Gino Fornaciari, Laura Giusti, Rosalba Ciranni
Department of Oncology, Division of Pathology, Section of Paleopathology
Via Roma, 57 – 56126 Pisa – Italy

Pandolfo III Malatesta (1370-1427) was a leading figure of the Italian Renaissance. He was General Captain of the Republican troops of Venice fighting against the Visconti of Milan. He later became prince of Brescia and Bergamo and, in 1412-1413, still fighting for the Serenissima Republic of Venice, he was successful in the war against the Hungarians. He was a valiant soldier and horseman with a very active and particular life style, representing a typical example of a XV century “condottiero”-prince. 
Historical sources report his death due to a fever during a pilgrimage to the Sanctuary of the Virgin Mary at Loreto (Central Italy) in 1427.

His tomb has recently been explored in Fano (Marche, Central Italy).
Autopsy was performed after careful x-ray and videographic examination with portable apparatus. This showed good preservation of the skeletal muscles, cartilage and internal organs such as the trachea and main bronchi, the hearth, the stomach, the small and large intestines, the penis and also the prostate. A large round stone of uric acid, still in situ, was found in the left kidney.

At first examination the external genitals of Pandolfo appeared in good conditions of preservation.
The penis was completely collapsed, in the form of a large ribbon at the level of the anterior perineal region, adhering to the scrotal residual skin on the medial surface of the left thigh. The testes, identifiable under the scrotal skin, were reduced to a sort of thin foil. The penis, stretched in anterior direction and on the bottom, showed inferiorly at its basis a large, oblong formation of about 3.5 x 2 cm. This organ, easily identifiable as the prostate in its typical position at the root of the penis, was evidently pushed to the bottom by the collapse of the perineal plan, most probably by the formation of gas in the abdominal cavity, as consequence of initial putrefaction. The penis measures 13 cm from the root to the apex of the glans and has a diameter of 4 cm in the middle of the body, with a narrowing of 2.5 cm at the basis of the glans corresponding to the cervix. It appears flattened, with a maximum thickness of about 0.5 cm. Considering the relative enlargement of the post-mortal collapse and flattening, these dimensions are in the normal range. X-ray and videographic examination of the root of the penis with the prostate demonstrate the presence of calcifications, frequent in the past and caused by severe chronic prostatitis.
At transversal sectioning the prostate reveals a rounding cavity of 13 x 20 mm, with walls of 2-3 mm, and two large anterior fibrous nodular formations with regular surfaces on the top, of 7 x 6 and 6 x 5 mm respectively, which narrow the lumen at about 5 mm.

Cavity and relative nodules are identifiable with the prostatic tract of a very ectatic urethra with two central large nodules of benign prostatic hypertrophy. These nodules well correspond to the nodular enlargements of the middle lobe which, as is well known in this condition, project up into the floor of the urethra as hemispheric masses directly beneath the urethral mucosa.

Histology shows fibrous bands of connective and muscular tissue surrounding some circular and oblong lacunae, with no preservation of epithelial structures.

The macroscopic and histologic pictures clearly show prostatic nodular hyperplasia.

This condition, present in about half of the men of the age of Pandolfo, caused some stenosis of the urethra with difficulty in urination and retention of urine in the bladder. Recurrent cystitis and renal infection, perhaps facilitated by the renal calculosis, could be relatively frequent.
The life style of Pandolfo, in particular the continuous practice of the horse-riding as knight wearing heavy and uncomfortable armors, can easily explain not only his chronic prostatitis but is also likely to have facilitate the insurgence of these acute infectious episodes.

We know with certainty that the last six months of life were particularly intense: after his marriage with a young woman in May, Pandolfo spent that hot summer in feasts, banquets and tournaments.
For this reason an urinary sepsis could have been the cause of the fever which, on the basis of historical records, killed the prince at the age of 57 years.