Clues potentially distinguishing lytic lesions of multiple myeloma from those of metastatic carcinoma.
*Paleopathology; Diagnosis; Differential; Female; Humans; Leukemia/*pathology; Male; Middle Aged; Multiple Myeloma/*pathology; Neoplasm Metastasis/*pathology
This study was conducted to determine whether individual bony lesions are specific for recognizing multiple myeloma and thereby distinguish it from metastatic cancer and leukemia. The lytic skeletal lesions of multiple myeloma are characterized by sharply defined, spheroid lesions. They have smooth borders and effaced/erased trabeculae. Unique spheroid myeloma lesions appear to be responsible for the "punched out" appearance of affected bone. The total absence of remodeling in myeloma forms a contrast to irregular preservation of trabeculae and buttressing, isolated "fronts of" cortical bone "resorption" coalescing to confluence, and the "golf-ball surface" phenomenon observed in metastatic cancer. The uniform effacement of both cortical and trabecular bone in multiple myeloma also contrasts with some cortical preservation in metastatic cancer. Leukemic lesions are more numerous than those of myeloma, but they lack the latter's "space-occupied" appearance. The relatively small holes and "fronts of resorption" of leukemia are quite different from the "space-occupied" lesions of multiple myeloma. Uniform size is a characteristic traditionally attributed to the bone lesions of multiple myeloma. The occurrence of isolated examples of uniform size lesions in metastatic cancer and of variable size lesions in some individuals with multiple myeloma precludes unequivocal use of size in differential diagnosis. Fortunately, the newly recognized macroscopic characteristics appear to separate multiple myeloma from metastatic cancer, and also distinguish myeloma from leukemia.
Rothschild B M; Hershkovitz I; Dutour O
American journal of physical anthropology
1998
1998-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/(SICI)1096-8644(199802)105:2%3C241::AID-AJPA10%3E3.0.CO;2-0" target="_blank" rel="noreferrer noopener">10.1002/(SICI)1096-8644(199802)105:2%3C241::AID-AJPA10%3E3.0.CO;2-0</a>
Clues To Recognition Of Fungal Origin Of Lytic Skeletal Lesions
Anthropology; blastomycosis; bones; clinical-features; defleshed bones; disease; erosive arthritis; Evolutionary Biology; histoplasmosis; lytic lesion; osteomyelitis; pathology; therapeutic considerations; yaws
The present study addresses the specificity of lyric osseous impact for distinguishing among metastatic cancer, tuberculosis, and fungal disease. Osseous impact is used in this manuscript as a convention to describe the macroscopic appearance of defleshed bones affected by the disease. Osseous changes in the skeleton of a 47-year-old black male, diagnosed in life as having blastomycosis, were characterized and compared to lyric lesions observed in ten individuals with tuberculosis and six with metastatic cancer in the Terry and Hamman-Todd Collections. Apparent distinguishing characteristics are identified. Eroded areas, present as fronts of resorption or the result of space-occupying masses in blastomycosis, with protruding, short, blunt, 1 x 2 mm spicules of new bone, are surrounded by periosteal reaction. These differed from smooth zones of resorption and coalesced lesions, with a smoothed marginal zone and space-occupied appearance-bone-displacing mass-in tuberculosis and lytic (non-permeative) lesions of metastatic cancer. Displacing is a convention (an artificial term) denoting bone resorption and reformation at the outer edge of the tumor mass, giving the impression that the surrounding bone had expanded beyond its original margins. Irregular trabeculae are occasionally preserved in the margins, but remodeling in the form of blunting of those trabeculae is not observed macroscopically in either tuberculosis or metastatic cancer. Two apparently specific lesion types are noted in blastomycosis. Periosteal reaction surrounding fronts of resorption appears specific, at least for nonarticular osseous lyric lesions, among the three entities studied. Remodeling of isolated internal trabeculae in the space-occupying mass lesions of blastomycosis also appears unique among the three disorders studied, Comparison with coccidioidomycosis suggests that extrapolation of blastomycosis findings to other fungal diseases is feasible; description of additional clinically diagnosed cases is awaited. (C) 1998 Wiley-Liss, Inc.
