This document describes various tumors that can occur in the jaws, classified as benign or malignant odontogenic tumors, non-odontogenic tumors, and metastatic tumors. It provides details on location, periphery, internal structure, effects on surrounding structures, imaging features, and differential diagnosis for common tumor types such as ameloblastoma, odontoma, central giant cell granuloma, and osteosarcoma. Radiographic evaluation is important for diagnosis and determining the extent of tumors of the jaws.

1. RADIOGRAPHIC FEATURES OF
TUMORS OF JAWS
Presented by
N.Narmatha
I year pg

2. WHO CLASSIFICATION:
• BENIGN TUMORS
Odontogenic tumors
Odontogenic epithelial tumors
• Ameloblastoma
• Recurrent ameloblastoma
• Calcifying epithelial odontogenic tumor
• Keratocystic odontogenic tumor
Mixed tumors (of odontogenic epithelium and odontogenic ectomesenchyme)
• Odontoma
• Ameloblastic fibroma
• Ameloblastic fibro-odontoma
• Adenomatoid odontogenic tumor
Mesenchymal tumors (odontogenic ectomesenchyme)
• Odontogenic Myxoma
• Benign Cementoblastoma
• Central Odontogenic Fibroma

3. NON ODONTOGENIC TUMORS
Benign tumors of neural origin
• Neurilemmoma
• Neuroma
• Neurofibroma
• Neurofibromatosis
Mesodermal tumors
• Osteoma
• Gardner ’ s Syndrome
• Central Hemangioma
• Arteriovenous Fistula
• Osteoblastoma
• Osteoid Osteoma
• Desmoplastic Fibroma of Bone

4. MALIGNANT TUMORS:
• Squamous Cell Carcinoma Arising in Soft Tissue
• Squamous Cell Carcinoma Originating in Bone
• Squamous Cell Carcinoma Originating in a Cyst
• Central Mucoepidermoid Carcinoma
• Malignant Ameloblastoma and Ameloblastic Carcinoma
• Metastatic Tumors
• Sarcomas
• Malignancies of the Hematopoietic System
• Multiple Myeloma
• Non-Hodgkin’s Lymphoma
• Burkitt’s lymphoma,Leukemia

5. AMELOBLASTOMA (Adamantinoma,adamantoblastoma,adontomes
embryolastiques and epithelial odontoma)
Location
• Molar - ramus region of the mandible, may extend to the symphyseal area.
• Maxilla - third molar area and extend into maxillary sinus and nasal floor.
Originate in an occlusal position to a developing tooth
Periphery
• Well defined and frequently delineated by a cortical border.
• The border is often curved
• Periphery in the maxilla - ill defined

7. INTERNAL STRUCTURE
• Radiolucent to mixed with the presence of bony septa creating internal
compartments.
• Septa can be straight ,more commonly coarse and curved
• Septa remodelled into curved shapes - honeycomb or soap bubble appearance
• Loculations are larger in posterior mandible and smaller in anterior mandible.
• Desmoplastic variety - irregular sclerotic bone

8. Effects on surrounding structures - cause
• Extensive root resorption
• Tooth displacement
An occlusal radiograph - demonstrate cystlike expansion and thinning of an
adjacent cortical plate leaving a thin “ eggshell ” of bone
Computed tomographic (CT) images reveal regions of perforation of the
expanded cortical plate

9. • Unicystic types of ameloblastoma - extreme expansion of the mandibular
ramus, and often the anterior border of the ramus is no longer visible

11. Differential diagnosis:
Odontogenic keratocyst
Giant cell granuloma
Odontogenic myxoma
Ossifying fibroma

12. RECURRENT AMELOBLASTOMA
• Multiple small cyst like structures with very coarse sclerotic cortical margins
• CT imaging - accurately demonstrate the anatomic extent of the tumor
• Detect perforation of the outer cortex and invasion into the surrounding soft
tissues.
• If soft tissue invasion is extensive –
MRI provide superior images of the nature and extent
of the invasion.

