A historical and palaeopathological perspective on cancer.

Cancer is often wrongly considered to be a modern disease in many popular medical venues. Cancers have been known to humanity since ancient times. In fact, its antiquity can be identified through the application of palaeopathological methodologies. The present perspective demonstrates by means of a historical and palaeopathological analysis how oncological manifestations were present long before the emergence of anatomically modern humans and addresses the epidemiological transition from ancient times to the contemporary world. The final section of the article examines breast cancer and its identification in ancient human remains.

Clinical and Anthropological Analyses of a Case From 19th Century South Africa With a Confluence of Uncommon Cranial Pathological Conditions.

This study combines clinical and anthropological analyses to investigate the complex cranial pathology of a South African individual from the 19th century. The cranium was examined macroscopically and radiographically. Conducting a standard differential diagnosis was challenging given the complexity and uncommon nature of the pathology and required drawing on relatively sparse paleopathological and clinical case reports. Multiple conditions were identified including biparietal thinning, basilar invagination, platybasia, and complicated chronic frontal sinusitis, where the intracranial extension of sinus infection may likely have contributed to the individual's death. The authors urge for awareness of these uncommon conditions, as their presence can easily be overlooked or confound skeletal assessments. This clinical study contributes to the authors' understanding of uncommon and poorly described paleopathological diseases and will help to better facilitate their diagnosis in future research. It represents one of the first studies describing such an unusual cooccurrence of uncommon pathologies in an archeological individual.

Protozoan parasites of birds from the Tremembé formation (Oligocene of the Taubaté Basin), São Paulo, Brazil.

OBJECTIVE: To analyze the presence of protozoan parasites in bird coprolites from the Tremembé Formation (Oligocene of the Taubaté Basin). MATERIALS: Twenty avian coprolites embedded in pyrobituminous shale matrices. METHODS: Samples were rehydrated and subjected to spontaneous sedimentation. RESULTS: Paleoparasitological analyses revealed oocysts compatible with the Eimeriidae family (Apicomplexa) and one single Archamoebae (Amoebozoa) cyst. CONCLUSIONS: The present work increases the amount of information about the spread of infections throughout the Cenozoic Era and reveals that the Brazilian paleoavifauna played an important role in the Apicomplexa and Amoebozoa life cycles. SIGNIFICANCE: This is the first record of protozoans in avian coprolites from the Oligocene of Brazil. These findings can help in the interpretation of phylogenies of coccidian parasites of modern birds, as certain taxonomic characters observed in the Oligocene Protozoa characterize monophyletic groups in current molecular phylogenetic analyses. LIMITATIONS: None of the oocysts were sporulated; therefore, it is not possible to identify the morphotypes to genus or species. SUGGESTIONS FOR FURTHER RESEARCH: Our results create new perspectives related to biogeographic studies of the parasitic groups described and may improve the understanding of the temporal amplitude of parasitic evolutionary relationships between Protozoans and birds.

Calcified uterine leiomyoma from an 18th-century nunnery in North Italy.

OBJECTIVE: To develop a differential diagnosis of a mass retrieved alongside skeletal remains in the crypt of the church of Santissima Annunziata of Valenza (Province of Alessandria, Northern Italy). MATERIAL: A calcified mass measuring 40 × 39 mm and 17.62 × 16.3817.62 × 16.38 mm. METHOD: The analysis utilized macroscopic assessment and histologic examination (including histochemical and immunohistochemical analyses). RESULTS: Morphological traits include an irregular and spongy external surface. Holes of different sizes lead toward the inner part of the object. A section of the mass shows an "intertwined bundle" pattern, confirmed by microscopic examination. CONCLUSIONS: Differential diagnosis determined the mass to be consistent with calcified leiomyoma. SIGNIFICANCE: Identifying uterine leiomyoma adds to the paucity of paleopathological literature on the condition and to calcified tumors more broadly. It also allows for an important discussion of women's gynecological health in the past and potentially among nulliparous women. LIMITATIONS: Neither histochemical staining nor immunohistochemical analysis demonstrated the certain muscular nature of the specimens due to the rehydration and decalcification processes, for which there are no gold standards. SUGGESTIONS FOR FURTHER RESEARCH: Calcified masses are common in the clinical literature but remain rare in paleopathological literature. Careful excavation and improved recognition of apparently calcified masses are necessary to improve recognition, diagnosis, and interpretation.

