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LETTER TO EDITOR
Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 132-133

Lymphangioma of the tongue presenting as macroglossia


Sudhaa Skin Centre, Jammu, Jammu and Kashmir, India

Date of Web Publication27-Mar-2017

Correspondence Address:
Mrinal Gupta
Sudhaa Skin Centre, 35-A, Lane No-7, Tawi Vihar, Sidhra, Jammu - 180 019, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.203003

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How to cite this article:
Gupta M. Lymphangioma of the tongue presenting as macroglossia. Indian J Paediatr Dermatol 2017;18:132-3

How to cite this URL:
Gupta M. Lymphangioma of the tongue presenting as macroglossia. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Dec 9];18:132-3. Available from: http://www.ijpd.in/text.asp?2017/18/2/132/203003

Sir,

Lymphangiomas are hamartomatous lymphatic malformations which arise due to sequestration of lymphatic tissue at different sites that do not communicate with other lymphatic channels. Majority of lymphangiomas are present at birth, and around 90% are developed before the age of 2 years. Up to 75% of these malformations arise in the head and neck region and are less frequently reported in the oral cavity.[1] In the oral cavity, the most common location is dorsum of the tongue, followed by lips and buccal mucosa. Clinically, they manifest as painless, slowly growing pink or yellow soft tissue masses studded with transparent cystic vesicles.[1],[2]

A 5-year-old male child presented to us with the chief complaint of a progressive mass on the tongue, which according to patient's mother has been present since birth and was smaller; however, since then, it has gradually increased to the present size. Initially, the mass was asymptomatic, but now, the child complains of difficulty in chewing and swallowing. On examination, a well-defined pinkish mass measuring about 3 cm × 3 cm was present on the left side of the dorsal aspect of the tongue, not crossing the midline. The surface of the mass was irregular and was studded with numerous transparent cystic vesicles [Figure 1]. On palpation, growth was soft and nontender. There was a reduction in tongue movements, but no loss of sensory functions was seen.
Figure 1: Well-defined mass seen on dorsal tongue studded with cystic vesicles

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On the basis of history and clinical examination, a diagnosis of lymphangioma of the tongue was made and the patient was advised surgical excision of the mass.

Lymphangioma may be present anywhere but may rarely affect the oral cavity. If tongue is affected, anterior dorsal part of the tongue is the most commonly affected site. Pathognomonic features of lymphangioma of the tongue are irregular nodularity of the surface of the tongue with gray and pink projections forming a pebbly surface that resembles a cluster of translucent vesicles or “frog egg” or tapioca pudding appearance.[2] It may lead to macroglossia with speech disturbances, poor oral hygiene, and bleeding from tongue associated with oral trauma.[3]

Histopathological features of lymphangioma consist of lymphatic vessels with marked dilatations. Endothelial lining is thin, and the spaces consist of proteinaceous fluid and lymphocytes. The lymphatic space contains lymphatic fluid, red blood cells, lymphocytes, macrophages, and neutrophils.

The main objective of the treatment of tongue lymphangiomas is the preservation of the taste sensation and restoration of the tongue size for articulation. The various modalities for lymphangioma are surgical excision, radiation therapy, cryotherapy, electrocautery, sclerotherapy, steroid administration, embolization, and ligation, laser surgery with Nd-YAG, CO2, and radiofrequency tissue ablation technique.[4] Various sclerosing agents have been tried in lymphangiomas such as hypertonic saline, 25% dextrose, sodium morrhuate, tetracycline, doxycycline, ethanol, bleomycin, and OK-432.[4]

Surgical excision is the treatment of choice as lymphangiomas are encapsulated or partially circumscribed. Recurrence is common in lymphangiomas because of its infiltrative nature. A recurrence rate 39% has been reported, and in such recurrent cases, intralesional injections of sclerosing agents can be given preoperatively.[5]

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Mandel L. Parotid area lymphangioma in an adult: Case report. J Oral Maxillofac Surg 2004;62:1320-3.  Back to cited text no. 1
    
2.
Bhayya H, Pavani D, Avinash Tejasvi ML, Geetha P. Oral lymphangioma: A rare case report. Contemp Clin Dent 2015;6:584-7.  Back to cited text no. 2
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3.
Kheur SM, Routray S, Ingale Y, Desai R. Lymphangioma of tongue: A rare entity. Indian J Dent Adv 2011;3:635-7.  Back to cited text no. 3
    
4.
Dogan N, Durmaz CE, Sencimen M, Ucok O, Okcu KM, Gunhan O, et al. The treatment of recurrent lymphangioma in the oral mucosa by cryosurgery. Oral Health Dent Manage Black Sea Count 2010;9:7.  Back to cited text no. 4
    
5.
Orvidas LJ, Kasperbauer JL. Pediatric lymphangiomas of the head and neck. Ann Otol Rhinol Laryngol 2000;109:411-21.  Back to cited text no. 5
    


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