13. AMELOBLASTOMA

14. AMELOBLASTOMA

15. CALCIFYING EPITHELIAL ODONTOGENIC TUMOR (Pindborg tumor
and ameloblastoma of unusual type with calcification)
Location:
• Mandible > premolar-molar area > unerupted or impacted tooth
• Reveal radiolucent area around the crown of a mature, unerupted tooth.
Periphery:
• Well defined cyst like cortex.
• May be irregular and ill defined.

16. Internal structure:
• Unilocular or multilocular with numerous
scattered, radiopaque foci
• radiopacities close to the crown of the
embedded tooth
• Small, thin, opaque trabeculae may cross the
radiolucency
Effects on surrounding structures.
• May displace a developing tooth or
prevent its eruption.
• Expansion of the jaw with maintenance of
a cortical boundary

17. ODONTOMA
Compound type - anterior maxilla in association with unerupted canine
Complex odontomas - mandibular first and second molar area.
Periphery:
• Well defined and may be smooth or irregular.
• Cortical border, and soft tissue capsule.

18. Internal structure:
• Radiopaque.
• Compound odontomas have a number of toothlike structures or denticles
that look like deformed teeth
• Complex odontomas contain an irregular mass of calcified tissue

19. Dilated odontoma - single calcified structure with
more radiolucent central portion (donut )
Effects on Surrounding Structures:
• Interfere with normal eruption of teeth.
• Associated with impaction, malpositioning, diastema, aplasia, malformation, and
devitalization of adjacent teeth.
• Large complex odontomas - expansion of the jaw with maintenance of the
cortical boundary.
Differential diagnosis:
Cemto-ossifying fibroma
Periapical cemental dysplasia
Dense bone islands

20. KERATOCYSTIC ODONTOGENIC TUMOR
Location
• Posterior body of the mandible
• Epicenter located superior to the inferior alveolar nerve canal
Periphery and shape
• Show evidence of a cortical border
• Smooth round or oval shape
Internal structure
• Radiolucent
• Curved internal septa - multilocular appearance

21. Effects on surrounding structures
• Propensity to grow along the internal aspect of the jaws - minimal expansion
• Upper ramus and coronoid process - considerable expansion occur
• Displace and resorb teeth (lesser degree)
• Inferior alveolar nerve canal - displaced inferiorly
• Invaginate and occupy the entire maxillary antrum.
Radiological types:
• Extraneous
• Collateral
• Developmental
• Envelopmental

23. Differential diagnosis:
• Dentigerous cyst
• Ameloblastoma
• Simple bone cyst

24. AMELOBLASTIC FIBROMA (Soft odontoma, soft mixed odontoma, mixed
odontogenic tumor, fibroadamantoblastoma, and granular cell ameloblastic
fibroma)
Location:
• Premolar – molar area of the mandible.
• May involve the ramus and extend forward to
the premolar-molar area.
• Common location - crest of the alveolar process
• A follicular relationship with an unerupted tooth
or in area where tooth failed to develop

25. Periphery: well defined and often corticated
Internal structure:
Unilocular (totally radiolucent) > multilocular with indistinct curved septa
Effects on surrounding structures:
• Large lesion - expansion with an intact cortical plate.
• Teeth may be inhibited from normal eruption or
may be displaced in an apical direction.
Differential diagnosis:
• Small dentigerous cyst
• Ameloblastoma
• Giant cell granulomas
• Odontogenic myxomas

26. AMELOBLASTIC FIBRO-ODONTOMA
Location:
• Posterior aspect of the mandible.
• Epicenter - occlusal to a developing tooth or toward the alveolar crest.
Periphery: well defined and sometimes corticated.
Internal Structure: Mixed, majority - radiolucent.
• Small lesions - appear as enlarged follicles with only one or two small
discrete radiopacities.

27. Differential Diagnosis
Complex and compound odontoma
• Larger lesions have more extensive calcified internal structure
• Round shape with a radiopaque enamel-like margin (doughnut.)
• often an associated impacted tooth is present.

28. ADENOMATOID ODONTOGENIC TUMOUR (Adenoameloblastoma and
ameloblastic adenomatoid tumor)
Location:
• Maxilla > incisor- canine-premolar region > cuspid region
• Have follicular relationship with an impacted tooth
• It does not attach at the cementoenamel junction but surrounds a greater part
of the tooth
Periphery: Well-defined corticated or sclerotic border.