Differential diagnosis for two 'holes in the head' of a child from 982 to 904 BP in northern South America.

OBJECTIVE: To present paleopathological evidence of a congenital anomaly with photographic support and a review that will help scholars to diagnose the condition. MATERIALS: Well-preserved skeletal remains of a child from central Colombia, dated 968-1046 CE. METHODS: Macroscopic examination and computerized axial tomography. RESULTS: Two holes were observed in the skull. CONCLUSIONS: The pathology is consistent with a neural tube defect or an inclusion cyst. SIGNIFICANCE: Neural tube defects and inclusion cysts, in paleopathology, are rarely reported in children. The preservation and origin of the individual make this case valuable. The photographic support and the review is useful for other scholars in the field. LIMITATIONS: It was not possible to determine a single cause. SUGGESTIONS FOR FUTURE RESEARCH: Review cases in identified osteological collections.

Paleopathology of the skull of Santorio Santorio, father of modern clinical experimental physiology.

The University of Padua (Italy) preserves the skull of Santorio Santorio, father of the modern clinical experimental physiology. A recent study performed with modern anthropological methods and medical instruments (CT scan) revealed the presence of a lobular formation in the left temporal bone, with an irregular morphology, internal bone sequestrum, a well-defined non-continuous sclerosis and both internal and external thinning of the cranial plate. Three oval depressions observed in the cranial vault, edentulism and moderate osteoarthritis of the temporomandibular joint were also investigated. The lobular formation was an epidermoid cyst and the oval depressions were the result of other cysts. The edentulism was consistent with some metabolic deficiency or disease, whilst the osteoarthritis appeared to be the result of antemortem tooth loss. This study allowed to investigate a complex and peculiar palaeopathological picture, linked to a piece of the history of the University of Padua.

Del Chamanismo al Galenismo: un acercamiento a la curaduría de la nueva sala permanente del museo de la Academia Nacional de Medicina / From Shamanism to Galenism: an approach to the curatorship of the new permanent room of the museum of the National Academy of Medicine

La nueva sala 'Del Chamanismo Al Galenismo' del Museo Ricardo Rueda González inaugurada en noviembre del año 2022, da inicio al museo con el fin de narrar una historia de la medicina desde el contexto local. Aquí se evidencia la experiencia humana compartida del sufrimiento y la esperanza entendidas como enfermedad y tratamiento que fue representada en el mundo prehispánico, durante la colonia y el en siglo XIX.

The new room 'From Shamanism to Galenism' of the Ricardo Rueda González Museum, inaugurated in November 2022, opens the museum with the aim of narrating a history of medicine from the local context. Here the shared human experience of suffering and hope understood as illness and treatment that was represented in the pre-Hispanic world, during the colony and in the 19th century is evidenced.

Two paleopathological cases suggestive of paralabral cysts of the shoulder.

OBJECTIVE: To undertake differential diagnosis of scapular bone defects found in two medieval skeletons buried in different necropoles of Friuli Venezia Giulia (Italy) and to evaluate the clinical significance of paralabral cysts in the context of shoulder pathology. MATERIALS: Individual JoT36 is an adult male exhumed from a necropolis belonging to a rural agricultural settlement dated to the 10th to 11th century A.D. Individual CIVT58 is an adult male from a Langobard necropolis dated to 630-670 A.D. METHODS: Macroscopic examination of the skeletons was performed using standard osteological methods and review of pertinent clinical literature to assist differential diagnosis. RESULTS: Between the glenoid cavity and the spinoglenoid notch of the right scapula of JoT36 there is a multilocular circular defect adjacent to the glenoid rim. On the neck of the left scapula of CIVT58, immediately above the spinoglenoid notch, there is a unilocular circular depression. In both cases, the cortical bone appears smooth without any evidence of erosion or sclerosis. CONCLUSIONS: Skeletal findings and historical/archaeological contexts of both cases are compatible with the diagnosis of paralabral cysts. SIGNIFICANCE: Paralabral cysts are relatively frequently observed in clinical settings but very few examples have been documented in paleopathological literature. This study seeks to improve recognition and interpretation of this pathology in historical/archaeological contexts. LIMITATIONS: Findings from a case report can neither generate epidemiological information nor be generalized. SUGGESTIONS FOR FURTHER RESEARCH: Identification of new cases may add valuable information about lifestyles and related shoulder pathologies in ancient times.

