Comparison of radiologic and gross examination for detection of cancer in defleshed skeletons

Abstract

The reliability of visual examination of defleshed bones was assessed for detection of postcranial metastatic disease in individuals known to have had cancer. This was compared with standard clinical radiologic techniques. The skeletons of 128 diagnosed cancer patients from an early 20th century autopsied skeletal collection (Hamann-Todd Collection) were examined. Radiologic examination detected evidence of metastatic disease in 33 individuals, compared to 11 by visual examination of the postcranial skeletons. Four of these cases were detected by both techniques. Blastic lesions were most commonly overlooked on visual examination, because they were localized to trabecular (internal bone) structures. The ilium was the most commonly affected bone, with lytic or blastic lesions detected in 30 of 33 individuals. While the proximal femur was affected in only nine individuals, x-ray of the proximal femur and ilium detected all individuals with postcranial evidence of metastatic disease. Skeletal distribution of metastases provides no clue to the location of origin or histologic subtype of the cancer. Survey of archeological human remains for metastatic cancer requires radiologic examination. Such skeletal surveys should x-ray at least the ilia and femora.

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

“…The study of ancient human remains recovered from archaeological sites and housed in museums and/or anthropological collections has indirectly enriched this field of research. In agreement with Rothschild and Rothschild (1995), the study of skeletal populations can unlock an important source of International Journal of Osteoarchaeology Int. J. Osteoarchaeol.…”

“…In paleopathology, there is some grade of difficulty in differentiating between secondary tumours, like metastatic carcinoma, and other pathological abnormalities such as primary tumours, haematological disorders, fungal diseases, infectious conditions and Hitiocytosis-X (De la Rú a et al, 1995; Rothschild & Rothschild, 1995).…”

“…Haematological disorders such as leukaemia and multiple myeloma may produce pathological alterations in bone tissue. Leukaemia, a malignant condition of the myeloid and lymphoid blood cells, can develop a pattern of diffuse osteopenia, followed by marked pitting in the metaphyseal surface of bones (Zimmerman & Kelley, 1982;Rothschild & Rothschild, 1995;Rothschild et al, 1997;Aufderheide & Rodríguez-Martín, 1998;Ortner, 2003). In acute leukaemia, the tumour cells can penetrate the periosteum throughout vascular foramina, producing an abnormal proliferation of grooves and pitting in the cortex (Zimmerman & Kelley, 1982).…”

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

“…It may be impossible to determine the source of the primary lesion (Rothschild & Rothschild, 1995;Schinz et al, 1952;Tubiana-Hulin, 1991). However, certain carcinomas do more readily metastasize to bone.…”

The use of the supero-inferior femoral neck diameter as a sex assessor

“…It constitutes the largest skeletal collection with accompanying demographic information in the world (Rothschild and Rothschild, 1995). The individuals in this collection, most of whom are AfricanAmericans and Caucasians born between the years of 1825 and 1910, were assembled by T. Wingate Todd and other anatomists of Western Reserve University between 1910 and 1940.…”