BACKGROUND: Primary non-Hodgkin lymphoma (NHL) of the jaws is a rare malignancy often clinically and radiographically mimicking odontogenic or inflammatory conditions, leading to delayed diagnosis. Because imaging findings are frequently nonspecific, recognition of characteristic radiographic patterns may facilitate earlier diagnostic suspicion and appropriate biopsy-based investigation. This study evaluated cone-beam computed tomography (CBCT) imaging characteristics of primary NHL of the maxilla and mandible in patients with histopathologically confirmed disease and no initial suspicion of malignancy.

CASE REPORT: Six patients with histopathologically confirmed primary NHL of the jaws were retrospectively analyzed. Clinical findings and medical histories were reviewed. CBCT images were evaluated for lesion location, border definition, internal architecture, and effects on adjacent anatomical regions. Diagnosis was established by biopsy, with histopathological and/or immunohistochemical confirmation. Most patients had unremarkable medical history. Common findings included paresthesia, tooth mobility, and facial swelling. Mandible was more frequently affected than maxilla. All lesions appeared as osteolytic areas with ill-defined and/or moth-eaten borders, causing cortical destruction and infiltration into adjacent structures. Involvement of the mandibular canal was observed in mandibular cases, whereas maxillary cases demonstrated extension into the maxillary sinus or nasal cavity. Floating teeth and/or spiked-tooth appearance were identified in several cases, reflecting aggressive disease.

CONCLUSIONS: Primary NHL of the jaws demonstrates nonspecific but aggressive radiographic features on CBCT that may overlap with odontogenic and inflammatory conditions. However, a recurring pattern characterized by ill-defined osteolysis, cortical involvement, and floating-teeth or spiked-tooth appearance should raise suspicion for malignancy. Recognizing these imaging features may support timely biopsy-oriented evaluation and histopathological confirmation, particularly when clinical and radiographic findings are atypical for routine odontogenic disease.

Keywords: Cone-Beam Computed Tomography, Jaw, Lymphoma, Non-Hodgkin