Osteoma of the zygomatic bone from 16th century Sardinia (Italy) in the framework of a paleoepidemiological study.

OBJECTIVE: The aim of this paper is to evaluate a case of osteoma of the zygomatic bone in a post-medieval individual in the context of a paleoepidemiological approach. MATERIALS: Forty-five skulls from the plague cemetery of Alghero (Sardinia, Italy), dating back to the end of the 16th century, were evaluated for the presence of osteomata on the outer surface of the cranial vault and facial bones. METHODS: Macroscopic examination was performed using standard anthropological methods. The bone presenting the lesion was submitted to radiological examination through cone beam; a 3D reconstruction was obtained with a surface 3D scanner. RESULTS: Only one case of osteoma was observed in an adolescent aged 13-15 years, located on the right zygomatic bone. The lesion consisted of a rounded mass of 0.5 cm in diameter composed of compact bone, as also the radiographic study demonstrates. The prevalence of osteoma on the outer surface of the cranial vault and facial bones in the population of Alghero was 2.2 %. CONCLUSIONS: This case offers the opportunity to enrich the knowledge about the presence of benign tumors among past populations and to evaluate this lesion in dry bone. SIGNIFICANCE: This study provides paleoepidemiological data on the scarce area of benign tumors in paleo-oncology and presents the first documented osteoma of the zygomatic bone in paleopathology. LIMITATION: Histological study was not performed for conservative issues. SUGGESTIONS FOR FUTURE RESEARCH: Increasing the attention to benign tumors is essential to deepen our knowledge about paleoepidemiology of neoplastic lesions.

On some paleopathological examples of amputation and the implications for healthcare in 13th-17th century Lithuania.

OBJECTIVE: To explore care that was likely provided to an adult male amputee from medieval Lithuania, positioning analysis within what is known of contemporary amputation practices. MATERIALS: Three sets of skeletal remains with evidence for amputation, dating to between the 13th-17th centuries AD and recovered during different archaeological excavations in Vilnius, Lithuania. METHODS: Macroscopic inspection of lesions, with additional X-ray analysis of the main subject. The Index of Care was used to investigate possible caregiving. RESULTS: Two individuals experienced amputation of a single element, and the third experienced bilateral hand amputation. Only one individual displayed healing. Historic sources suggest use of amputation for punitive purposes during this period, and judicial punishment is proposed as the most likely reason for amputation in at least two cases. CONCLUSIONS: Evidence of long-term healing in one individual suggests receipt of care. This individual likely relied on family and/or community members for survival immediately following amputation, and subsequently for support in managing disability. SIGNIFICANCE: Successfully combining osteology with history in a framework for analyzing care provision in past Eastern European society, this study underlines the critical importance of context in undertaking bioarchaeology of care analyses. It also adds two examples of perimortem abscissions in this region to the paleopathological record. LIMITATIONS: Our approach relied on skeletal interpretation. Soft tissue was lost to decomposition and no relevant archaeological evidence was found in association with the remains. SUGGESTIONS FOR FURTHER RESEARCH: A review of skeletal collections may allow identification of overlooked cases of amputation (and care).

Demographics and significance of porotic hyperostosis as assessed by surface microscopy.