29. Internal structure
• Radiopacities in two thirds of cases.
• May be completely radiolucent,
• May contain faint radiopaque foci
• Show dense clusters of ill-defined radiopacities - like cluster of small pebbles
• Intraoral radiographs - demonstrate calcifications

30. Effects on surrounding structures
• Adjacent teeth are displaced.
• Root resorption is rare.
• Inhibit eruption of an involved tooth.
• Some expansion of the jaw may occur - outer cortex is
maintained.
Differential diagnosis
• Follicular cyst
• OKC
• Calcifying odontogenic cysts
• Ameloblastic fibro odontoma
• CEOT

31. ODONTOGENIC MYXOMA (myxoma, myxofibroma, fibromyxoma)
Location
More common in mandible – premolar and molar areas and rare in ramus and
condyle (non – tooth-bearing areas).
Maxilla - alveolar process in the premolar ,molar regions and zygomatic process.
Periphery
Well defined, have corticated margin but
most often poorly defined (maxilla)

32. Internal structure
• Cyst like unilocular outline
• Mixed radiolucent-radiopaque internal pattern.
• Multilocular appearance.
• Characteristic septa - straight, thin-etched septa - tennis racket or stepladder

33. Effects on surrounding structures
• Displaces and loosens teeth but rarely causes resorption of teeth.
• Scallops between the roots of adjacent teeth
• Tendency to grow along the involved bone -- large size is achieved -
considerable expansion

34. Additional Imaging - CT and MRI - establishing the intraosseous extent of tumor
The high tissue signal characteristic of this tumor in T2-weighted magnetic
resonance images - useful in establishing tumor extent and the presence of a
recurrent tumor
Differential Diagnosis
• Ameloblastoma
• Central giant cell granuloma
• Central hemangioma
• Osteogenic sarcomas

35. BENIGN CEMENTOBLASTOMA (Cementoblastoma and true cementoma)
Location
more often in mandible - premolar or first molar
Periphery
well-defined radiopacity with a cortical border and a well-defined radiolucent
band just inside the cortical border.

36. Internal structure
• Mixed radiolucent- radiopaque lesions where the majority is radiopaque.
• Amorphous or may have a wheel spoke pattern
Effects on surrounding structures
• External resorption can be seen.
• Cause expansion of the mandible but with an
intact outer cortex.
Differential diagnosis
• Cemental dysplasia
• Periapical sclerosing osteitis
• Dense bone island
• Hypercementosis

37. CENTRAL ODONTOGENIC FIBROMA(Simple odontogenic fibroma and
odontogenic fibroma)
Location -mandible - molar premolar region > maxilla anterior to the first molar.
Periphery - well defined.
Internal structure
Smaller lesions - unilocular
Larger lesions - multilocular pattern.
Internal septa - fine and straight or it may be granular,
Totally radiolucent

38. Effects on surrounding structures
• Expansion with maintenance of a thin cortical boundary or
• Grow along the bone with minimum expansion
• Tooth displacement and root resorption has been reported.
Differential diagnosis
• Desmoplastic fibromas
• Odontogenic myxoma
• Giant cell granuloma

39. NEURILEMMOMA (schwannoma)
Location
• Mandible
• Located within an expanded inferior alveolar
nerve canal posterior to the mental foramen
Periphery
• Well defined and corticated as it expands the cortical walls of the inferior
alveolar canal.
• Small lesions appear cystlike - fusiform in shape as the tumor expands the
canal.
Internal structure
• Uniformly radiolucent.
• Give a false impression of a multilocular pattern.

40. Effects on surrounding structures
• Cause enlargement of the foramen.
• Expansion of the inferior alveolar canal is slow and thus the outer cortex of the
canal is maintained
• Expansion of the canal is usually localized with a definite epicenter
• Cause root resorption
Differential diagnosis
• Hemangioma
• Arteriovenous fistula

41. NEUROMA(Amputation neuroma and traumatic neuroma)
relate to the extent and shape of the proliferating mass of neural tissue.
Location - mental foramen > anterior maxilla > posterior mandible.
Periphery
well-defined, corticated borders , usually forms in the mandibular canal.
Internal Structure - Totally radiolucent.
Effects on Surrounding Structures
expansion of the inferior alveolar nerve canal
Differential Diagnosis
It is not possible to differentiate this lesion from other benign neural
tumors.

