Secondary cancer in an Anglo-Saxon female

A mature/elderly female skeleton from the Anglo-Saxon cemetery at Eccles, Kent, is described. A diagnosis of Paget's disease of the left tibia is made. The macroscopic radiological features of perforating and non-perforating osteolytic lesions in the cranium and femora are described. The differential diagnosis is discussed. The lesions are considered to be due to metastatic carcinoma, possibly from a primary carcinoma of the breast. There is a brief resumé of other recorded examples of metastatic carcinoma in early skeletons.     

Skeletal metastatic carcinoma: A case from 15th–20th century Coimbra,Portugal

This paper discusses the differential diagnosis of unusual and distinct pathological changes in the skeletal remains of a 40+‐year‐old female from 15th–20th century Coimbra (Portugal). The most affected area seems to have been the skull, but multiple lesions, lytic and/or blastic, have been found throughout the post‐cranial skeleton, more specifically in the scapulae, clavicles, humerus, sternum, ribs, sacrum, innominates and femurs. The differential diagnosis of the lesions gave rise to several possible pathological conditions, namely, Langerhans cell histiocytosis (granulomatosis or Histiocytosis X), multiple myeloma and metastatic carcinoma. Various macroscopic and radiological aspects lead us to consider metastatic carcinoma as the most probable diagnosis. Despite the argumentative identity of the possible primary lesion, age, sex and the mixed nature of the osseous response are consistent with cancer of the breast but do not exclude other carcinomas, namely lung cancer. With temporal and regional differences emerging in the frequency of malignant tumours, the identification of new cases becomes important, particularly from geographic areas where few cases have been reported. In fact, the present report adds to the only case of metastatic carcinoma detected in non‐identified Portuguese human skeletal remains until now. Copyright © 2009 John Wiley & Sons, Ltd.     

A possible case of metastatic carcinoma in a middle Sican burial from Batán Grande,Perú

The skeleton of a young to middle-aged adult excavated at the base of the Pre-Incaic pyramid of Huaca Las Ventanas, northern coast of Peru, shows an osteoplastic formation on the fifth lumbar vertebra compatible with a diagnosis of metastatic carcinoma, possibly from the prostate gland.     

A case of metastatic carcinoma from 18th century London

In 1999 the AOC Archaeology Group excavated the cemetery of All Hallows by the Tower, London, UK, prior to redevelopment. The majority of the burials are post‐medieval, dating from circa 1776 to 1835. Skeleton (4105) was buried with a lead coffin plate. The data on the coffin plate revealed that the skeleton was that of Ann Sumpter, who died aged 31 years on the 25 May 1794. The skeleton displays pathology that is indicative of a metastatic carcinoma. A precise diagnosis is not possible, but given the individual is female it is statistically most likely the secondaries have originated from a breast or lung tumour. Breast tumours are thought to have been more common than lung tumours in the past, and therefore the most probable diagnosis is a breast carcinoma. Copyright © 2006 John Wiley & Sons, Ltd.     

Metastatic carcinoma in a 14th–19th century skeleton from Constância (Portugal)

During 2002, the extensive archaeological excavations of the ancient Constância necropolis (Centre of Portugal), dated from 14th–19th centuries, resulted in the exhumation of 151 individuals. Among the several paleopathological cases, a middle‐aged female skeleton with osteolytic lesions in her skull, axial skeleton, upper limbs and femurs was observed. These pathological findings are characterised by an asymmetric pattern with osteolytic focus of distinct size and irregular shape. Some skeletal elements display both osteolytic and osteoblastic lesions. The latter exhibit deposition of fine layers of woven bone. Lesions were observed macroscopically and radiology was used as a complementary method of scrutiny, especially in cases of unclear observation. The case was diagnosed as that of a probable metastatic carcinoma due to the multifocal distribution of the lesions in areas of intense haematopoietic activity, their morphology and some osteoblastic responses, as well as the presence of pathological fractures in the ribs. The skeleton's sex and age at death are in agreement with the proposed diagnostic, constituting the first case of malignant carcinoma detected in non‐identified Portuguese human skeletal remains. Copyright © 2009 John Wiley & Sons, Ltd.     