BACKGROUND: Examination of parietal surface anatomy has been limited because standard techniques have insufficient resolution to identify and characterize the structures of interest. Perspectives derived thereof have not clarified their nature. Surface microscopy is pursued as a nondestructive technique to assess the character and implications of porotic pores (referred to as porotic hyperostosis), which have been subject of much speculation. METHODS: The external surface of the skulls, selected on the basis of age and gender, from the Hamann-Todd human collection are examined by epi-illumination microscopy for surface pores and to assess correlation with age, ethnicity, gender, anemia, infection, cancer, hypertrophic bone disorders, renal disease, and fractures. RESULTS: Pore-like surface defects are present in 2.7%-5% of individuals in the third-fifth decades of life; 7%, in the sixth-eighth; and 25%, in the ninth-11th, but absent in the second decade of life. They are gender and birthdate independent, but slightly more common in African Americans. Fractures are more common among individuals with parietal pores, while tuberculosis, cancer, and hypertrophic bone diseases and anemia are less common. DISCUSSION: This is the first study to actually examine the prevalence of parietal pores as a function of known age, race, and sex and provides a baseline for comparison with populations in which those variables are not clearly identifiable. While some porotic pores may be related to marrow hyperplasia, transcortical circulation may explain the majority.

Paleopathology of Endocranial Lesions: A Possible Case of a Middle Meningeal Artery Aneurysm in an Etruscan Child from Pontecagnano (Southern Italy).

A middle meningeal artery (MMA) aneurysm is a type of intracranial aneurysm that has been rarely documented and is not completely understood in clinical medicine and especially in pediatrics, because juvenile cases have been extremely uncommon. Vascular conditions have occasionally been diagnosed in osteoarchaeological remains, providing evidence of their occurrence in previous eras. In the present report, we have described a lesion that was highly consistent with a case of an MMA aneurysm observed in an Etruscan child, whose remains had been exhumed during archaeological excavations in the necropolis of Pontecagnano (Salerno, southern Italy). The remains date back to the seventh to sixth century BC. Macroscopic and radiological examinations revealed an oval depression in the endocranial area corresponding to the parietal branch of the right MMA. The localized thinning of the bone and the absence of a bone reaction were compatible with a long-lasting compression of vascular origin highly consistent with an MMA aneurysm. Primary malignant bone tumors, bone metastasis, benign neoplastic conditions, and other non-neoplastic conditions, including calvarial venous malformations, eosinophilic granuloma, and sarcoidosis, could be excluded from the differential diagnosis, although the occurrence of other pathologies, such as dural arteriovenous fistulas, could not be rejected. Although it was not possible to definitely establish whether the MMA aneurysm was symptomatic, it could not be ruled out that rupture and subsequent extradural hemorrhage and/or intracranial hemorrhage could have caused the death of the child. From a paleopathological viewpoint, the case illustrated provides an interesting historical perspective on a rare neurovascular disorder that continues to be debated in modern clinical research.

Congenital kyphosis due to a body agenesis from Ancient Egypt.

In Paleopathology, total lack of a vertebral body is a rare finding, mostly due to infectious diseases or tumors. We report the case of an adult male from the necropolis next to "Temple of the Millions of Years" of Thutmose III dated to the Late Old Kingdom and First Intermediate Period (2345-2055 BCE). He showed a fracture of T12, more than 50%, associated with the complete disappearance of the body of L1 and bilateral transverse process. Infection and tumor involvement were ruled out due to the morphology of the spinal segment. The most likely diagnosis was complete body agenesis. Congenital kyphosis related to vertebral agenesis has been described as a possibility in paleopathology, but it had not been reported until now.

A Severe Case of Biparietal Thinning in a Medieval Skull From a Northern Italy Necropolis.

ABSTRACT: This study aims at presenting a case of symmetrical and bilateral thinning observed in a skull belonging to the skeleton of a mature woman from the medieval cemetery of Caravate (north Italy). Macroscopical, radiological, and histological analyses were performed to investigate the condition. The analyses allowed us to detect a progressive loss of both the outer table and the diploe, and the sparing of the inner table. As a controversial condition in the clinical and paleopathological literature, this case poses some difficulties in discussing the differential diagnosis. However, the sex determination, estimation of the age-at-death and different characteristics observed at the level of the postcranial bones, in particular the fractures recorded on different vertebral bodies, allowed us to correlate the biparietal thinning found in this subject to ageing and osteoporosis.

Cranial Surgery in Italy During the Bronze Age.