42. NEUROFIBROMA (neurinoma)
Location -Occur in the mandibular canal,
in cancellous bone, and below the periosteum.
Periphery
Sharply defined and may be corticated ,
have indistinct margins.
Internal structure
Unilocular but on occasion may have a
multilocular appearance.
Effects on surrounding structures
Fusiform enlargement of the canal

43. NEUROFIBROMATOSIS (von recklinghausen disease) -Alterations in the
shape of the mandible:
• Enlargement of the coronoid notch
• An obtuse angle between the body and the ramus,
• Deformity of the condylar head,
• Lengthening of the condylar neck,
• Lateral bowing and thinning of the ramus
• Enlargement of the mandibular canal ,
mental and mandibular foramina

44. • Increased incidence of branched mandibular canal.
• Erosive changes to the outer contour of the mandible
• Interference with normal eruption of the molars
• Abnormal accumulations of fatty tissue within deformities of the
mandible have been observed in CT

45. OSTEOMA
Location
• Mandible > maxilla > posterior aspect of the mandible (lingual side of the
ramus) or Inferior mandibular border below the molars
• Condylar and coronoid regions.
• May be exophytic, extending outward into adjacent soft tissues
• Paranasal sinuses(frontal sinus)
Periphery - Well-defined borders.

48. Internal structure
Compact bone – radiopaque
Cancellous bone show evidence of internal trabecular structure
Effects on surrounding structures
Large lesions can displace adjacent soft tissues, such as muscles, and cause
dysfunction.

49. GARDNER’S SYNDROME (familial multiple polyposis)
• Occasionally osteomas may not be present,
• Presence of five or more dense bone islands
• Multiple unerupted supernumerary and permanent teeth in both jaws

50. CENTRAL HEMANGIOMA
Location - Mandible - posterior body, ramus and within the inferior alveolar canal.
Periphery - Well defined and corticated, may be ill defined
Sunray like appearance
Internal structure
• Multilocular appearance - honeycomb pattern
• Inferior alveolar canal involvement - serpiginous shape
- multilocular appearance
• Totally radiolucent.
• When hemangioma involves soft tissue –
phlebolith may occur

51. Effects on surrounding structures
• Roots of teeth - often resorbed or displaced
• Mandibular and mental foramen - enlarged.
• Involved bone - enlarged, have coarse internal trabeculae.
• Developing teeth may be larger and erupt earlier
Further diagnostic imaging - conventional angiography and
magnetic resonance angiography.
Differential diagnosis
Osteogenic sarcoma

52. ARTERIOVENOUS FISTULA
Location - Ramus and retromolar area ,mandibular canal.
Periphery - well defined and corticated.
Internal Structure
Multilocular appearance - radiolucent.
Effects on Surrounding Structures –
well-defined (cyst like) lesions in the bone.
Changes in the inferior alveolar canal
Additional Imaging - CT with contrast injection and magnetic resonance
angiography
Differential Diagnosis
Multilocular lesions

53. ARTERIOVENOUS FISTULA

54. Osteoblastoma(giant osteoid osteoma)
Location - tooth-bearing regions and commonly around the temporomandibular joint
(within the condyle or the temporal bone).
Periphery
• Diffuse or may show some sign of a cortex.
• Soft tissue capsule around the periphery
Internal structure
• Radiolucent
• Calcific material - sunray pattern or fine granular
bone trabeculae.

55. Effects on Surrounding Structures
• Expand bone, but usually a thin outer cortex is maintained.
• Invaginate the maxillary sinus or middle cranial fossa.
Differential Diagnosis
• Osteogenic sarcoma
• Osteoid osteomas
• Cemental dysplasia

56. OSTEOID OSTEOMA
Location
• Cortex of the limb bones
• Body of the mandible
Periphery
well defined by a rim of sclerotic bone
Internal Structure
• young lesions - small ovoid or round radiolucent area (core).
• mature lesions - central radiolucency may have a radiopaque foci

