Typical radiological

features of tumors and

tumor-like lesions
Dr. Fahed Habash
Important causes of tumours (swellings) of
the jaws:

 Cysts, predominantly odontogenic cysts.

 Odontogenic tumours.
 Giant cell lesions.
 Fibro-osseous lesions.
 Primary (nonodontogenic) neoplasm of bone.
 Metastatic neoplasm.
Important types of odontogenic tumours:

 Benign epithelial neoplasms:

• Ameloblastoma.
• Adenomatoid odontogenic tumour.
• Calcifying epithelial odontogenic tumour.
• Calcifying (ghost cell) odontogenic cyst.
• Squamous odontogenic tumour.
 Benign mixed epithelial and connective tissue
neoplasms:
• Ameloblastic fibroma.

 Benign connective tissue:

• Odontogenic fibroma.
• Odontogenic myxoma.
• Cementoblastoma.

 Hamartomas:
• Odontomas.
 Malignant epithelial neoplasms:
• Odontogenic carcinomas.

 Malignant connective tissue:

• Odontogenic sarcomas.
ameloblastoma

 Neoplasm of odontogenic epithelium.

 The most common odontogenic neoplasm
but 1% of all oral tumors.
 Usually presents between ages 30 & 50.
 80% occur in the mandible, 70% arise in
the molar region and ascending ramus.
 Locally invasive but does not metastasise.
 Typically asymptomatic and appears as a
multilocular cyst radiographically.
 As the tumor enlarge the patient may become
aware of a gradually increasing facial
deformity and expansion of jaw-bone.
 Treated by excision with a margin of normal
tissue.
Radiographic features of
ameloblastoma
Shape:
Multilocular, distinct septa dividing the lesion
into compartment with large areas centrally
and with smaller areas on the periphery.
Occasionally monolocular (unicytic
ameloblastoma) in early stages.
Sometimes the radiographic appearance can
be described as soap-bubble appearance.
 Outline : smooth and scalloped
 Well defined
 Well corticated
 Radiolucent with internal radiopaque septa.
 Effect : adjacent teeth displaced, loosened, often
resorbed.
 Extensive expansion in all dimentions.
 Maxillary lesions can extend into the paranasal
sinuses, orbit or base of the skull.
Unicystic ameloblastoma
 10-15% of ameloblastoma
 It usually presents as a monolocular
radiolucency associated with the crown of an
unerupted lower third molar, resembling a
dentigerous cyst, or as a monolocular
radiolucency at the apices of the teeth,
resembling a radicular cyst.
 So we need always formulating a radiological
differential diagnosis.
 Ameloblastic fibroma:

 Rare.
 Benign mixed epithelial and connective tissue
neoplasm.
 Neoplasm of both odontogenic epithelium
and mesenchyme.
 Usually seen in children or young adult.
 They are slow-growing and usually
asymptomatic, but expand the jaw.
 Radiogragraphically these tumors resemble
ameloblastomas but develop in younger age
group.
Radiographical appearance of
ameloblastic fibroma
Site: mandible and rarely in maxilla (premolar-
molar region).
Shape: Multilocular
Monolocular in early stages
Outline :
Smooth, well defined and well corticated.
Radiolucent with internal radiopaque septa if
multilocular.
Effect
 Adjacent teeth displaced

 Buccal/ lingual expansion of the jaw.

 Could be associated with unerupted tooth.

Adentenomatoid odontogenic tumour:
 Rare.
 Origin, odontogenic epithelium.
 Usually present between 15 & 20.
 Most common in the anterior maxilla.
 Often appears radiographically as a unilocular
dentigerous cyst.
 Is often associated with unerupted tooth which may
simulate a dentigerous cyst.
 However, as the lesion matures, small opacities
(snowflakes) within the central radiolucency may be
seen peripherally.
 Adjacent teeth are often displaced as the lesion
expands but are rarely resorbed.
Calcifying epithelial odontogenic tumour:

 Rare neoplasm of odontogenic epithelium.

 Usually presents between ages 30 & 50.
 Often termed pindborg tumor.
 The typical site is post part of mandible (premolar-
molar region).
 They are often associated with uneruptrd teeth.
 Locally invasive but does not metastasise.
 Radiographs show a translucent area with poorly
defined margin, usually increasing radiopacities
within the tumor as it matures.
 Adjacent teeth can be either displaced and /or
resorbed.
Calcifying odontogenic cysts (Gorlin cyst):

 Rare lesion, it is now classified by WHO as an

odontogenic tumor.
a neoplasm of odontogenic epithelium.
 Wide age range.
 usually found in the mandible and occasionally
associated with odontome or unerupted tooth.
 Radiographically well defined unilocular radiolucent
lesion and often undistinguishable from non-neoplastic
jaw cyst.
 As the lesions matures, a variable amount of calcified
material, of tooth-like density, becomes evident
scattered throughout the radiolucency.
 Calcification in the cyst wall may suggest the
diagnosis.
 Odontogenic Myxoma and fibroma:

 Rare.
 These very similar non-invasive tumors originate from the
odontogenic connective tissue of the developing tooth germ
which produce either excessive collgen (fibroma) or excessive
ground substance(myxoma).
 Usually seen in young adults.
 Form a multilocular, (soap-bubble radiolucency). Occasionally
monolocular, smooth and often scalloped, well defined with
variable cortication.
 Most common site is posterior mandible. Sometimes posterior
maxilla.
 Effect = adjacent teeth displaced , extensive buccal and lingual
expansion.
Radiolucent non-odontogenic
tumors
 Central haemangioma
 Intrinsic primary malignant bone tumors
(osteosarcoma,fibrosarcoma and chondrosarcoma)
 Extrinsic primary malignant tumors involving bone
(squamous cell carcinoma)
 Secondary bone tumors
 Lymphoreticular tumors of bone (multiple myeloma,
langerhans cell disease)
 Giant cell lesions
 Fibro-osseous lesions.
Central haemangioma
 This is a rare, benign lesion that occasionally
affect the jaws, particularly mandible.
 Developmental malformation of the blood
vessels in the marrow spaces, rather than a
true neoplasm.
 Usually discovered in adolescents.
 Life threatening nature of the lesion with a
very variable radiographic appearance,