lymphangiomas have marked predilection for the head and neck region [ 50 - 70% ] . about half of the lesions are noted at birth and around 90% develop by 2 years of age . small lymphangiomas , less than 1 cm , occur on the alveolar ridge , with 2:1 male to female distribution . the prognosis is good for most patients , although large tumors of neck / tongue may result in airway obstruction and death . a 7-year - old female child reported with multiple papular lesions on the anterior two - thirds of the dorsum and ventral surface of tongue [ figures 1 and 2 ] . the lesions were present from birth , she had feeding difficulty in early days , and bleeding occurred frequently . an incisional biopsy was taken and histopathological examination revealed numerous endothelial lined small lymphatic channels containing lymph tissue . extravasated red blood cells were noticed [ figure 3 ] . clinical photograph showing papular lesions on tongue clinical photograph showing papular lesions on tongue photomicrograph showing endothelial lined lymphatic channels filled with lymph [ h & e stain ] a 32-year - old female patient reported to our department with a swelling on the right lateral dorsum of the tongue , which she noticed a few months back . there was bleeding occasionally from the swelling . on examination , a 3 cm  2 cm nodular mass with papillary lesions , with slight change in the surface texture , was noticed on the middle one - third of the right lateral dorsum of the tongue [ figures 4 and 5 ] . incisional biopsy was performed , and the histopathology showed endothelium - lined lymphatic channels filled with lymph , below the epithelium . clinical photograph showing papular lesions on tongue clinical photograph showing papular lesions on tongue with macroglossia photomicrograph showing endothelial - lined lymphatic channels filled with lymph [ h and e stain ] an 8-year - old male child reported with bleeding from an enlarged tongue . on examination , multiple papular lesions were noticed on the anterior two - thirds of the dorsum of the tongue . a few blood - filled papules were seen , and the rest of the lesion had the same color as the adjacent mucosa [ figure 7 ] . incisional biopsy was done , and histopathological examination showed multiple intertwining lymph vessels in a loose fibrovascular stroma [ figure 8 ] . clinical photograph showing papular lesions on tongue with macroglossia photomicrograph showing endothelial - lined vessels filled with lymph and a 7-year - old female child reported with multiple papular lesions on the anterior two - thirds of the dorsum and ventral surface of tongue [ figures 1 and 2 ] . the lesions were present from birth , she had feeding difficulty in early days , and bleeding occurred frequently . an incisional biopsy was taken and histopathological examination revealed numerous endothelial lined small lymphatic channels containing lymph tissue . extravasated red blood cells were noticed [ figure 3 ] . clinical photograph showing papular lesions on tongue clinical photograph showing papular lesions on tongue photomicrograph showing endothelial lined lymphatic channels filled with lymph [ h & e stain ] a 32-year - old female patient reported to our department with a swelling on the right lateral dorsum of the tongue , which she noticed a few months back . there was bleeding occasionally from the swelling . on examination , a 3 cm  2 cm nodular mass with papillary lesions , with slight change in the surface texture , was noticed on the middle one - third of the right lateral dorsum of the tongue [ figures 4 and 5 ] . incisional biopsy was performed , and the histopathology showed endothelium - lined lymphatic channels filled with lymph , below the epithelium . clinical photograph showing papular lesions on tongue clinical photograph showing papular lesions on tongue with macroglossia photomicrograph showing endothelial - lined lymphatic channels filled with lymph [ h and e stain ] an 8-year - old male child reported with bleeding from an enlarged tongue . on examination , multiple papular lesions were noticed on the anterior two - thirds of the dorsum of the tongue . a few blood - filled papules were seen , and the rest of the lesion had the same color as the adjacent mucosa [ figure 7 ] . incisional biopsy was done , and histopathological examination showed multiple intertwining lymph vessels in a loose fibrovascular stroma [ figure 8 ] . clinical photograph showing papular lesions on tongue with macroglossia photomicrograph showing endothelial - lined vessels filled with lymph and they represent developmental malformations that arise from sequestrations of lymphatic tissue that do not communicate normally with the rest of the lymphatic system . three types , a ] lymphangioma simplex ( capillary lymphangioma ) , b ] cavernous lymphangioma , and c ] cystic lymphangioma ( cystic hygroma ) ] , have been described . oral lymphangiomas may occur at various sites but are more frequent in the anterior two - thirds of the tongue , where they often result in macroglossia . usually , the tumor is superficial in location and demonstrates a pebbly surface , resembling a cluster of translucent vesicles . the superficial lesions are manifested as papillary lesions , which may be of the same color as the surrounding mucosa or of a slightly reddish hue . the deeper lesions appear as diffuse nodules or masses without any significant change in surface texture or color . irregular nodularity of the surface of the tongue with gray and pink projections and macroglossia is the pathognomonic feature of lymphangioma of the tongue . small lymphangiomas , less than 1 cm , occur on the alveolar ridge , with 2:1 male to female distribution . the vessels often diffusely infiltrate the adjacent soft tissues and demonstrate lymphoid aggregates in their walls . the lymphatic spaces contain lymphatic fluid , red blood cells , lymphocytes , macrophages , and neutrophils . surrounding connective tissue stroma consists of loose fibrotic tissue with a number of inflammatory cells . the capillary lymphangioma consists of small capillary - sized vessels , cavernous lymphangioma consists larger dilated lymph channels , and cystic lymphangioma exhibits large macroscopic cystic spaces . more often , all sizes of vessels may be found within the same lesion . in the intraoral lymphangiomas , surgical excision is the treatment of choice . because of the non - encapsulated and  infiltrating  nature of the lymphangioma , complete removal is difficult , and hence recurrence is common .