A Case of Osteosarcoma in a Late Medieval–Early Modern Skull from Kyjov (Czech Republic)

After the reconstruction of the original parish church of the Moravian town of Kyjov in the latter part of the seventeenth century, human skeletal remains from the disturbed graves of the surrounding cemetery were gathered in a vault which was partially excavated in 1994. Among disarticulated bones of at least 106 individuals, a fragmented skull of a young male was found, with a massive outgrowth of bone on the right parietal, originally continuing fluently on the non-preserved frontal scale, on edges lifting the outer lamina. The inner lamina was covered less intensively by the bony growth. Radiography and CT scans showed a non-homogeneous structure, the inside being irregular and the outside granulated or radially striated. A metastatic lytic focus was detected in the same bone. Histology and SEM examination showed an uneven mineralization of the bone tissue, consisting of rough, thickened and irregularly spaced trabeculae, with cellular remains or mineralized matrix on the surface. The differential diagnosis took meningioma into consideration but the most probable diagnosis was osteogenic sarcoma, which is still infrequent in the palaeopathological record from the Old World and its localization in the cranial vault is very rare. © 1997 by John Wiley & Sons, Ltd.     

A nineteenth-century case of carcinoma of the prostate,with a note on the early history of the disease

A case of prostatic carcinoma is described in the skeleton of a named individual who died in 1834. The tumour was recognized from widespread periosteal new bone throughout the skeleton and by the presence of sclerosing metastases in many bones, including the pelvis and all the vertebrae. A number of features of the disease present here are said to be uncommon in modern patients, including spiculated periosteal new bone and some degree of spinal stenosis. In two previous cases of prostatic carcinoma described in the literature, periosteal new bone was a prominent feature and was probably responsible for the disease being recognized. It is likely that if skeletons from mature males were routinely X-rayed, considerably more cases would be noted and a more accurate estimate of the prevalence of this disease in the past would thus be ascertained. © 1997 John Wiley & Sons, Ltd.     

Neolithic case of metastasizing carcinoma: Multiple approaches to differential diagnosis

The remains of the fragmented skeleton of a mature male individual from a Neolithic mass burial (ca. 5000 years BP) are presented. The lesions consist of osteoblastic proliferation and replacement of previously normal haematopoietic tissue. The most affected area seems to have been the iliac blade. So-called ‘seeding’ of tumour tissue has been found in different loci in the femoral neck, sacrum, L4 and scapula. Differential diagnosis points to metastatic carcinoma, most likely from the prostrate gland. In order to support the observations, radiological and histological analyses have been performed. Trace element analyses of tumour and control samples have shown the limited contribution of these data to ascertain the aetiology of secondary neoplasias in buried material.     

Metastatic carcinoma in a leper skeleton from a Medieval cemetery in Chichester England

Both leprosy and metastatic cancer are well documented in the literature on human skeletal palaeopathology. The manifestation of both pathological conditions in a single archaeological skeleton has not been reported. A case from a Medieval site in Chichester, England exhibits bone lesions and patterns of skeletal involvement indicative of both these diseases. Evidence of leprosy is largely restricted to the lower tibiae, fibulae and the bones of the feet. Fine destructive foci and reactive fibre bone associated with metastatic cancer are distributed in many of the remaining areas of the skeleton. There is minimal overlap in the areas of the skeleton involved in the two pathological processes.     

A probable case of metastatic carcinoma from the late prehistoric eastern Tennessee River Valley

There are few described cases of metastatic carcinoma from the prehistoric eastern United States and none primarily differentially diagnosed from the southeast. A mature adult female exhibiting several large lytic cranial lesions suggestive of neoplastic disease was identified in a late prehistoric Mississippian Period (AD 1200–1600) context. Burial 371 is from Ledford Island, a Mouse Creek phase (AD 1400–1500) site from the Chickamauga Reservoir of southeastern Tennessee. It is the only case in this reservoir (total adult n = 843). The radiographs of the otherwise asymptomatic postcranium yielded radiolucencies in both proximal femora, both medial clavicles, the sternum, the surviving humeral metaphysis and fragmentary innominate. The locations are all consistent with metastasized carcinoma. The identity of the possible primary lesion is argumentative. Age, sex and the mixed nature of the osseous response are consistent with carcinoma of the breast but not to the exclusion of bronchogenic, thyroid, or kidney cancers. Copyright © 2002 John Wiley & Sons, Ltd.     

