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Lymphangioma of the tongue

Pía López Jornet MD, DDS, PhD Oral Medicine, University of Murcia.

Abstract

Lymphangioma is a benign, harmatomatous tumour of lymphatic vessels with a marked predilection for the head and neck region The aim of this report was to document a rare case of lymphangioma of the tongue .

Key words :Cystic hygroma, Lymphangioma, Macroglossia

Lymphangioma is a benign, harmatomatous tumour of lymphatic vessels with a marked predilection for the head and neck region . Oral lesions are most frequently found on the tongue and usually demonstrate a pebbly appearance as by their superficial location. Occurrence in other areas such as cheeks, lips, floor of the mouth, palate and gingiva has been reported ( 1-3).

The aim of this report was to document a rare case of lymphangioma of the tongue

The patient was an 1-year-old girl referred to the Oral Diagnostic Clinic, with macroglossia .The patient having any systemic diseases. Her parents informed us that her tongue lesion had been present since around the time of birth. On oral examination, we noted a slightly reddened, enlarged tongue with multifocal, pebbly, vesicle-like lesions on the tip, dorsal and lateral surfaces (Fig. 1 & 2).

The colour of the lesions ranged from yellow to purple. Clinically, lymphangioma of the oral cavity are rather characteristic. Usually, the lesions present superficially as a pebbly, vesicle-like feature with so-called ‘frog-egg’ or ‘tapioca-pudding’ appearance (1). If located deeper, lymphangioma may present as a submucosal mass (2). According to the size of the vessels, this lesion may be classified into lymphangioma simplex (capillary lymphangioma), cavernous lymphangioma, and cystic lymphangioma (cystic hygroma) (1) .It is an important cause of macroglossia in children and the clinical differential diagnosis include vascular malformation, hemangioma, neurofibroma, teratoma, lingual thyroid, dermoid cyst, thyroglossal duct cyst, heterotopic gastric mucosal cyst, and granular cell tumour , Down’s syndrome (4).

Treatment of lymphangioma is surgical excision. However, some clinicians do not recommend treatment for non-enlarging lymphangioma of the tongue because of the difficulty in removal and the high recurrence rate (1). Where treatment is elective, another factor for consideration is the level of cooperation of patients, especially in younger children. When treatment is indicated, particularly in cases with potential upper airway obstruction, laser surgery has been useful as this approach allows blood vessels to be sealed during surgery (1,2). Treatment using sclerosing agents is ineffective, probably as a result of the discontinuous basement membrane of the lymphatic vessels (3)

References

1.Neville BW, Damm DD, Allen CM, Bouquot JE: Soft Tissue Tumors (2002). In Oral and Maxillofacial pathology 2nd edition. Edited by: Neville BW. Philadelphia: W.B. Saunders; 475-7.

2.Brennan TD, Miller AS, Chen SY (1997) Lymphangiomas of the oral cavity: a clinicopathologic, immunohistochemical, and electron- microscopic study. J Oral Maxillofac Surg 55:932-5.

3.Motahhary P, Sarrafpour B , Abdirad A (2006) Bilateral symmetrical lymphangiomas of the gingiva: case report. Diagnostic Pathology 1: 1596-9.

4.Nanda S, Reddy BS, Nigam S (2003 Painless sessile swellings on the tongue of a 7-year-old boy.Pediatr Dermatol 20:361-3.

Correspondence

P. López Jornet

Clínica Odontológica Universitaria

Hospital Morales Meseguer

Adv. Marques de los velez s/n

Murcia 30008

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