistochemical study on the histogenesis. Annals of Saudi Medicine 1999: 19; 527-9.

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