Is Unresolved Inflammatory Angiogenesis a Mechanism for the Delayed Development of Skeletal Lesions in Syphilis?

A recently described case of putative early tertiary syphilis in a young adult male from 6th century Anglo‐Saxon England exhibits a distinctive endocranial pathology. A case–control study using both clinical and archaeological materials was performed to investigate a possible association of the pathology with syphilis. Scanning electron microscopy and microcomputed tomography were used to image the syphilitic case and normal cranial material. Although the pathology does seem to have an association with syphilis (OR = 13.14), the sample size is small, and the authors caution against overinterpretation of the results. The study confirms observations by other authors suggesting the lesion has some association with a range of pathological conditions. Any association with syphilis seems to be restricted to the early tertiary stages and is possibly absent in the later stages of the disease. The morphological differences present in the samples observed by scanning electron microscopy and microcomputed tomography illustrate the abnormal nature of the vascularity within the syphilitic cranium. The widespread presence of similar lesions within other tubular bones leads the authors to propose hypothesis that unresolved angiogenesis is the underlying mechanism behind the skeletal changes in tertiary syphilis. This angiogenic model accounts for several diverse characteristics in the progression of skeletal disease resulting from infection by spirochetes of the Treponema pallidum family. Copyright © 2012 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.