Meningiomas in Ancient Human Populations

Abstract

Meningiomas are the most common tumor of the central nervous system and can result in skeletal manifestations, including hyperostosis of the adjacent cranial bone, enostoses, depressions, and enhanced vascular impressions. However, their identification in the paleopathological literature has been rare and few cases have received broad acceptance of the diagnosis. A review of the literature identified some 43 cases in which individuals were argued to have suffered from meningiomas. Most were seen in older individuals but were more likely to affect males. Eleven individuals exhibited hyperostosis, the most easily recognized indicator, usually located on the parietal bone; the hyperostotic region averaged 8 cm in diameter and 3.0 cm in height. Seven displayed lytic lesions with areas much smaller in size than the hyperostosis, and many had vascular changes. The other cases had indicators that varied greatly in terms of location and expression and included both sclerotic lesions and hollow areas. Several authors also suggested other possible causes of the lesions. The findings reflect the non-pathognomonic nature of the effects of meningiomas. However, given their likely frequency and potentially severe effects in ancient people, it is argued that they should be taken into consideration more frequently when performing differential diagnoses.

Recognizing and Distinguising the Phenomenon Referred to as Meningioma

“…Examination of the purported occurrences of meningiomas reported by Cook and Danforth [18] and of additionally recognized cranial pathology (delineated in Table 2) suggested the need for reevaluation. The sex ratio reported by Cook and Danforth [18] is converse to that observed in clinical samples [49,61,83]. ..That may be explainable, as their report seems to conflate several diagnostic entities.…”

“…Medically (clinically)-documented cases of meningiomas, hemangiomas and cranial marrow hyperplasia in adults were examined to establish a macroscopic standard for confident identification of meningiomas and for distinguishing them from hemangiomas and marrow hyperplasia, manifest as porotic hyperostosis. Images and descriptions of archeologic site alleged meningioma cases (derived from Pub Med and Google searches and from 40 years of personal files) (Table 2), including those suggested by Cook and Danforth [18], were then examined for conformity with those criteria.…”

“…Reassessment of past attributions revealed few cases that fulfilled criteria (Table 2) for meningiomas, identified cases actually representing hemangiomas and identified inadequate support for confident diagnosis in many others. Further, Cook and Danforth's ( [18] citation of Siriani et al [71] as reporting 19 th -20 th century meningioma in an individual from the Erie County Poor House apparently represents their unassessed utilization of a secondary or tertiary citation, as there is no record of any such presentation at the 2014 Paleopathology Association meeting. Excluding uncertain cases, those with alternative diagnoses and unconfirmed citations, the ratios women to men is 5:4 for meningiomas.…”

“…I have long sought clarification of post hoc examples and the literature related to meningiomas. A variety of cranial pathologies of disparate sizes and morphologies (e.g., 18,87) have been so-attributed. Given past experience with the trans-phylogenetic uniformity of findings for a given disease [63,64], it seems reasonable to conduct an intensive examination of what is being referred to as meningiomas.…”

Recognizing and Distinguishing the Phenomenon Referred to as Meningioma

“…A variety of cranial pathologies of disparate sizes and morphologies (e.g., refs. [1,2] have been attributed. Given past experience with the trans-phylogenetic uniformity of findings for a given disease [3,4], it seems reasonable to conduct an intensive examination of what is being referred to as meningioma.…”