congenital granular cell lesion ( cgcl ) is a rare benign soft tissue tumor of the newborn . it is also synonymously known as gingival granular cell tumor ( gct ) of the newborn and was first described by newmann in 1871 , hence also called as newmann 's tumor . cgcl is a rare lesion of the newborn with an incidence of just 0.0006% . to the best of our knowledge though benign , this tumor may cause hindrance in breathing and suckling , depending upon the size and position of the growth . although spontaneous regression has been documented , but the recommended treatment is surgical excision with no reports of recurrence after resection . this case report is unique as differential diagnosis has been included so as to help the clinician to arrive at a more conclusive diagnosis thereby helping him to plan the treatment accordingly . also , more the number of case reports on this entity more is the likelihood that we will be able to build a conclusive base for the histogenesis of this uncommon and obscure lesion . a 2-month - old female child was referred with the chief complaint of difficulty in feeding since a few days . on examination a 2  2  1 mm pedunculated growth was observed arising from the left side of maxilla in the canine region . the lesion was pink in color , similar to that of the surrounding mucosa , surface was smooth without any ulcerations and was firm in consistency . the patient was uncomfortable because of this small growth which was possibly hindering proper suction during breast feeding.[figure 1 ] . there was minimal bleeding during the procedure and the infant was comfortable with breast feeding from the very next day . clinical photograph showing small pedunculated gingival mass hematoxylin and eosin ( h and e ) stained section showed keratinized stratified squamous epithelium and underlying connective tissue stroma . high power view showed delicate collagen fibers , numerous young fibroblasts and granular cells [ figure 2 ] . the granular cells were large oval cells with an eosinophillic and granular cytoplasm and single basophilic nucleus ; these were seen to be scattered amidst the connective tissue [ figure 3 ] . photomicrograph showing delicate collagen fibers abundant fibroblasts and granular cells ( h&e stain , 200 ) large oval cells with granular cytoplasm and single basophilic nucleus which were scattered between collagen fibers and fibroblasts . hematoxylin and eosin ( h and e ) stained section showed keratinized stratified squamous epithelium and underlying connective tissue stroma . high power view showed delicate collagen fibers , numerous young fibroblasts and granular cells [ figure 2 ] . the granular cells were large oval cells with an eosinophillic and granular cytoplasm and single basophilic nucleus ; these were seen to be scattered amidst the connective tissue [ figure 3 ] . photomicrograph showing delicate collagen fibers abundant fibroblasts and granular cells ( h&e stain , 200 ) large oval cells with granular cytoplasm and single basophilic nucleus which were scattered between collagen fibers and fibroblasts . epulis is a greek word literally meaning  of the gums  and is used to describe a variety of gingival overgrowths . cgcl is a rare , gingival tumor that usually arises in the incisor - canine region of the maxilla ( maxilla : mandible ratio is 3:1 ) . this soft tissue tumor appears as smooth - surfaced , pedunculated growth which may be lobulated at times and arises from the gingival mucosa of maxilla or mandible . it ranges in size from few millimetres to 9 cm ( as reported till date ) , with a female preponderance of 8:1 . they are usually firm in consistency , covered by a smooth or erythematous mucosa and are attached by means of a stalk to the underlying tissue . early diagnosis can be made by prenatal ultrasonography or magnetic resonance imaging ( mri ) . however , mri is considered to be superior to ultrasonography , showing its gingival origin without local extension . histogenesis of this tumor is unclear and the proposed cells of origin are probably derived from one of the sources , that is , odontogenic epithelium , undifferentiated mesenchymal cells , pericytes , fibroblasts , smooth muscle cells , nerve related cells and histiocytes . an endogenous hormonal stimulus has been proposed as the reason for its occurrence in neonates and for female predominance . but this theory was not accepted because of the lack of detectable estrogen and progesterone receptors within the lesion . gct is comparatively less vascular with an occasional component of pseudoepitheliomatous hyperplasia and contains more conspicuous nerve bundles as compare to cgcl . cgcl solely occurs on the gum pads of infants ; whereas , gct occurs in adults and may involve multiple organs . immunohistochemically , gcts are reactive to s-100 protein and laminin , while these are absent in cgcl . gcts also show positive staining for ngfr / p75 and inhibin- , while cgcl does not . differential diagnosis includes melanotic neuroectodermal tumor of infancy ( mnti ) , hemangioma , fibroma , embryonal rhabdomyosarcoma , granuloma , malignant granular cell myoblastoma , chondrogenic and osteogenic sarcoma and schwannoma . however , mnti and cgcl are distinctly different as mnti is infiltrating , contains melanin pigment and tumor mass comprises of alveolar spaces lined by cuboidal or large polygonal cells having pale cytoplasm . hemangioma is primarily a vascular lesion with budding endothelial cells and essentially not present at birth ; whereas , cgcls manifest within the 1 month of life . embryonal rhabdomyosarcoma is a malignant tumor of striated muscle and uncommon in the oral cavity . histologically , granular cells are in ribbons separated by septa giving an appearance of invasion or infiltration into underlying tissues . chondrogenic and osteogenic sarcoma are malignant tumors characterized by chondroid or osteoid tissue , respectively . schwannoma is a tumor of neural origin which shows antoni a and b areas and verocay bodies . in conclusion , cgcl can be diagnosed by prenatal sonography , but prenatal findings are not specific .
congenital granular cell tumor ( cgct ) , or congenital epulis , is an uncommon benign soft tissue lesion that usually arises from the alveolar mucosa of neonates and may cause respiratory and feeding problems . 
 the histogenesis and clinical history of the lesion remains obscure . 
 treatment involves surgical excision and recurrences are rare . 
 the present report describes a case of congenital granular cell lesion ( cgcl ) in the anterior segment of maxillary alveolar ridge of a 2-month - old female . 
 this lesion was causing feeding problem and was excised under local anesthesia , with no recurrence even after 3 years .