Prenatal diagnosis and multidisciplinary approach to the congenital gingival granular cell tumor Mario Messina a, * , Filiberto M. Severi b , Guiseppe Buonocore c , Francesco Molinaro a , Giovanna Amato a , Felice Petraglia b a Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico bLe ScotteQ, 53100 Siena, Italy b Section of Neonatology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico bLe ScotteQ, 53100 Siena, Italy c Section of Obstetrics and Reproductive Medicine, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico bLe ScotteQ, 53100 Siena, Italy Abstract Objective: Congenital gingival granular cell tumor (CGCT) is a rare benign lesion appearing at birth on the alveolar median ridge of the maxilla. Etiology is still unclear because spontaneous regression of the lesion is rare. Methods: The present report describes 2 cases of neonatal CGCT, highlighting benefits of ultrasonography to treatment of the prenatally diagnosed lesion. Results: The patients immediately underwent surgical exeresis. Pathology revealed a tumor of large polyedric cells with vacuolar central nuclei and eosinophil granular cytoplasm. Conclusions: Prenatal diagnosis is fundamental in the therapeutic approach to CGCT: ultrasonography methodologies allow diagnosis of the lesion in the uterus at the 36th gestational week, thus also allowing planning of delivery and, immediately later, the surgical treatment. That permits planning of delivery in a third-level center with considerable benefit for both the mother and the newborn. D 2006 Elsevier Inc. All rights reserved. Congenital gingival granular cell tumor (CGCT) is a rare benign lesion appearing at birth on the alveolar median ridge of the maxilla [1,2]; it is also defined as congenital epulis, granular cell rabdioma, congenital myoblastoma, or Neumann’s tumor [3]. Congenital gingival granular cell tumor is more frequently diagnosed on the maxillary than on the mandibular alveolar ridge (ratio, 1:3) [4] and more frequently affects females than males (ratio, 8-10:1) [5-8]. It has been described in the literature worldwide [2]. Etiology is still unclear [9]. Because spontaneous regression of the lesion is rare [10,11], surgical excision is the only valuable therapeutic option. Ultrasonog- raphy presently allows diagnosis of the lesion in the uterus around the 36th week of gestation; in addition, by means of tridimensional reconstruction, planned delivery in a third- level center is permitted with considerable benefit for both the mother and the newborn. 0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2006.07.003 * Corresponding author. Tel.: +39 577 586501; fax: +39 577 586174. E-mail address: messinam@unisi.it (M. Messina). Index words: Congenital epulis; Granular cell rabdioma; Myoblastoma; Oral tumor Journal of Pediatric Surgery (2006) 41, E35–E38 www.elsevier.com/locate/jpedsurg