ROSALBA CIRANNI,1* MAURA CASTAGNA,2
ABSTRACT: Goiter is still a frequent pathological condition of the thyroid gland. Goiter consists of an enlargement of the gland caused by several physiopathologic events, the most important of which is deficient intake of iodine. A series of eighteenth-century mummies housed in the church of Santa Maria della Grazia in Comiso includes one individual showing a pathological condition, with a very large swelling in the antero-inferior region of the neck. X-rays showed small scattered radiopaque foci. Routine histology showed a large number of circular follicles immersed in fibrous tissue. Finally, immunohistochemistry revealed a strong reactivity for thyroglobulin. The data confirmed the nature of the tissue as thyroid, and the macroscopic diagnosis is that of thyroid goiter.
The mummy described in this study is one of 50 mummified individuals housed in the mortuary chapel called the Chapel of the Dead annexed to the church of Santa Maria della Grazia in Comiso (Sicily) at the beginning of the eighteenth century. The individuals are almost all males of different ages, varying from young to old adult, who died in the eighteenth century and the first half of the nineteenth century. The majority are Capuchin friars, and the others are laymen belonging to the third order of the Capuchins. The former are housed in the right wall and the latter in the left wall of the chapel (Fig. 1). Twenty mummies are la-beled with the individual's name and date of death, which ranges between 1742 and 1838 (Amadei and Fornaciari, 1996).
All the mummies were found lying in slanting niches of the chapel. They were removed, catalogued, undressed, and submit-ted to autopsy. The first macroscopic survey showed several kinds of pathology, such as atherosclerosis, splenomegaly, pulmonary fi-brosis, and acariasis. In particular, the indi-vidual labeled CM 5 showed an enormous enlargement in the antero-inferior region of the neck at the level of the thyroid gland (Fig. 2).
For us to confirm the thyroid nature of the enlargement, after X-ray some fragments of the specimen were rehydrated, paraffin-embedded, and processed for hematoxylin-eosin and Van Gieson staining. Finally, immunohisto-chemistry was performed to reveal the presence of thyroglobulin. Immunohistochemistry has successfully been employed in a number of paleopathological studies, demonstrating that antigenic properties in ancient tissues are preserved and that preservation is related to different mummification processes and body storage conditions (Krypczyk and Tapp, 1986; Fulcheri and Rabino Massa, 1986; Fornaciari and Marchetti, 1986; Fornaciari et al., 1989).BACKGROUND
MATERIALS AND METHODS
The CM 5 mummy belonged to an anony-mous adult male, 1.60 m tall, aged 25 ± 10 years (Todd, 1920; Miles, 1963), wearing linen monastic clothes. The partially preserved soft tissues of the arms, legs, hands, thorax, and abdomen showed a dark yellow skin. The head and feet were almost completely skeletonized, and the mummy had no hair.
At autopsy, the abdomen and thorax cavities were void of recognizable organs but full of different kinds of materials, such as leaves, fragments of clothes, and paper, evidently introduced there by mice.
The antero-inferior region of the neck showed a very large and well-mummified round subcutaneous tumefaction of the soft tissues (6x4x1 cm) very close to the thyroid cartilage. The organs of the neck were very well preserved, and it was possible to identify easily the larynx, the trachea, and the esophagus, which were macroscopically regular.
The aim of this study is to establish the tissue nature of the CM 5 neck tumefaction. The dimension and acidophily of the circular formations detected inside the fibrous tissue by Van Gieson staining, their content with homogeneous PAS-positive colloid-like material, and finally their strong and specific immunoreactivity for the thyroglobulin anti-body clearly demonstrated the thyroid nature of the specimen and the colloid composition of the inside material. The calcifications are due to long-standing hemorrhage since goiter frequently shows regressive phenomena such us hemorrhages, necrosis, or scarring that can explain the presence of dystrophic calcified areas. All the data support the diagnosis of macronodular goiter.