Streitfragen über Kernenergie

Abstract

Despite significant improvement of cytostatic treatment results in certain cancer types during the past years, the final outcome in common solid neoplasms remains unsatisfactory. Findings of clinical studies dealing with combination chemotherapy of metastatic breast cancer which involved almost 10 000 patients were reviewed. No significant improvement in the overall survival times (average 18 months after the start of therapy) was found in this selected group of patients who were treated with intensive palliative chemotherapy. Recently, increased efforts have been undertaken to identify new, active cytostatics in suitable preclinical systems. Promising results from experimental studies carried out during the last 3 years are presented. HECNU, a new water-soluble nitrosourea, has shown significant activity in brain tumours. Steroid-hormone-linked nitrosoureas have been found to be superior to conventional nitrosoureas in experimental mammary carcinoma. In this model, alkylphosphocholines exhibited outstanding therapeutic activity and a completely novel toxicity profile. 4-amino-N-(2′-aminophenyl) benzamide has proved effective in the treatment of slow-growing tumours. Tumour-inhibiting complex compounds with ruthenium or titanium as central metals have shown significant activity in colorectal carcinoma. Osteogenic tumours were treated effectively with razoxane or cisplatin-linked phosphonates. Some of the compounds mentioned are undergoing clinical trials.     

CT and micro‐CT analysis of a case of Paget's disease (osteitis deformans) in the Grant skeletal collection

This paper presents a case study in which Paget's disease of bone is differentially diagnosed in an individual from the Grant skeletal collection using non‐destructive computed tomography (CT) and micro‐computed tomography (micro‐CT) analyses of the pubis, in addition to plain film radiography and macroscopic examination. In archaeological and modern osteological samples diagnosis frequently relies on macroscopic examination, plain film radiography and histological examination of bone samples. CT and micro‐CT modalities provide researchers with a non‐destructive view of the internal structure of bone unhampered by the superimposition that is characteristic of plain film radiographs. Given the importance of the increased cortical and trabecular thickness in the differential diagnosis of Paget's disease, these techniques are ideal means by which to non‐destructively examine culturally‐sensitive and scientifically‐valuable human remains for signs of Paget's disease of bone. Copyright © 2009 John Wiley & Sons, Ltd.     

Bone reactions on a pliocene cetacean rib indicate short‐term survival of predation event

There is little osteological evidence of non‐lethal predation events in the archaeological or vertebrate paleontological record. A small section of Pliocene cetacean rib collected from the Yorktown Formation within the PCS Phosphate Mine (formerly Lee Creek Mine), Aurora, North Carolina, U.S.A., shows evidence of this kind of trophic interaction. In this case study, we offer a diagnosis of bone traumatic pathology in which three bone‐forming lesions on the partial rib are interpreted as the reaction to a bite inflicted by a macro‐predator, the first such report from a marine environment. In addition to the three well‐defined lesions, a thin layer of woven bone covers much of the remaining cortical bone. The combination of the three bone‐forming lesions and the thin layer of woven bone suggest the presence of an inflammatory process almost certainly caused by infection secondary to the trauma. Survival following the traumatic event was probably less than 6 weeks. The Neogene chondrichthyan fauna from this locality preserves several large predators, including Carcharocles megalodon, Carcharodon carcharias, Isurus xiphidon and Parotodus benedeni, which were all capable, at least in terms of their size, of having bitten the cetacean. Although most of the odontocetes known from the Yorktown Formation were too small to have inflicted this wound, some of the physeterids may have been large enough to have caused the lesions on the partial rib. This evidence of predation in Pliocene whale bone raises the possibility of similar lesions being found in whale bone recovered from archaeological sites. Copyright © 2010 John Wiley & Sons, Ltd.     

FOCUS: Bone Needles in Mallorcan Prehistory: a Reappraisal

A review of bone needles from the Mallorcan earliest prehistory is presented. They are not artifacts, but actually represent natural items, identified as Myotragus balearicus fibular diaphysis. The corpus fibulae ofM. balearicus is here illustrated by first time. Archaeological and paleontological implications of this diagnosis are discussed in this paper.     

Skeletal Manifestations of Skin Ulcer in the Lower Leg

Skin ulcers of the lower leg are known to cause both destructive and, more commonly, bone‐forming lesions. Typically, bone‐forming lesions in this disorder have clearly defined margins although there may be extensive reactive bone formation involving much or all of the adjacent diaphysis. These lesions are best described in patients from tropical areas, and in these environmental contexts, these are known as tropical ulcers, but leg ulcers can be caused by a variety of diseases and conditions, of which vascular insufficiency plays an important role among the elderly. The lesions are important clinically because of the disability associated with the ulcer and because of complications that can develop including osteomyelitis and cancer. In most cases, the bone lesions caused by ulcer are easily diagnosed in archaeological human skeletal remains and provide some insight into the prevalence of this disorder in antiquity. In this paper, we review the gross and radiological manifestations of bone lesions resulting from overlying skin ulcer in tibiae of 13 cases including archaeological and modern medically documented skeletons. In two of the cases, there is medical documentation regarding the presence of a chronic ulcer on the lower leg. The objectives of this paper were to explore the diversity of bone lesions associated with ulcers of the tibia and to provide an improved basis for the diagnosis of this disorder in human skeletal remains. Copyright © 2011 John Wiley & Sons, Ltd.     

