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Congenital Epulis — MFDS Part 1 MCQ

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HardOral PathologyCongenital EpulisMFDS Part 1

A female neonate has a pedunculated mass on the anterior maxillary alveolar ridge that was present at birth. Histological examination shows sheets of bland polygonal cells with abundant eosinophilic granular cytoplasm beneath attenuated squamous epithelium. Which additional finding most strongly supports congenital granular cell epulis rather than a conventional granular cell tumour?

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Correct answer: B — Absence of S100 immunoreactivity in the granular cells

The correct answer is B. Congenital granular cell epulis is a benign lesion present at birth, usually on the anterior maxillary alveolar ridge of a female neonate. Although its granular-cell morphology resembles conventional granular cell tumour, its granular cells are characteristically S100-negative; its precise histogenesis remains uncertain. Conventional granular cell tumour is usually S100-positive, making E the principal diagnostic distractor. Cytokeratin-positive odontogenic epithelium would support an epithelial odontogenic lesion, while a dental papilla/enamel-organ pattern would indicate a biphasic odontogenic tumour. Trilineage haematopoietic tissue would suggest extramedullary haematopoiesis. Congenital epulis generally stops growing after birth, has no recognised malignant potential and may occasionally regress spontaneously.

Reference: Cheung JM, Putra J. Congenital Granular Cell Epulis: Classic Presentation and Its Differential Diagnosis. Head and Neck Pathology. 2020;14:208–211. https://pubmed.ncbi.nlm.nih.gov/30888637/