Skull vault trepanation is a surgical practice that has been found in prehistoric human remains. We carried out a review of the literature on cranial trepanations performed during the Bronze Age in Italy. In total, 19 individuals, most of whom were adult males, with 33 trepanations have been reported, including a new specimen from the Italian Middle Bronze Age (1700-1400 BCE), found at Grotta della Monaca (Calabria). The evidence of cranial trepanations is geographically uneven across Italy, with the highest occurrence in Sardinia. Several trepanation techniques were applied in Italy during this period, where the drilling method was the most common solitary technique utilized. The survival rate of 79.3% in Bronze Age Italy suggests that trepanation was carried out with remarkable success. This analysis gives further insight into ancient human behavior and enhances our knowledge of surgical practices in antiquity, shedding light on the origins of neurosurgery.

Significant Asymmetry of the Bilateral Upper Extremities of a Skeleton Excavated from the Mashiki-Azamabaru Site, Okinawa Island, Japan.

The human skeleton of a young adult male with marked asymmetry of the bilateral upper extremities was excavated from the Mashiki-Azamabaru site (3000-2000 BCE) on the main island of Okinawa in the southwestern archipelago of Japan. The skeleton was buried alone in a corner of the cemetery. In this study, morphological and radiographic observations were made on this skeleton, and the pathogenesis of the bone growth disorder observed in the left upper limb was discussed. The maximum diameter of the midshaft of the humerus was 13.8 mm on the left and 21.2 mm on the right. The long bones comprising the left upper extremity lost the structure of the muscle attachments except for the deltoid tubercle of the humerus. The bone morphology of the right upper extremity and the bilateral lower extremities was maintained and was close to the mean value of females from the Ohtomo site in northwestern Kyushu, Japan, during the Yayoi period. It is assumed that the anomalous bone morphology confined to the left upper extremity was secondary to the prolonged loss of function of the muscles attached to left extremity bones. In this case, birth palsy, brachial plexus injury in childhood, and acute grey matter myelitis were diagnosed. It was suggested that this person had survived into young adulthood with severe paralysis of the left upper extremity due to injury or disease at an early age.

Trepanations in the ancient Greek colony of Akanthos: Skull surgery in the light of Hippocratic medicine.

OBJECTIVE: The study presents seven new cases of trepanations on four individuals from the ancient Greek colony of Akanthos (5th - 1st c. BC) and juxtaposes the paleopathological observations with the Hippocratic treatises. MATERIALS: A meta-analysis of 42 published trepanations on 27 individuals from Greece. METHODS: Trepanations from Akanthos were observed macroscopically, stereoscopically and by computer tomography. The meta-analysis considers the demographic, geographical and temporal distribution, the techniques, associated pathology, and survival rate. RESULTS: Trepanations were observed on four females in Akanthos. Three trepanations were performed with scraping and four with drilling. Two individuals exhibited significant signs of healing, and two survived shortly after the operation. In two cases, trepanation was practiced for treating cranial injuries. In Greek antiquity trepanation was performed predominantly in males, principally as a surgical treatment of cranial injuries. The survival rate was 62.9 %. Scraping was the oldest, most frequent and successful technique. CONCLUSIONS: Trepanation performed systematically in Greece since the Bronze Age (ca. 2,000 BC). Hippocrates who rationally conceived medicine, codified the pre-existing empirical knowledge. The trepanations from Akanthos show technical similarities but also discrepancies from the Hippocratic recommendations, confirming the mental and technical readiness of the ancient surgeon. SIGNIFICANCE: The synchronous to Hippocrates trepanations from Akanthos, provide the opportunity to compare physical evidence with the written sources. LIMITATIONS: The frequency of trepanations is affected by the representativeness and the state of the skeletal preservation. SUGGESTIONS FOR FUTURE RESEARCH: Trepanations published in previous decades, need to be reassessed with new imaging modalities. A standard recording methodology is fundamental for data comparison.

A critical review of the anthropological and paleopathological literature on osteopetrosis as an ancient rare disease (ARD).

