Lymphangioma Mimicking Apical Periodontitis

Department of Health Sciences, Federal University of Goiás, Goiânia, GO, Brazil.
Journal of endodontics (Impact Factor: 3.38). 01/2011; 37(1):91-6. DOI: 10.1016/j.joen.2010.08.002
Source: PubMed


Lymphangiomas mimicking apical periodontitis, usually found in soft tissue of children and infants younger than 2 years, are extremely rare in aged patients, particularly in bone tissues.
An 81-year-old woman was seen in a radiological service to undergo imaging studies for the placement of dental implants. A panoramic radiograph showed a radiolucent multilocular structure in the left mandibular molar region, where teeth #17 and #18 had previously been treated endodontically. A fracture in tooth #17 was detected. Because of the patient's clinical history and the characteristics of the image, which showed changes in trabecular bone structure, the patient was referred for cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) for further evaluation. CBCT scans demonstrated a well-circumscribed lesion immediately below the roots of teeth #17 and #18. MRI showed no involvement of the surrounding soft tissues, and the lesion affected only the mandibular bone. Incision biopsy was performed, and the tissue sample (histopathology specimen) was sent to microscopic evaluation.
Microscopically, there was a proliferation of vascular endothelium covered by long and mature endothelial cells. In the vessel lumens, there was eosinophilic material similar to lymph. The microscopic examination suggested the diagnosis of lymphangioma.
Pathologies of non-endodontic origin such as lymphangioma, which might be in the area of the tooth apex, should be included in the differential diagnosis of apical periodontitis. Histopathologic examination is mandatory for their diagnosis and treatment.

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Available from: Cleomar Donizeth Rodrigues, Jun 18, 2015
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    • "Radicular cyst Surgical removal Rodrigues et al (19), 2011 Lymphangioma F/81 y 8 y A radiolucent multilocular image inthe left mandibular molar region The teeth had already been endodontic treated Asymptomatic Periapical inflammation and after endodontic treatment neoplasia The patient was not treated because of health issues and died 2 years after of cardiac complications Martins et al (46), 2007 Intraosseous schwannoma F/34 y Not mentioned In the alveolar bone, a radiolucent, unilocular, well-circumscribed lesion with a dense sclerotic border situated between the second premolar and first molar in the right mandibular area was noted "
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