Radiologic and Pathologic Characteristics of Benign and Malignant Lesions of the Mandible

Abstract

Mandibular lesions develop from both odontogenic and nonodontogenic origins and have varying degrees of destructive potential. Common benign cystic lesions include periapical (radicular) cysts, follicular (dentigerous) cysts, and odontogenic keratocysts. Benign solid tumors represent a broad spectrum of lesions such as ameloblastomas, odontomas, ossifying fibromas, and periapical cemental dysplasia. Malignant tumors that often involve the mandible include squamous cell carcinomas, osteosarcomas, and metastatic tumors. In addition, vascular lesions such as hemangiomas and arteriovenous malformations may develop, further expanding the differential diagnosis. Because mandibular lesions have a wide range of pathologic features but similar imaging appearances, familiarity with embryologic characteristics and secondary findings is crucial. Patient age at manifestation, prevalence, location within the mandible, cystic or solid appearance, border contour, and effect of the lesion on adjacent structures are all considerations in making the diagnosis. Despite this information, however, many lesions are impossible to differentiate without biopsy. In such cases, defining the degree of malignant potential is very helpful. Although imaging will not always provide a specific diagnosis, it should help narrow the differential diagnosis, thereby helping to guide patient treatment.

Reliance on Diagnostic Elements in Panoramic Imaging with Focus on Ameloblastoma and Keratocystic Odontogenic Tumor: Psychometric Study

“…finding for AB 3,4,11,16) . Struthers and Shear 13) reported that an AB had a far greater potential for adjacent tooth root resorption than a cystic lesion, which included dentigerous and primordial cysts, which have a similar histopathology to that of odontogenic keratocysts and KOTs.…”

“…In addition, resorption of the roots of adjacent teeth is unique to ABs and indicates an aggressive tumor 3,4,11,16) . On the other hand, the radiographic features of a KOT reveal solitary, uni-or multiloculated lesions, often with daughter cysts that extend to the surrounding bone, and well-defined radiolucent lesions with a smooth or loculated periphery 4,12) . Keratocystic odontogenic tumors can also expand to cortical bone and erode the cortex 4) .…”

“…On the other hand, the radiographic features of a KOT reveal solitary, uni-or multiloculated lesions, often with daughter cysts that extend to the surrounding bone, and well-defined radiolucent lesions with a smooth or loculated periphery 4,12) . Keratocystic odontogenic tumors can also expand to cortical bone and erode the cortex 4) . However, we have yet to identify a definitive difference between these two types of lesion on panoramic radiographs as they both generate similar radiographic findings.…”

Six cases report of differential diagnosis of periapical diseases

“…The main distinction between apical periodontitis and periapical cemental dysplasia is that the necrosis in former is caused by pulpitis, while the latter is caused by a primarily pathological process of cementum [5]. By radiographic examination, the clinical process of the periapical cemental dysplasia was characterized by three different periods including normal alveolus, bone fibrosis and density, and atypical remineralization of bone.…”

Ameloblastic carcinoma of the mandible with metastasis to the skull and lung: advanced imaging appearance including computed tomography, magnetic resonance imaging and positron emission tomography computed tomography

“…3 The differential diagnosis includes benign odontogenic tumours, including ameloblastoma; odontogenic cysts; non-odontogenic cysts; benign non-odontogenic solid lesions, including central giant cell granuloma; malignant odontogenic tumours, including clear cell odontogenic carcinoma; ameloblastic fibrosarcoma; odontogenic carcinoma; odontogenic carcinosarcoma and primary intraosseous carcinoma; and malignant non-odontogenic tumours, including squamous cell carcinoma and metastasis from other primary carcinoma most commonly lung, breast and gastrointestinal tract. 9 Ameloblastic carcinoma and ameloblastoma can have a similar radiographical appearance; however, certain imaging features may aid the diagnostic distinction. Radiographically both lesions can be radiolucent, either unilocular or multilocular, which generally has a honeycomb appearance with tooth root resorption.…”