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)

Abstract

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.

Multiple myeloma bone lesions in skeletal remains: Report of two known cases from the 20th century CAL Milano Cemetery Skeletal Collection

“…Osteolytic bone metastases are round to oval with denticulated margins and pitted surrounding bone (Aufderheide & Rodríguez‐Martín, , pp. 388–390; Marks & Hamilton, ; Marques et al, ; Ortner, , pp. 532–537; Ragsdale et al, ; Rothschild et al, ; Strouhal, ; Waldron, , p. 189).…”

“…A table compiling the morphological criteria described in the literature regarding MM lesions (Aufderheide & Rodríguez‐Martín, ; Ortner, ; Rothschild et al, ; Strouhal, , ; Waldron, ) and osteolytic lesions in metastatic carcinoma (Aufderheide & Rodríguez‐Martín, , pp. 388–390; Marks & Hamilton, ; Marques, Santos, & Cunha, ; Ortner, , pp. 532–537; Ragsdale, Campbell, & Kirkpatrick, ; Rothschild et al, ; Strouhal, ; Waldron, , p. 189) was realised for comparison (Table ).…”

Ectopic eruption of a lower permanent molar from the mediaeval necropolis of Alcáçova do Castelo, Mértola, Portugal

“…We can only be certain that it is a distal molar. As outlined by Marques et al (2013) "better a broader diagnosis than a misdiagnosis". Although its aetiology is not always possible to determine, an ectopic molar eruption may be the consequence of local iatrogenic activity (Silva et al, 2007;Wong et al, 2007;Wang et al,2008;Kayal and Jayachandran, 2011;Iglesias-Martin et al, 2012;Shivashankara et al, 2012) The condition can occur in the mandibular condyle, the coronoid process, orbit, palate, nasal cavity, nasal septum, chin and maxillary sinus (Shivashankara et al, 2012).…”

Multiple osteochondromas in a 16th–19th century individual from Setúbal (Portugal)

“…The paleopathological diagnosis entails careful analyses of the morphology and pattern of distribution of the lesions, the age and sex of the individual, and the context from which the specimen was retrieved (Ortner, 2003;Marques et al, 2013).…”