A procedural guide to metacarpal radiogrammetry in archaeology

The technique of metacarpal radiogrammetry was devised in 1960 as a clinical method to aid in the identification of thinned cortical bone, which may help in diagnosis of osteoporosis. Through taking measurements from radiographs, calculations of the amount of cortical bone can be made. The technique is relatively simple and is not destructive. This paper examines the value of the application of this technique to archaeological remains. A standardized methodology of bone assessment is incorporated to enhance the comparability of future research. Statistical tests demonstrate that the technique is robust, as the position of the bone on the film, radiographic enlargement and use of either the left or right metacarpal will not affect the results obtained. However, differences in film type and measurement position can introduce unacceptable variance into the results. Therefore, guidance is given on future applications of the technique. The technique does have value as a widely available, non‐destructive technique for assessing cortical bone loss and the probable prevalence of osteoporosis in archaeological collections. Copyright © 2004 John Wiley & Sons, Ltd.     

Better a Broader Diagnosis Than a Misdiagnosis: The Study of a Neoplastic Condition in a Male Individual who Died in Early 20th Century (Coimbra,Portugal)

The paleopathological record of neoplastic conditions in the past is considered scarce. The detection of tumours in ancient populations is hindered by the quality and quantity of signs visible on the skeleton, the methodological approach, the preservation of remains, and by difficulties of differential diagnosis. The aims of this paper are to report the extensive and multiple osteolytic lesions observed in an adult male and to discuss the possible etiology of these lesions. The individual, a 71‐year‐old male who died in 1932, is part of the Coimbra Identified Skeletal Collection. Records indicate that he died of a ‘heart lesion’. The present study used macroscopic, radiological, and computerized tomography examinations to analyse the skeletal remains of the individual number 439. The type and pattern of the lesions detected, which were most prominent on the skull, were compared with both clinical and paleopathological diagnostic criteria for different nosologic groups. The differential diagnosis addresses problems expressed both in clinical and in paleopathological literature with regard to the difficulties in distinguishing metastatic tumours from multiple myeloma. The nature of the lesions represented by this individual precludes an exact diagnosis. Therefore, we employed a broader category, neoplastic condition, instead of choosing a more specific diagnosis that would likely have resulted in a misdiagnosis due to overlapping features on this individual's condition. Further investigations are necessary to establish more replicable indicators and to improve confidence in retrospective diagnosis of these types of conditions. Copyright © 2011 John Wiley & Sons, Ltd.     

High performance liquid chromatography (HPLC) in the investigation of gout in palaeopathology

Gout is a disease caused by the abnormal accumulation of uric acid in the body, which can result in sodium urate crystals forming tophi at joints, with associated erosion of bone and cartilage. Only two examples of tophi have been reported from archaeological individuals, and the diagnosis of gout based on dry bone manifestations can be difficult. This paper presents preliminary results of a new technique to aid the diagnosis of gout in palaeopathology, namely high performance liquid chromatography (HPLC). Five archaeological skeletons with suspected gout (diagnosed using visual and radiological analysis) and three controls were analysed. Two of the gouty individuals had a white powder in their erosive lesions. HPLC showed the presence of uric acid in bone in four of the five individuals with evidence of gouty arthritis and was negative for uric acid in bone from the three controls. The white powder was also positive for uric acid. With reliance on the presence of articular erosions, cases of gout will be missed in archaeological human bone. HPLC measurement of uric acid could prove useful in the differential diagnosis of erosive arthropathy in archaeology. It may also be useful in identifying individuals with an increased body pool of uric acid, linked to conditions included in the term ‘metabolic syndrome’. As a result, HPLC uric acid measurement also has the potential to provide additional information on health and lifestyle in past communities. Copyright © 2008 John Wiley & Sons, Ltd.     

A case of healing spinal infection from classical Rome

This paper describes a spinal infection in an adult male skeleton from Ist century AD necropolis in Rome. Pathological alterations of the lower thoracic vertebrae, including bone destruction and fusion, suggest tuberculous spondylitis as the most probable diagnosis. The rarity of healing infections, as well as the non‐diagnostic appearance of the lesions, have prompted this note. Copyright © 2005 John Wiley & Sons, Ltd.