Case Report/Clinical Techniques| Volume 37, ISSUE 1, P91-96, January 2011

Lymphangioma Mimicking Apical Periodontitis

Published:October 15, 2010DOI:



      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.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kerr D.A.
        • Ash M.M.
        • Millard H.D.
        Oral diagnosis.
        Mosby, St Louis1978 (13–77)
        • Wood N.K.
        • Goaz P.W.
        Differential diagnosis of oral and maxillofacial lesions.
        5th ed. Mosby, St Louis1991 (330–2)
        • Faitaroni L.A.
        • Bueno M.R.
        • Carvalhosa A.A.
        • Ale K.A.B.
        • Estrela C.
        Ameloblastoma suggesting large apical periodontitis.
        J Endod. 2008; 34: 216-219
        • Rodrigues C.D.
        • Estrela C.
        Traumatic bone cyst suggestive of large apical periodontitis.
        J Endod. 2008; 34: 484-489
        • Bueno M.R.
        • Carvalhosa A.A.C.
        • Castro P.H.S.
        • Pereira K.C.
        • Borges F.T.
        • Estrela C.
        Mesenchymal chondrosarcoma mimicking apical periodontitis.
        J Endod. 2008; 34: 1415-1419
        • Estrela C.
        • Decúrcio D.A.
        • Silva J.A.
        • Mendonça E.F.
        • Estrela C.R.A.
        Persistent apical periodontitis associated with calcifying odontogenic cyst.
        Int Endod J. 2009; 42: 539-545
        • Sapp J.P.
        • Eversole L.R.
        • Wysocki G.P.
        Contemporary oral and maxillofacial pathology.
        2nd ed. Mosby, St Louis2004 (309–10)
        • Regezi J.A.
        • Sciubba J.J.
        • Jordan C.K.
        Oral pathology: clinical pathologic correlations.
        5th ed. Saunders, Philadelphia2008 (166)
        • Quin Z.P.
        • Xin Z.F.
        • Ren L.
        • Liu X.J.
        • Yao S.G.
        • Linyi S.
        Long-term results of intratumorous bleomycin-A5 injection for head and neck lymphangioma.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 86: 139-144
        • Yonetsu K.
        • Nakayama E.
        • Kawazu T.
        • Kanda S.
        • Ozeki S.
        • Shinohara M.
        Value of contrast-enhanced magnetic resonance imaging in differentiation of hemangiomas from lymphangiomas in the oral and maxillofacial region.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 496-500
        • Wegner G.
        Ueber Lymphangiome.
        Arch Klin Chir. 1977; 20: 641
        • Enzinger F.M.
        • Weiss S.W.
        Tumors of lymph vessels.
        in: Gay S.M. Soft tissue tumors. Mosby, St Louis1995: 679-700
        • Marchevsky A.M.
        • Kaneko M.
        Mesenchymal tumor of the mediastinum.
        in: Surgical pathology of the mediastimum. Raven Press, New York1984 (235–8)
        • Miller W.S.
        The lymphatic and lymph flow in the human lung.
        Am Rev Tuberc. 1919; 3: 193-209
        • Moore K.L.
        The cardiovascular system.
        in: Wonsiewicz M. The developing human. Saunders, Philadelphia1988: 325-333
        • Bill A.H.
        • Sumner D.S.
        A unified concept of lymphangioma and cystic hygroma.
        Surg Gynecol Obstet. 1965; 120: 79-86
        • Levine C.
        Primary disorders of the lymphatic vessels: a unified concept.
        J Pediatr Surg. 1989; 24: 233-240
        • Coffin C.M.
        • Dehner L.P.
        • O’Shea P.A.
        Pediatric soft tissue tumors.
        Williams & Wilkins, Philadelphia1997
        • Swank D.W.
        • Hepper N.G.G.
        • Folkert K.E.
        • Colby T.V.
        Intrathoracic lymphangiomatosis mimicking lymphangioleiomatosis in a young woman.
        Mayo Clin Proc. 1989; 64: 1264-1268
        • Gleason T.J.
        • Yuh W.T.
        • Tali E.T.
        • Harris K.G.
        • Mueller D.P.
        Traumatic cervical cyst lymphangioma in adult.
        Ann Otol Rhinol Laryngol. 1993; 102: 564-566
        • Kindblom L.-G.
        • Angervall L.
        Tumors of lymph vessels.
        Contemp Issues Surg Pathol. 1991; 18: 163
        • Fisher I.
        • Orkin M.
        Acquired lymphangioma (lymphangiectasis).
        Arch Dermatol. 1970; 101: 230
        • Flanagan B.P.
        • Helwig E.B.
        Cutaneous lymphangioma.
        Arch Dermatol. 1977; 113: 24
        • Rosenquist G.J.
        • Wolfe D.C.
        Lymphangioma and bone.
        J Bone Joint Surg. 1968; 34A: 158
        • Neville B.W.
        • Damm D.A.
        • Allen C.M.
        • Bouquot J.E.
        Oral and maxillofacial pathology.
        2nd ed. Saunders, Philadelphia2002 (616–8)
        • Bozkaya S.
        • Ugar D.
        • Karaca I.
        • et al.
        The treatment of lymphangioma in the buccal mucosa by radiofrequency ablation: a case report.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: e28-e31