OBJECTIVE: A reappraisal of the available evidence of osteopetrosis in the archaeological record as first step in promoting new approaches to rare diseases in paleopathology. MATERIALS AND METHODS: Three different approaches are combined: a survey of the last 50 years of bioarchaeological publications; an online search addressing six of the more widely used search engines; macroscopic and radiographic analyses of the human remains from the Neolithic site of Palata 2 (Italy). RESULTS: The combined results of the literature survey and the online search identified six cases of osteopetrosis. The majority of search hits place this disease into differential diagnoses. The investigation of the remains from Palata 2, one of the six cases in literature, indicates a non-specific sclerosis of the cranial vault. CONCLUSIONS: Of the six cases of osteopetrosis, only two, one of the autosomal-recessive type (ARO) and one of the autosomal-dominant type (ADO), are supported by direct osteoarchaeological evidence. Therefore, inaccurate differential diagnoses generate an inflated number of cases in the paleopathological record. SIGNIFICANCE: This reappraisal calls for a more informed and evidence-based approach to osteopetrosis and, more generally, to rare diseases in paleopathology. LIMITATIONS: Lack of specific publications on osteopetrosis; more case studies may be present in "gray literature". SUGGESTIONS FOR FURTHER RESEARCH: Cases of osteopetrosis from archaeological and historical collections as well as medical literature are needed to increase knowledge about this rare disease. More precise differential diagnoses are required, particularly when dealing with rare diseases.

Estudio anatómico de la hiperostosis porótica en órbitas oculares: cribra orbitalia en la población arqueológica de Tutuquén, región del Maule, Chile / Anatomical study of porotic hyperostosis in the eye orbits: cribra orbitalia in the archaeological population of Tutuquén, Maule region, Chile

RESUMEN: La cribra orbitalia o hiperostosis porótica del techo orbitario es considerada una manifestación ósea microperforativa de condiciones patológicas hematológicas, especialmente la anemia ferropénica. Este hallazgo, se enmarca de manera casi exclusiva a estudios en poblaciones arqueológicas. El propósito de este estudio fue describir la expresión de cribra orbitalia en una población arqueológica de Chile central. Restos óseos de 32 individuos fueron analizados, los cuales fueron obtenidos de la población del Monumento Arqueológico Cementerio Tutuquén, los que están depositados en el Museo Regional de Rancagua. En cada una de la muestras incluidas, se evaluaron períodos de datación, sexo, rango etáreo, presencia v/s ausencia de cribra orbitalia y en los casos en que ésta estuvo presente, se determinó su intensidad mediante visión directa con lente de aumento. Un 59,38 % de los individuos presentó cribra orbitalia. De éstos, 26,32 % fueron de sexo femenino, 31,58 % de sexo masculino y 42,10 % indeterminado. De los individuos del período 10.000 AP, 33,33 % presentó cribra orbitalia; de los individuos del período 7.000 AP un 50 % y de los individuos pertenecientes al período 1.000 AP, un 68,4 %. Al clasificar la severidad de la cribra orbitalia se observó que 31,57 % de los individuos presentaron Cribra orbitalia tipo I; 36,84 % tipo II; 10,52 % tipo III; 10,52 % tipo IV y 10,52 % tipo V. Los datos aportados complementarán el conocimiento morfopatológico de la órbita ocular humana desde el estudio de poblaciones arqueológicas.

SUMMARY: The cribra orbitalia or porotic hyperostosis of the orbital roof is considered a microperforative bone manifestation of hematological pathological conditions, especially iron deficiency anemia. This finding is almost exclusively part of studies in archaeological populations. The purpose of this study was to describe the expression of cribra orbitalia in an archaeological population of central Chile. Bone remains of 32 individuals were analyzed, which were obtained from the population of the Tutuquén Cemetery Archaeological Monument, which are deposited in the Regional Museum of Rancagua. In each of the included samples, dating periods, sex, age range, presence v / s absence of cribra orbitalia were evaluated and in the cases in which it was present, its intensity was determined by direct vision with a magnifying lens. The 59.38 % of the individuals presented cribra orbitalia. Of these, 26.32 % were female, 31.58 % male, and 42.10 % undetermined. Of the individuals in the period 10,000 BP, 33.33 % presented cribra orbitalia; of the individuals of the period 7,000 AP, 50% and of the individuals belonging to the period 1,000 AP, 68.4 %. When classifying the severity of the cribra orbitalia, it was observed that 31.57 % of the individuals had type I; 36.84 % type II; 10.52 % type III; 10.52 % type IV and 10.52 % type V. The data provided will complement the morpho-pathological knowledge of the human eye orbit from the study of archaeological populations.