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Oral Granular Cell Tumors Workup

  • Author: Steven Brett Sloan, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Feb 19, 2016

Laboratory Studies

No clinical laboratory tests are used for these lesions. A definitive diagnosis requires biopsy.



Conservative excisional biopsy is indicated because both lesions are rarely larger than 2 cm in diameter. As a general rule, the depth of biopsy for granular cell tumors approximates the diameter of the lesion. Margins do not need to be extensive; generally, a few millimeters is adequate.

The depth of biopsy for congenital epulis is the periosteum. Removal of bone is not indicated. Since these are exophytic lesions, surgical margins do not need to be much greater than the clinical margins.


Histologic Findings

The granular cell tumor is characterized by the presence of sheets or clusters of plump, polygonal cells with a granular cytoplasm. These lesions are not circumscribed and often come into intimate contact with the overlying surface squamous epithelium. A frequent finding is pseudoepitheliomatous hyperplasia of the overlying epithelial layer. These cells generally are uniform and do not exhibit significant atypical features. Malignant granular cell tumors, which fortunately are rare, may have a very benign histologic appearance. Tumor cells more or less stain uniformly positive for S-100 protein, neuron-specific enolase, CD68, PGP9.5, and inhibin alpha.[14, 15, 16, 17]

Congenital epulis also contains sheets and/or clusters of plump cells with a granular cytoplasm.

Pseudoepitheliomatous hyperplasia generally is not present. Congenital epulis lacks specificity for S-100 protein and is vimentin positive.

Contributor Information and Disclosures

Steven Brett Sloan, MD Associate Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Site Director, Connecticut Veterans Affairs Healthcare System; Assistant Clinical Professor, Yale University School of Medicine

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Journal of the American Academy of Dermatology;Up to Date;Medical Review Institute of America.

Specialty Editor Board

David F Butler, MD 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: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

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.


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.

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