title: Nonendodontic lesions misdiagnosed as apical periodontitis lesions: series of case reports and review of literature.
abstract: BACKGROUND
  This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source.
  
  
  METHODS
  A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain.
  
  
  RESULTS
  The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings.
  
  
  CONCLUSIONS
  Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.
authors: João de Barros Barreto University Hospital, Belém, Pará, Brazil.
authors: Flavia
authors: F
authors: Sirotheau Corrêa Pontes
authors: Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.
authors: Felipe
authors: F
authors: Paiva Fonseca
authors: João de Barros Barreto University Hospital, Belém, Pará, Brazil.
authors: Adriana
authors: A
authors: Souza de Jesus
authors: João de Barros Barreto University Hospital, Belém, Pará, Brazil.
authors: Ana Carolina
authors: AC
authors: Garcia Alves
authors: João de Barros Barreto University Hospital, Belém, Pará, Brazil.
authors: Leila
authors: L
authors: Marques Araújo
authors: João de Barros Barreto University Hospital, Belém, Pará, Brazil.
authors: Liliane
authors: L
authors: Silva do Nascimento
authors: João de Barros Barreto University Hospital, Belém, Pará, Brazil. Electronic address: harp@ufpa.br.
authors: Hélder Antônio
authors: HA
authors: Rebelo Pontes
mesh_terms: D000293:Adolescent; D000328:Adult; D000564:Ameloblastoma / Q000175:diagnosis; D018277:Carcinoma, Mucoepidermoid / Q000175:diagnosis; D002485:Cementoma / Q000175:diagnosis; D003788:Dental Pulp Diseases / Q000175:diagnosis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007570:Jaw Cysts / Q000175:diagnosis; D007571:Jaw Diseases / Q000175:diagnosis; D007573:Jaw Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000175:diagnosis; D009631:Nonodontogenic Cysts / Q000175:diagnosis; D009808:Odontogenic Tumors / Q000175:diagnosis; D010484:Periapical Granuloma / Q000175:diagnosis; D010485:Periapical Periodontitis / Q000175:diagnosis*
keywords: Apical periodontitis; endodontic lesions; misdiagnosis; neoplasia mimicking apical periodontitis; periapical lesion