57. Effects on surrounding structures
Stimulate a sclerotic bone reaction and cause thickening of the outer cortex by
stimulating periosteal new bone formation.
Differential diagnosis
Sclerosing osteitis,
Cemento ossifying fibroma,
Beningn cementoblastoma,
Cemental dysplasia

58. DESMOPLASTIC FIBROMA OF BONE (aggressive fibromatosis)
Location
Mandible or maxilla >ramus and posterior mandible.
Periphery
Ill defined and has an invasive characteristic
commonly seen in malignant tumors.
Internal structure
Radiolucent especially when the lesion is small.
Larger lesions - multilocular with very coarse, thick septa- straight or have an
irregular shape

59. • Effects on surrounding structures
• Expand bone and often break through the outer cortex invading the surrounding
soft tissue.
• CT or MRI is required to determine the exact soft tissue extent of the lesion.

60. MALIGNANT DISEASES OF THE JAWS

61. SQUAMOUS CELL CARCINOMAARISING IN SOFT TISSUE
(Epidermoid carcinoma)
Location
• Lateral border of the tongue
• Lip and floor of the mouth
• Attached gingiva and underlying alveolar bone ,tonsils, soft palate, and buccal
vestibule.

62. Periphery and shape
• Erode into underlying bone from any direction - radiolucency - polymorphous
and irregular in outline.
• Invasion - ill-defined, non corticated border
• Rarely, border appear smooth without a cortex
• If bone involvement is extensive - periphery appears to have fingerlike
extensions
• If pathologic fracture occurs - borders show sharpened thinned bone ends
• Sclerosis seen

64. Internal structure
• Totally radiolucent
• Occasionally small islands of residual normal trabecular bone are visible
Effects on surrounding structures
• Widening of the periodontal ligament space with loss of adjacent lamina dura.
• Teeth may appear to float
• Teeth are grossly displaced from their former position.
• Grow along the inferior neurovascular canal and through the mental foramen -
increase in width and loss of the cortical boundary.

65. • Destruction of adjacent normal cortical boundaries such as the floor of the
nose, maxillary sinus or buccal or lingual mandibular plate
• Posterior aspect of the maxilla may also be effaced.
• Inferior border of the mandible - thinned or destroyed.
• Pathologic fracture may occur.
DIFFERENTIAL DIAGNOSIS
• Osteomyelitis

66. Squamous cell carcinoma originating in bone
Location:
Mandible >maxilla >molar region > anterior aspect of the jaws.
Originates only in tooth-bearing parts of the jaw.
Periphery and shape
Ill defined > well defined,rounded or irregular in shape
Internal structure
Radiolucent - very little residual bone left within the center of the lesion.
Small lesions - overlying buccal or lingual plates may cast a shadow that may mimic
the appearance of internal trabecular bone.

67. Effects on surrounding structures
• Destruction of the antral or nasal floors,
• Loss of the cortical outline
• Effacement of the lamina dura.
• Teeth appear to be floating in space.
Differential diagnosis
• Periapical cyst or granulomas
• Odontogenic cysts and tumors

68. SQUAMOUS CELL CARCINOMA ORIGINATING IN A CYST
(Epidermoid cell carcinoma and carcinoma ex odontogenic cyst)
Location
Tooth-bearing portions of the jaws > mandible > anterior maxilla.
Periphery and shape
• Round or ovoid.
• Small lesion – well defined periphery and even corticated.
• Advanced lesion - ill-defined, infiltrative periphery that lacks any cortication.

69. Internal Structure
Radiolucent
Effects on Surrounding Structures
Thinning and destroying the lamina dura of adjacent teeth or adjacent cortical
boundaries - complete destruction of the alveolar process
Differential Diagnosis
• Dental cyst
• Multiple myeloma
• Metastatic disease

70. CENTRAL MUCOEPIDERMOID CARCINOMA (mucoepidermoid carcinoma)
Location
• Maxilla = mandible > premolar and molar region > anterior mandible.
• Above the mandibular canal
Periphery and shape
• Unilocular or multilocular expansile mass
• Well defined and well corticated
Internal structure
• Multilocular - soap bubble or honeycomb internal structure
• Separated by thin or thick cortical septa.

