Rare Case of an Ancient Craniofacial Osteosarcoma with Probable Surgical Intervention

Abstract

Osteosarcoma is the most common primary malignant bone tumor both today and in antiquity. Nevertheless, it is a comparatively rare tumor. This paper describes a case of a highly aggressive craniofacial lesion from the 11th-12th centuries AD, most likely representing osteosarcoma. During the paleopathological study, macroscopic, endoscopic, radiological, scanning-electron and light microscopic investigations were performed. The skull of the approximately 40-50 year-old female revealed several pathological findings. The most impressive macroscopic feature was an extensively spiculated periosteal reaction ("sunburst" pattern) in combination with a massive bone destruction most likely derived from a highly aggressive tumor originating in the ethmoidal area of the medial wall of the orbit. The central parts of the lesion showed excessive new and most probably neoplastic bone formation indicating an underlying high-grade osteosarcoma. The light microscopic examination revealed three different levels of bony structures representing different qualities of bone tissues. Besides the mass lesion, signs of a healed multiple incomplete trephination of the left parietal bone was observed. This case represents a unique example in which the concomitance of a tumor and an incomplete trephination could be observed from the skeletal remains of an ancient individual. The case opens new considerations as to whether surgical interventions, such as incomplete trephination, might have been used already in the Middle Ages as a therapeutic approach.

Possible cases of leprosy from the Late Copper Age (3780-3650 cal BC) in Hungary

“…Osteolytic formations may be manifested in the skull and on the facial bones. Carcinoma of the nasal cavity causes destruction of the hard palate and the inner portion of the maxilla, whereas carcinoma of the ethmoid may destroy the frontal bone and the orbital wall [35,64]. However, in all cases the complete reactive bone is absent.…”

A csontok ásványtani vizsgálata

“…Ehhez a szükséges információk: a vizsgálni kívánt anyag kristálytani alapadatai (rácsparaméterek, tércsoport, kémiai összetétel, atomkoordináták, kristályméret és -alak, stb) -amik alapján felépítjük a kristályszerkezetet -, így csak a csontokat érintő megbetegedések vizsgálata lehetséges. Emellett a talajban lezajló tafonómiás jelenségek is nehezíthetik a pontos diagnózis felállítását[63],[64].Daganatos csontok ásványtani vizsgálatáról eddig kevés tanulmány született[65],[29]. Ezek a tanulmányok azt mutatták, hogy a daganatos csontszövet krisztallitjainak mérete kisebb, mint a normál csont krisztallitjaé.…”