Multimodal imaging features of primary jaw lymphoma: a retrospective analysis of 53 cases.
TL;DR
This is the first study to systematically characterize cortical micro-perforation as a distinctive imaging feature of primary jaw lymphoma, and this finding may help reduce misdiagnosis as an odontogenic infection.
Abstract
Objectives
This study systematically evaluated imaging characteristics of primary jaw lymphoma using multiple modalities to improve diagnostic accuracy and differentiation from other maxillofacial pathoses.
Methods
Fifty-three patients with histopathologically confirmed jaw lymphoma (January 2000-March 2025) were retrospectively reviewed. Clinical data including chief complaints and misdiagnosis history were investigated. Imaging features-lesion location, soft-tissue swelling, cortical destruction pattern, internal structure, and metabolic activity-were assessed using panoramic radiography, CT, MRI, and PET.
Results
Initial misdiagnoses as odontogenic infection or inflammation led to inappropriate treatments in 27 of 53 cases (50.9%). Lesions most commonly involved the maxillary tuberosity (24.5%), with maxillary sinus extension in 74.2% of maxillary cases. Prominent soft-tissue swelling was observed in 50.9%, while severe cortical destruction predominated (61.2%). CT evaluation revealed cortical micro-perforations in 48.9% of cases occurring exclusively within the maxilla-though predominant in only 16.3%. PET imaging commonly demonstrated multi-site involvement with intense FDG uptake comparable to brain activity.
Conclusions
Primary jaw lymphoma demonstrated characteristic features including severe cortical destruction with micro-perforation and prominent soft-tissue swelling. Frequent cortical micro-perforations highlight the importance of careful CT evaluation for subtle cortical breakthrough. Recognition of these features, particularly with non-specific clinical symptoms, may improve early diagnostic suspicion, reduce misdiagnosis as odontogenic infection, and facilitate timely biopsy and management. ADVANCES IN KNOWLEDGE This is the first study to systematically characterize cortical micro-perforation as a distinctive imaging feature of primary jaw lymphoma. This finding may help reduce misdiagnosis as an odontogenic infection.