Medical Care

Treatment for granular cell tumors and congenital epulis is surgery. While extensive surgery is not indicated, recurrence of granular cell tumors has been reported several years after removal. Recurrence of congenital epulis has not been reported; however, the number of total cases is small. If congenital epulis is asymptomatic and surgery is deferred, the lesion may regress spontaneously.^[25]

Surgical Care

Excision with a scalpel under local anesthesia is the preferred method; however, surgical margins are difficult to determine intraoperatively in the case of the granular cell tumor. Excision down to the periosteum usually is the goal for treating congenital epulis; however, recurrence does not seem to occur even if this lesion is not completely removed.

Activity

Advise the patient with routine postoperative precautions.

Complications

Complications may occur as a result of risks associated with routine excisional biopsy.

Long-Term Monitoring

Granular cell tumors have been reported to recur several years after removal. Long-term follow-up care is warranted.

Medication

Vered M, Carpenter WM, Buchner A. Granular cell tumor of the oral cavity: updated immunohistochemical profile. J Oral Pathol Med. 2009 Jan. 38(1):150-9. [QxMD MEDLINE Link].
Ordóñez NG. Granular cell tumor: a review and update. Adv Anat Pathol. 1999 Jul. 6(4):186-203. [QxMD MEDLINE Link].
Caltabiano R, Cappellani A, Di Vita M, Lanzafame S. The unique simultaneous occurrence of a squamous cell carcinoma and a granular cell tumor of the tongue at the same site: a histological and immunohistochemical study. J Craniofac Surg. 2008 Nov. 19(6):1691-4. [QxMD MEDLINE Link].
Lahmam Bennani Z, Boussofara L, Saidi W, Bayou F, Ghariani N, Belajouza C, et al. [Childhood cutaneous Abrikossoff tumor]. Arch Pediatr. 2011 Jul. 18(7):778-82. [QxMD MEDLINE Link].
Becelli R, Perugini M, Gasparini G, Cassoni A, Fabiani F. Abrikossoff's tumor. J Craniofac Surg. 2001 Jan. 12(1):78-81. [QxMD MEDLINE Link].
Nagaraj PB, Ongole R, Bhujanga-Rao BR. Granular cell tumor of the tongue in a 6-year-old girl--a case report. Med Oral Patol Oral Cir Bucal. Mar 2006. 11(2):E162-164. [QxMD MEDLINE Link].
Curtis BV, Calcaterra TC, Coulson WF. Multiple granular cell tumor: a case report and review of the literature. Head Neck. 1997 Oct. 19(7):634-7. [QxMD MEDLINE Link].
Taneeru S, Guttikonda VR, Yeluri S, Madala J. Granular cell ameloblastoma of jaw - Report of a case with an emphasis on its characterization. J Clin Exp Dent. 2013 Jul 1. 5(3):e154-6. [QxMD MEDLINE Link]. [Full Text].
Dive A, Dhobley A, Fande PZ, Dixit S. Granular cell tumor of the tongue: Report of a case. J Oral Maxillofac Pathol. 2013 Jan. 17(1):148. [QxMD MEDLINE Link]. [Full Text].
Farooqui SM, Khan MS, Adhikari L, Doshi V. Multifocal Pulmonary Granular Cell Tumor Presenting with Postobstructive Pneumonia. Case Rep Pulmonol. 2017. 2017:8513702. [QxMD MEDLINE Link].
Ofori E, Ramai D, Lui YX, Reddy M. Esophageal Granular Cell Tumor: A Case and Review of the Literature. Gastroenterology Res. 2017 Dec. 10 (6):372-375. [QxMD MEDLINE Link].
Rajagopal MD, Gochhait D, Shanmugan D, Barwad AW. Granular Cell Tumor of Cecum: A Common Tumor in a Rare Site with Diagnostic Challenge. Rare Tumors. 2017 Jul 3. 9 (2):6420. [QxMD MEDLINE Link].
Saleh H, El-Fakharany M, Frankle M. Multiple synchronous granular cell tumors involving the colon, appendix and mesentery: a case report and review of the literature. J Gastrointestin Liver Dis. 2009 Dec. 18 (4):475-8. [QxMD MEDLINE Link].
