Multimodal imaging features of primary jaw lymphoma: a retrospective analysis of 53 cases

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.