Goiter represents one of the mechanisms by which the gland can compensate for a low intake of iodine or for disorders of iodine biosynthesis. Goiter occurs in endemic or sporadic form. The endemic form occurs mainly in those areas characterized by a low dietary intake of iodine (Andes, Alps, Hima-layas); dietary goitrogens such as thiocyanates, fluorides, and calcium may also contribute to endemic goiter. Sporadic goiter is less common than the endemic form, but the mechanisms are not well understood. In both forms, during the early stages, histology is characterized by hypertrophy and hyperplasia of the follicular epithelium, with scant colloid. Later changes show accumulation of colloid and atrophy of the follicular epithelium. A marked secondary enlargement of the gland follows the massive colloid accumulation and is designated as colloid goiter (Cotran et al., 1994).
The available data do not allow us to establish whether goiter was endemic or not in the area of Comiso. Studies on the contem-porary population show no significant occur-rences and, in any case, did not employ appropriate epidemiological methods. In con-trast, the areas of northern and eastern Sicily are very well studied and documented for endemic goiter (Vigneri, 1988; Regalbuto et al., 1996), which suggests that the'disease was uncommon or absent in the area of Comiso. Since the results obtained in our laboratory clearly demonstrate the thyroid nature of the tumefaction and its colloid composition, it is possible to form some reasonable hypotheses regarding the CM 5 case.
Inside the chapel, the CM 5 mummified body was housed in the right wall, which was reserved only for friars, whereas laymen were buried in the left wall. Owing to the friars' habit of often moving away from their birthplaces in the course of their lives, it can be hypothesized that the CM 5 friar came from Sicilian areas outside Comiso where goiter occurs today. The friar likely suffered from the endemic form of disease (Vigneri, personal communication). However, other hypotheses, including the sporadic form of the disease, although less probable, cannot be excluded (Cotran et al., 1994).
A review of paleopathological literature has shown few cases of well-mummified thyroids. Three cases have been reported by Zimmerman, two during his study of the human remains from Nebwenenef's Egyptian tomb (1983) and one from an Eskimo mummy (Zimmerman and Smith, 1975). Fulcheri and Rabino Massa (1986), who investigated the preservation of antigenic properties on mummified tissues by immunohistochemistry, found that only one out of three suspect thyroid samples from Predynastic, Dynastic, and Paleochristian mummies were positive for thyroglobulin antibody. As yet, only one case of thyroid disease, recorded and described on the basis of autopsy, has been found in a Peruvian female mummy dated around 94 BC (Gerszten et al., 1976).
In this case, the sex, age, and presence of a marked atherosclerosis supported the diagnosis of hypothyroidism. In the case of Comiso, a similar diagnosis appears to be more difficult because of the absence of typical skeletal features. Furthermore, the sex and the geographical area of the burial were unable to help in the diagnosis. Only modern biomedical techniques have made it possible to diagnose a case of goiter.
We thank Professor Riccardo Vigneri (Gi-useppe Garibaldi Hospital, University of Catania) for his advice and Mrs. Rosetta Biondi, Mrs. Lucia Cosci, Mr. Marcello Gam-bini, and Mr. Federico Soldani (Santa Chiara Hospital, University of Pisa).
Amadei A, Fornaciari G. 1996. Le mummie della Chiesa di Santa Maria della Grazia in Comiso, Ragusa (XVIII-XLX secolo): dati antropologici, paleodemografici e paleonutrizionali. Archivio per l'Antropologia e la Etnologia 125:141-163.
Todd TW. 1920. Age changes in the pubic bone: I. The male white pubis. Am J Phys Anthropol 3:285-334.
* Correspondence to: Rosalba Ciranni, Department of Oncology, University of Pisa, via Roma, 57, 56126 Pisa, Italy. E-mail: firstname.lastname@example.org
Fig. 1. An impressive view of the Chapel of the Dead annexed to the church of S. Maria delle Grazie in Comiso. The mummified bodies are lying in the niches of the wall.
Articolo inserito il 13 novembre 2008 e letto 31706 volte
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