Kelly EF, Stein AA, Ma XC, Yeguez J. A rare case of perianal granular cell tumor: case report and literature review. J Surg Case Rep. 2017 Jun. 2017 (6):rjw186. [QxMD MEDLINE Link].
Akkaya H, Toru HS, Ayva ES, Karabulut Z, Durusoy C. Metachronous Occurrence of Granular Cell Tumor in Breast Skin and Scalp: Diagnostic Challenging Differentiating Benign from Malignant and a Literature Review. Case Rep Pathol. 2016. 2016:8043183. [QxMD MEDLINE Link].
Hatta J, Yanagihara M, Hasei M, Abe S, Tanabe H, Mochizuki T. Case of multiple cutaneous granular cell tumors. J Dermatol. 2009 Sep. 36 (9):504-7. [QxMD MEDLINE Link].
Benson KA, Crandall M. Cutaneous Granular Cell Tumor on the Arm in a Middle-Aged Man. J La State Med Soc. 2015 Nov-Dec. 167 (6):252-3. [QxMD MEDLINE Link].
Lapid O, Shaco-Levy R, Krieger Y, Kachko L, Sagi A. Congenital epulis. Pediatrics. 2001 Feb. 107(2):E22. [QxMD MEDLINE Link].
McGuire TP, Gomes PP, Freilich MM, Sándor GK. Congenital epulis: a surprise in the neonate. J Can Dent Assoc. 2006 Oct. 72(8):747-50. [QxMD MEDLINE Link].
Vera-Sirera B, Vera-Sempere F. Adult rhabdomyoma with oncocytic changes affecting the floor of the mouth: optical, immunohistochemical, and ultrastructural study. J Craniofac Surg. 2012 Sep. 23(5):e412-5. [QxMD MEDLINE Link].
Junquera LM, de Vicente JC, Vega JA, Losa JL, Albertos JM, López-Arranz JS. Granular-cell tumours: an immunohistochemical study. Br J Oral Maxillofac Surg. 1997 Jun. 35(3):180-4. [QxMD MEDLINE Link].
Le BH, Boyer PJ, Lewis JE, Kapadia SB. Granular cell tumor: immunohistochemical assessment of inhibin-alpha, protein gene product 9.5, S100 protein, CD68, and Ki-67 proliferative index with clinical correlation. Arch Pathol Lab Med. 2004 Jul. 128(7):771-5. [QxMD MEDLINE Link].
Stewart CM, Watson RE, Eversole LR, Fischlschweiger W, Leider AS. Oral granular cell tumors: a clinicopathologic and immunocytochemical study. Oral Surg Oral Med Oral Pathol. 1988 Apr. 65(4):427-35. [QxMD MEDLINE Link].
Freitas VS, dos Santos JN, Oliveira MC, Santos PP, Freitas Rde A, de Souza LB. Intraoral granular cell tumors: clinicopathologic and immunohistochemical study. Quintessence Int. 2012 Feb. 43(2):135-42. [QxMD MEDLINE Link].
Ruschel HC, Beilke LP, Beilke RP, Kramer PF. Congential epulis of newborn: report of a spontaneous regression case. J Clin Pediatr Dent. 2008. 33(2):167-9. [QxMD MEDLINE Link].
Philipp K, Barnes EL, Carrau RL. Eagle syndrome produced by a granular cell tumor. Arch Otolaryngol Head Neck Surg. Dec 2001. 127(12):1499-1501. [QxMD MEDLINE Link].

Media Gallery

Clinical photograph of a granular cell tumor on the tongue of a 38-year-old man.
Granular cell tumor.
Congenital epulis.

of 3

Author

Steven Brett Sloan, MD Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Program Director, Connecticut Veterans Affairs Healthcare System

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Dermatology<br/>Received income in an amount equal to or greater than $250 from: American Academy of Dermatology.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

James W Patterson, MD Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Acknowledgements

Robert Howell, DDS, MSD Professor, Department of Diagnostic Sciences, West Virginia University School of Dentistry

Disclosure: Nothing to disclose.

Melinda Jen, MD Department of Pediatrics, Section of Pediatric Dermatology, Children's Hospital of Philadelphia

Melinda Jen, MD, is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.