71. Effects on surrounding structures
• Expansion of adjacent normal bony walls
• Buccal and lingual cortical plates, inferior border of the mandible, and
alveolar crest are usually intact - may be thinned and grossly displaced.
• Mandibular canal depressed or pushed laterally or medially
• Teeth remain unaffected - although adjacent lamina dura may be lost.
Differential diagnosis
Ameloblastoma and glandular odontogenic cyst

72. MALIGNANT AMELOBLASTOMAAND AMELOBLASTIC CARCINOMA
Location
Mandible > maxilla >premolar and molar region,
Periphery and shape
Well-defined border with cortication, presence of crenations, or scalloping
of the border
Breaching of the cortical boundary

73. Internal structure
Unilocular or multilocular - honeycomb or
soap-bubble pattern
Septa are robust and thick.
Effects on surrounding structures
• Teeth may be moved bodily, root resorption seen
• Bony borders may be effaced or breached
• Erode the lamina dura and displace normal anatomic boundaries
Differential diagnosis
• Benign ameloblastoma,
• Odontogenic keratocyst, odontogenic myxoma, and central mucoepidermoid
tumor

74. METASTATIC TUMORS
Location
Posterior areas of the jaws > mandible > maxilla > maxillary sinus > anterior hard
palate > mandibular condyle
Lesions of the mandible are bilateral
Periphery and shape
Well demarcated or ill-defined invasive margins
polymorphous in shape.
Internal Structure
Radiolucent
Area of patchy sclerosis - new bone formation

75. Effects on surrounding structures
• Periosteal reaction – spiculated pattern
• Effaces the lamina dura
• Increase in the width of the periodontal ligament space
• Cortices of crypt destroyed.
• Teeth may seem to be floating in a soft tissue mass

76. OSTEOSARCOMA (osteogenic sarcoma)
Location
• Mandible > maxilla > posterior mandible ,tooth-bearing region, angle, and
Vertical ramus, alveolar ridge, antrum, and palate.
• Lesion may cross the midline
Periphery and Shape
• ill-defined border
• radiolucent with no peripheral sclerosis or encapsulation.
• sunray spicules or “ hair-on-end ” trabeculae may be seen
• Codman ’ s triangle

78. Internal structure
• Radiolucent, mixed radiolucent-radiopaque, or quite radiopaque.
• The internal osseous structure may take the appearance of granular- or
sclerotic appearing bone, cotton balls, wisps, or honeycombed internal
structures
• Normal trabecular structure of the jaws is lost.

79. Effects on surrounding structures
• Widening of the periodontal membrane
• Antral or nasal wall cortices may be lost in maxillary lesions.
• Mandible - destroy the cortex of neurovascular canal and adjacent lamina dura
neurovascular canal may be symmetrically widened and enlarged.
Differential diagnosis
• Fibrosarcoma or metastatic carcinoma
• Prostate and breast metastases
• Ossifying fibroma
• fibrous dysplasia
• Ewing ’s sarcoma, solitary plasmacytoma, and even osteomyelitis

80. CHONDROSARCOMA(chondrogenic sarcoma)
Location.
• Mandible = maxilla
• Maxillary lesions - anterior region in areas
• Mandibular lesions - coronoid process, condylar head and neck, symphyseal
region.
Periphery and shape
• Round, ovoid, or lobulated
• Well defined and at times corticated
• Sunray or hair-on-end appearance.
• Aggressive lesions - infiltrative, ill-defined, and noncorticated borders.

81. Internal structure
• Mixed radiolucent radiopaque appearance - motheaten bone
• Central radiopaque structure - flocculent implying snowlike features
• Ground-glass – appearing abnormal bone

82. Effects on surrounding structures
• Grossly expand still maintaining its cortical covering
• Lesions of the condyle cause its expansion -remodeling
• Articular fossa and eminence.
• Widened joint space
• Erosion of the articular fossa
• root resorption and tooth displacement may occur
• Widening of the periodontal membrane space.

83. EWING ’ S SARCOMA(endothelial myeloma and round cell sarcoma)
Location
Mandible > maxillar = posterior areas
Periphery and shape Radiolucency that is poorly demarcated and never corticated,
ragged border
Solitary, cause pathologic fracture with adjacent radiographically visible soft tissue
masses
Round or ovoid

84. Internal structure
Radiolucent.
Effects on surrounding structures
Codman ’ s triangle or sunray or hair-on-end spiculation
Adjacent normal structures effaced.
No root resorption,
Although it does destroy the supporting bone of adjacent teeth.

