Leukemia and lymphoma mimicking periapical conditions resulting in endodontic treatment: a systematic review.

Introduction: Leukemia and lymphoma mimicking periapical conditions can lead to significant diagnostic pitfalls. Guidance for endodontists in managing such cases is barely explored. This systematic review aimed to summarize the clinicopathological, imaging, and management aspects of leukemia/lymphoma that mimicked periapical conditions and resulted in endodontic treatment.

Methods: Searches were conducted in PubMed, Embase, Scopus, Web of Science, and LILACS, supplemented by manual scrutiny and gray literature. Case reports and/or case series were included. Critical appraisal of the studies was performed using the Joanna Briggs Institute tool.

Results: Among 3,617 identified records, 32 studies involving 37 individuals (mean age 43.6 years; male-to-female ratio 1.2:1) were included. Diffuse large B-cell lymphoma was diagnosed in 21 (56.8%) individuals. The anterior maxilla and posterior mandible were the most frequently affected sites (29.7% each). Radiographically, 97.3% of the lesions exhibited radiolucency in the periapical region. Endodontic treatment preceded the diagnosis of leukemia/lymphoma in 94.6% of cases, while retreatment occurred in 5.4%. The mean time to final diagnosis was 4.9 months.

Conclusion: Leukemia and lymphoma can be misdiagnosed as periapical conditions, leading to inappropriate endodontic treatments and delayed diagnoses. Endodontists should become familiar with the broad clinicoradiographic spectrum of these rare, but potentially life-threatening hematolymphoid malignancies.