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

Abstract

Multiple myeloma (MM) is of special interest in anthropology, in particular in the differential diagnosis with metastatic carcinoma. In this paper, we present two cases of known MM and discuss the criteria for diagnosis in comparison with the literature. Two skeletons from the identified CAL Milano Cemetery Skeletal Collection were selected for the antemortem clinical diagnosis of MM in their associated medical data. Each lesion observed during the anthropological analysis was reported and considered. Lesions were observed in both cases in the pelvis, sacrum, ribs, vertebrae, scapulae, proximal ends of femora and humeri as well as in the skull. Moreover, they presented similar morphological traits. Consequently, lesions in MM are multifocal, round, lytic, sharply demarcated, relatively uniformly small, and specifically located in highly vascularized areas of the skeleton. These results are consistent with data from the literature and strengthen the criteria for diagnosis of the condition.

A probable case of multiple myeloma from Bronze Age China

“…Macroscopic and radiographic assessments indicate that the disease process in this individual is characterized by osteolytic activity, with no evidence of new bone formation. The distribution of the observed lesions is similar to that of some types of neoplastic disease, as these conditions can produce widespread lytic lesions (Biehler-Gomez et al, 2019;Rothschild and Rothschild, 1995). There are, however, a suite of conditions that can mimic one another.…”

“…These lesions are typically uniformly small to medium-sized (5 mm to 2 cm in diameter) and are circular or ovoid in shape, with well-defined margins and no evidence of osteoblastic response of surrounding bone. Multiple lesions may coalesce (Biehler-Gomez et al, 2019). Lesions can be located anywhere in the skeleton but are most commonly found on the cranium, ribs, ossa coxae, and vertebrae (Borggrefe et al, 2015).…”

“…Some research has suggested that vertebral lesions in multiple myeloma are restricted to the vertebral bodies and are not found on the neural arches, whereas neural arch lesions are commonly seen in metastatic carcinoma (Jacobson et al, 1958). However, a recent study on clinically diagnosed individuals with multiple myeloma has shown that osteolytic lesions can be present on the vertebral neural arches (Biehler-Gomez et al, 2019).…”

Mercury poisoning in two patients with tertiary syphilis from the Ca’ Granda hospital (17th‐century Milan)

“…Bone lesions in leukaemia present as diffuse superficial solitary pits (Rothschild et al, 1997). Multiple myeloma and metastatic carcinoma predominantly affect individuals over 40 years of age, with bone lesions emerging within the diploe and progressing toward the external and internal tables (Biehler‐Gomez et al, 2019a, 2019b; Biehler‐Gomez & Cattaneo, 2021; Ortner, 2003; Strouhal, 1991). In the present case, destructive bone changes showed an inward progression.…”

Dingoes, companions in life and death: The significance of archaeological canid burial practices in Australia

“…This plasma cell disorder is rare both in humans and dogs, but produces numerous conspicuous lytic lesions of relatively regular size in the bone surface and marrow, typically without associated new bone formation or peripheral bone reactions as seen in other potentially similar-presenting cancers [110,112]. Multiple myeloma lesions are thus feasibly identifiable via differential diagnosis in archaeological specimens [112][113][114]. In dogs, it is significantly more frequently diagnosed in older animals and in non-neutered males [115], with an average age at diagnosis between 8 and 12 years old [116] but with cases recorded as young as 4 years old [117].…”