Leukemia in Ancient Egypt: Earliest case and state‐of‐the‐art techniques for diagnosing generalized osteolytic lesions

Abstract

Malignant bone tumors are uncommon among archaeological skeletal remains, and the general skeletal involvement is even less frequent. Multiple myelomas along with metastases are the most common conditions in paleopathology, whereas malignant myeloproliferative diseases have only been described in a handful of cases. We present a probable case of acute lymphocytic leukemia in a skeleton of an individual from Ancient Egypt, dated to the end of the First Intermediate Period and the beginning of the Middle Kingdom (c 2160–2000 bc). The excavation of the Temple of Millions of Years of Thutmosis III located in el‐Assasif (Luxor, Upper Egypt) recovered a total of 41 complete individual from an associated grave‐Necropolis placed close to the north enclosure wall. The individual, a 16 to 21‐year‐old male, showed a severe disease affecting all the skeleton with, predominantly, osteolytic lesions and areas of new bone formation. Gross examination under magnification and X‐ray in field were performed. We review the paleopathological literature to compare the cases previously reported of malignant disease. The morphology and distribution of the lesions of the individual are discussed to make an adequate differential diagnosis in the individual. Several criteria suggest that the disease was most likely acute lymphocytic leukemia: The individual died before the age of 21, the patterns of the bone lesions as well as its distribution below the elbow and knee joints, the presence of a gap in the coronal suture, and the mandible involvement. If this is the case, it would be the oldest case of leukemia described in Ancient Egypt and could help to understand the evolution patterns of cancer in the history.

A probable case of subligamentous tuberculous spondylitis: The concealed body of theLate Modern Period(early 16th century to early 20th century),Franciscancrypt ofSt. AnthonyandSt. Eusebiuschurch,Lombardy,Italy

“…Moving on to leukaemia, its distinctive marks could be identified in the presence of fronts of resorption, erosion, and pitting of the bones, with marginal amount of new bone formation. These, generally spread both in cranial and postcranial elements, are the distinctive marks of leukaemia that have not been observed in our case (Isidro, Seiler, & Seco, ; Ortner, ; Rothschild et al, ; see also clinical data: Juliusson & Hough, ).…”

Pediatric paleoradiology: Applications and best practice protocols for image acquisition and reporting

“…Less commonly, the entire skeleton was imaged to characterize a suspected disease process or to provide as complete an assessment as possible. Such complete evaluations of individual skeletons have shown, for example, diffuse skeletal lesions consistent with syphilis (Mansilla & Pijoan, 1995); lytic lesions (Lewis, 1998); erosions suggestive of juvenile arthritis (Rothschild et al, 1997); evidence for osteogenesis imperfecta (Cope & Dupras, 2011); skeletal stigmata of child abuse (Blondiaux et al, 2002; Wheeler et al, 2013); diffuse cortical porosity and subperiosteal bone deposition felt to represent renal osteodystrophy (Mays & Turner‐Walker, 2008); lytic lesions suggestive of acute lymphocytic leukemia (Isidro et al, 2019); and metabolic deficiency (Wheeler et al, 2013). Such studies reveal the importance of imaging the entire skeleton, as minor lesions may not be visible macroscopically on bone surfaces (Western & Bekvalac, 2015).…”

The rarest among the rare? Acrometastases and disability in the past and beyond

“…Interestingly, there are at least five published paleopathological reports with mention to metastases in the hands and/or feet, including one young male with lymphocytic leukemia (Isidro et al, 2019) and in diagnosis of MBD of four adults (Fornaciari et al, 2009;Luna et al, 2015;Minozzi et al, 2018;Strouhal, 1993). Considering the T A B L E 2 Summary of the lesions' distribution and main features (individual from burial number 3 from the Chapel of the Convent of the Holy Spirit, Portugal).…”

“…Interestingly, there are at least five published paleopathological reports with mention to metastases in the hands and/or feet, including one young male with lymphocytic leukemia (Isidro et al, 2019) and in diagnosis of MBD of four adults (Fornaciari et al, 2009; Luna et al, 2015; Minozzi et al, 2018; Strouhal, 1993). Considering the alleged rarity of cancers in past populations, it is surprising that acrometastases are apparently more frequent (~2%, 6/~270 to 300 published cancers; Hunt et al, 2018; Marques et al, 2021) in the past when compared with current clinical landscape.…”