Vai alla homepage Vai alla homepage Vai al Sito dell'Università di Pisa
MODULI DI RICERCA NEL SITO
oppure

 
 
Vai alla Homepage
 
METASTATIC CARCINOMA IN A SKULL FROM SAVOCA (SICILY)

di Fornaciari Gino

Articoli > Paleopatologia > Progetto Mummie Siciliane

 
 
     

Luca Ventura, Vincenzo Urbani*, Lorenzo Arrizza**, Antonio Fornaciari***, Luisa Lo Gerfo***, Gino Fornaciari***.

Department of Pathology, San Salvatore City Hospital, L’Aquila, Italy;
*Department of Radiology, Villa Serena Clinic, Città S. Angelo (PE), Italy;
**Centre of Electronic Microscopy, University of L’Aquila, Italy;
***Division of Paleopathology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Italy.

 

Keywords: Savoca - mummies – osteolysis – metastasis – carcinoma.
Palabras clave: Savoca – momias – osteolìsis – metàstasis – carcinoma.

Introduction
The Capuchins crypt in Savoca, north-eastern Sicily, is well known for hosting an interesting collection of male mummies, dating back to XVIII-XIX century. During a preliminary survey of these human remains, we examined eleven additional, isolated, partially mummified or skeletonized heads, located in the left side of the crypt (Fig. 1).

Material and methods
One of these heads was a badly preserved calva, lacking the right temporal bone and parts of sphenoid and occipital bones. It showed diffusely closed ectocranial sutures, belonging to an old male (over 60 years). A Wormian bone in the lambdoid suture and a honeycomb-like structure in the left orbit were also observed (Fig. 2).
A radiologic (RX) and computed tomography (CT) study was performed at the Department of Radiology of the Villa Serena Clinic, Città S. Angelo, by using a spiral CT scanner (Philips Brilliance).
Samples from the largest and one of the smaller lesions underwent scanning electron microscopy (SEM), performed with a Philips XL30/CP scanning electron microscope at the Centre of Electronic Microscopy, University of L’Aquila.
Additional histologic and confocal microscopy examination was performed on rehydrated and decalcified samples, priorly submitted to SEM.

Results
Twelve parietal and sphenoidal lytic areas were found at macroscopic or radiologic examination: six of them were evident only on the inner surface and one only on the external aspect of skull vault. The largest diameter of the lesions ranged between 21 and 3 mm.
RX and CT scanning highlighted the true extent of the lesions, more pronounced within the diploic layer (Fig. 3). A sclerotic rim was evident around a single posterior lesion. Endocranial remnants were noted in the right above the right occipital bone.
SEM revealed the clear osteolytic character of the process with no evidence of osteoblastic reaction (Figg. 4-5). Such findings were confirmed with histology and confocal microscopy.

Discussion
The absence of postcranial and maxillary bones caused difficulties in the evaluation of the individual’s sex and age at death (Ubelaker, 1989; Meindl & Lovejoy, 1985), as well as in estimating the true extension of the disease (Waldron, 1987). The limited anthropological characters and the presence of only male individuals in the crypt allowed to determine sex and age at death with acceptable accuracy (Ubelaker, 1989; Meindl & Lovejoy, 1985). The endocranial remnants found above the occipital were more evident in the right side of the bone, indicating a slight right rotation of the head after burial.
The macroscopic and radiologic features of the lesions (asymmetrical distribution, variable size, low density, irregular borders), along with their microscopic details, allowed the diagnosis of osteolytic metastatic carcinoma (Duhig, Strouhal & Nĕmečkova, 1996; Strouhal et al., 1991).
Multiple myeloma shares with secondary carcinoma multifocality, lytic character, marrow origin and anatomical sites, but could be reasonably ruled out just because it usually presents a greater density of the lesions, which appear regularly round, smallest and less variable in size, with sharply delimited radiological borders without sclerotic rimming of the surrounding bone (Strouhal, 1991; Waldron, 1987).
No firm conclusion could be drawn about neoplasm’s primary site, but lung, kidney and gastrointestinal tract can be taken into account as the most probable ones, due to the age and gender of the individual (Bullough, 2004). Prostate carcinoma, the most prevalent primary cancer in the elderly male people, can be easily excluded as it usually displays purely blastic or sclerotic secondary lesions (Waldron, 1987; Bulloguh, 2004).

References
Ubelaker D.H., 1989. Human skeletal remains. Excavation, analysis,
interpretation. Washington: Taraxacum, 44-95.
Meindl, R.S. and C. O. Lovejoy, 1985. Ectocranial suture closure: a revised
method for the determination of skeletal age at death based on the lateral-anterior sutures. American Journal of Physical Anthropology, 68, 57-66.
Duhig, C., E. Strouhal and A. Nĕmečkova, 1996. Case of a secondary
carcinoma of Anglo-Saxon period from Edix Hill, Barrington, Cambridgeshire, England. Journal of Paleopathology, 8, 25-3.
Strouhal, E., L. Vyhánnek, L. Horáčková, L. Benešová and A. Nĕmečková,
1996. Malignant tumors affecting the people from the ossuary at Křtiny (Czech Republic). Journal of Paleopathology, 8, 5-24.
Strouhal, E., 1991. Myeloma multiplex versus osteolytic metastatic
carcinoma: differential diagnosis in dry bones. International Journal of Osteoarchaeology, 1, 219-224.
Waldron, T., 1987. Lytic lesions in a skull: a problem in diagnosis. Journal of
Paleopathology, 1, 5-14.
Bullough, P., 2004. Orthopaedic pathology. Mosby: St. Louis, 471-487.

Fig. 1.The left side of the crypt with mummified or skeletonized heads.

 

Fig. 2. Right view of the calva with lytic lesions.

 

Fig. 3. Standard lateral radiograph showing multiple, irregular, transparent lesions.

 

Fig. 4. SEM: external surface of an osteolytic lesion (original magnification: 15x).

 

Fig. 5. SEM: spongiotic diploe with focal newly formed trabeculae (original magnification: 30x).

 

 

 

 

 

 
vai alla pagina degli articoli
articolo precedente: MEDICINA GRECO-ROMANA E PALEOPATOLOGIA
articolo successivo: PALEOPATOLOGIA DEL CIMITERO SIGNORILE DEL CASTELLO DI MONTE DI CROCE (XI SECOLO)
 

Questo articolo è stato visualizzato 4367 volte.

0 COMMENTI PRESENTI
COMMENTA L'ARTICOLO
 
NOME*: COGNOME*:
EMAIL (NON VERÀ MOSTRATA)
COMMENTO:
CASELLA ANTISPAM    (risultato in cifre numeriche)

Postato da Fornaciari Gino Il 08/02/2008

Torna alla pagina degli Articoli |Vai alla Homepage

 
 
TRADUCI LA PAGINA

Ricerca tra gli articoli secondo i seguenti criteri:

Autore
Categoria
Parte del testo
 
 
     
 

www.paleopatologia.it
Il contenuto del sito è di proprietà del Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie in Medicina dell'Università di Pisa. Per la sua riproduzione, anche parziale, si prega di contattare i webmasters.
Creative Commons License
Ultimo aggiornamento: 6 November, 2013 - info@paelopatologia.it © 2008