85. FIBROSARCOMA
Location
Mandible >premolar/molar region.
Periphery and Shape
• Ill-defined borders - ragged
• Poorly demarcated, noncorticated, and lack any semblance of a capsule.
• Radiographic border may underestimate the extent of the tumor because
these lesions typically are infiltrative.
• Soft tissue lesions adjacent to bone - saucerlike depression
• Sclerosis may occur

86. Internal structure
Entirely radiolucent
Less aggressive –residual jawbone or reactive osseous bone formation occurs.
Effects on surrounding structures
The most common effect on adjacent structures is destruction
Codman’s triangle or sunray spiculation
Differential diagnosis
• Central malignancies,
• Metastatic carcinoma,
• Multiple myeloma, and primary or secondary intraosseous carcinoma,
• Dental cyst, chondrosarcoma and osteosarcoma

87. MULTIPLE MYELOMA (Myeloma, plasma cell myeloma, and plasmacytoma)
Location
• mandible > maxilla - posterior body and ramus
Periphery and Shape
• Well defined but not corticated - “ punched out. ”.
• Untreated or aggressive areas of destruction
may become confluent – multilocularity
• Soft tissue lesions- smooth-bordered soft tissue masses
possibly with bone destruction

88. Internal structure
No internal structure
Occasionally islands of residual bone ,appear radiopaque - rare
Effects on surrounding structures
• Teeth may appear “ too opaque ”
• Loses its cortical boundary in whole or in part
• Mandible - thinning of the lower border of the mandible or endosteal scalloping
• Rarely a sunray appearance
Differential diagnosis
Metastatic carcinoma, osteomyelitis, simple bone cysts, brown tumors of
hyperparathyroidism

89. NON-HODGKIN ’ S LYMPHOMA (malignant lymphoma and lymphosarcoma)
Location
Extranodal
Maxillary sinus, posterior mandible, and maxillary regions.
Periphery and shape
• Destruction of the overlying cortex
• Rounded or multiloculated and lack a defining outer cortex
• Borders - ill defined and invasive.
Internal structure
Entirely radiolucent, reactive bone formation,patchy radiopacity - rare.

90. Effects on surrounding structures
• In maxillary sinus - antral walls may be effaced and a soft tissue mass visible
radiographically
• Destroy cortex of the neurovascular canal.
• Grow in the periodontal ligament space of mature teeth
• Laminated or spiculated bone formation.
• MRI - habit of growing along soft tissue spaces and along the surface of bone.
Differential diagnosis
Multiple myeloma and metastatic carcinoma, ewing ’ s sarcoma ,langerhans
histiocytosis, osteolytic osteosarcoma ,central squamous cell carcinomas

91. BURKITT’S LYMPHOMA
Location
African cases may involve one jaw or both the maxilla and mandible
and affect posterior parts of the jaws
Periphery and Shape
• Multiple ill defined noncorticated radiolucencies
• Expansion breaches its outer cortical limits - balloonlike expansion with
thinning of adjacent structures
Internal Structure
radiolucent

92. Effects on surrounding structures
• Displace the developing tooth bud
• Root development ceases.
• Lamina dura destroyed, and
• Cortical boundaries thinned and later destroyed
• May show sunray spiculation – rare
Differential diagnosis
Metastatic neuroblastoma,Ewing’s tumor,Osteolytic osteosarcoma,
cherubism,non-hodgkin’s lymphoma

93. References:
White and pharoah – 6 th edition
Carter RL : Patterns and mechanisms of spread of squamous carcinomas of
the oral cavity , Clin Otolaryngol Allied Sci 15 : 185 - 191 , 1990 .
Casiglia J , Woo SB : A comprehensive review of oral cancer , Gen Dent 49 : 72 -
82 , 2001 .
Marchetta FC , Sako K , Murphy JB : The periosteum of the mandible and
intraoral carcinoma , Am J Surg 122 : 711 - 713 , 1971 .
McGregor AD , MacDonald DG : Routes of entry of squamous