title: Lymphangioma mimicking apical periodontitis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Sciences, Federal University of Goiás, Goiânia, GO, Brazil. cleomarrodrigues@hotmail.com
authors.forename: Cleomar Donizeth
authors.initials: CD
authors.lastname: Rodrigues
authors.forename: Máximo Joaquim Calvo
authors.initials: MJ
authors.lastname: Villar-Neto
authors.forename: Ana Paula Veras
authors.initials: AP
authors.lastname: Sobral
authors.forename: Márcia Maria Fonseca
authors.initials: MM
authors.lastname: Da Silveira
authors.forename: Luciano Barreto
authors.initials: LB
authors.lastname: Silva
authors.forename: Carlos
authors.initials: C
authors.lastname: Estrela
mesh_terms: D000369:Aged, 80 and over; D000539:Alveolar Process / Q000000981:diagnostic imaging / Q000473:pathology*; D054893:Cone-Beam Computed Tomography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008202:Lymphangioma / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008334:Mandible; D010483:Periapical Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D010485:Periapical Periodontitis / Q000000981:diagnostic imaging / Q000473:pathology*