Hershkovitz I; Rothschild B M; DuTour O; Greenwald C
American Journal of Physical Anthropology
1998
1998-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/(sici)1096-8644(199805)106:1%3C47::aid-ajpa4%3E3.3.co;2-x" target="_blank" rel="noreferrer noopener">10.1002/(sici)1096-8644(199805)106:1%3C47::aid-ajpa4%3E3.3.co;2-x</a>
Hyperostosis Frontalis Interna: An Anthropological Perspective
Anthropology; breast cancer; estrogen; Evolutionary Biology; hyperostosis frontalis interna; skeletal populations
Hyperostosis frontalis interna (HFI) is manifested by the accretion of bone on the inner table of the frontal bone. Despite the vast literature on HFI, ambiguity exists as to its etiology, osteogenesis, demography, and history. This stimulated the present broad-scale study of HFI which included the evaluation of 1,706 early 20th century skulls (1,007 males and 699 females) from the Hamann-Todd and Terry human osteological collections, as well as 2,019 pre-19th century East-Mediterranean, Amerindian, and Central European skulls. In addition, 72 cadavers were dissected for gross inspection and histology. Special attention was paid to the relationship of the brain and meninges to endocranial lesions. HFI is an independent condition, not a symptom of a more generalized syndrome as suggested in the past. It can appear in a variety of forms but each is the result of the same process and probably of the same etiology. Investigators' previous failure to recognize the mild stages of HFI (types A and B) as an early form of the general HFI process led to erroneous statistics and interpretations of observations. HFI should also be considered a phenomenon separate from HCI, hyperostosis cranialis diffusa (HCD), and other endostoses, even when it appears in association with them. To avoid ambiguity and facilitate the description of cranial hyperostoses, uniform nomenclature (HFI, HCD) has been recommended. HFI is rarely seen in historic populations, regardless of geographical origin. It is most commonly found among females and is believed to be associated with prolonged estrogen stimulation. While its magnitude of manifestation and frequency are much higher in females, HFI is not a purely female phenomenon. Males with hormonal disturbances such as atrophic testis were found to manifest HFI type D. HFI is associated with age insofar as it is much less frequent in females under 40 years of age. Although advanced cases of HFI (types C and D) have been observed in individuals as young as 40 years of age, it is more frequently found after age 60. The frequency of HFI type D will not increase from age 60. Type-predicted analysis by cohort reveals significant ethnic differences. Changes in African American (AA) females appear earlier in life and progress more rapidly than in European American (EA) females. Analysis of radiographs shows a discrepancy between the anatomic prevalence of HFI and its radiological recognition, which is very poor for mild cases. This apparently resulted in the misconceptions that HFI is entirely an old-age phenomenon, and that it is exclusively female. Histological analysis shows that the inner table along with the closely attached dural layer play a major role in the osteogenesis of HFI. Contrary to previous models, no evidence for diploe or ectocranial plate involvement was found. Cadaver study suggests that the predilection for the frontal area may be related to an altered blood supply and/or vascular stretching. (C) 1999 Wiley-Liss, Inc.
Hershkovitz I; Greenwald C; Rothschild B M; Latimer B; DuTour O; Jellema L M; Wish-Baratz S
American Journal of Physical Anthropology
1999
1999-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/(sici)1096-8644(199907)109:3%3C303::aid-ajpa3%3E3.0.co;2-i" target="_blank" rel="noreferrer noopener">10.1002/(sici)1096-8644(199907)109:3%3C303::aid-ajpa3%3E3.0.co;2-i</a>
Identification of childhood arthritis in archaeological material: Juvenile rheumatoid arthritis versus juvenile spondyloarthropathy
ankylosing spondylitis; Anthropology; bone erosion; criteria; defleshed bones; diagnosis; erosive arthritis; Evolutionary Biology; growth retardation; onset stills disease; Pathology; polyarthritis; pseudoarthrosis
The opportunity to examine the defleshed skeleton of an individual diagnosed in life (Hamann-Todd collection, individual 2036) afforded a unique opportunity to demonstrate the bone damage characteristic of at least one form of juvenile rheumatoid arthritis (JRA). Characteristics helpful for recognition of JRA in archaeological material include peripheral articular marginal and subchondral erosions, axial (e.g., zygapophyseal or sacroiliac) joint erosions, fusion of axial (cervical zygapophyseal) and/or peripheral joints, premature epiphyseal closure and/or ballooned epiphyses, growth retardation with underdeveloped (short and overtubulated) long bones, short mandibular rami with underdeveloped condyles and concomitant micrognathia, and demineralization (osteopenia). Distinguishing between JRA and juvenile spondyloarthropathy, however, is not always possible, as illustrated by this case. (C) 1995 Wiley-Liss, Inc.
Rothschild B M; Hershkovitz I; Bedford L; Latimer B; Dutour O; Rothschild C; Jellema L M
American Journal of Physical Anthropology
1997
1997-02
Journal Article
<a href="http://doi.org/10.1002/(sici)1096-8644(199702)102:2%3C249::aid-ajpa7%3E3.0.co;2-t" target="_blank" rel="noreferrer noopener">10.1002/(sici)1096-8644(199702)102:2%3C249::aid-ajpa7%3E3.0.co;2-t</a>
Recognition of leukemia in skeletal remains: report and comparison of two cases.
Acute/*pathology; Archaeology; Bone and Bones/diagnostic imaging/*pathology; Child; Female; Humans; Leukemia; Male; Middle Aged; Museums; Myeloid; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*pathology; Preschool; Radiography; Skull/diagnostic imaging/pathology; Spine/diagnostic imaging/pathology
Recognition of disease in the archeologic record is facilitated by characterization of the skeletal impact of documented (in life) disease. The present study describes the osteological manifestations of leukemia as identified in the skeletons of two individuals diagnosed during life: a 3-year-old black girl with acute lymphocytic leukemia and a 60-year-old white male with acute myelogenous leukemia in the Hamann-Todd collection. Contrasting with the lack of specificity of radiologic findings, macroscopic skeletal changes appear sufficiently specific to allow distinguishing leukemia from other forms of cancer. While leukemia appears confidently diagnosable, distinguishing among the varieties (e.g., myelogenous and lymphocytic) does not appear possible at this time. Skeletal findings in leukemia are presented in tabular form to facilitate their application to future diagnosis of the disease in the archaeological record.
Rothschild B M; Hershkovitz I; Dutour O; Latimer B; Rothschild C; Jellema L M
American journal of physical anthropology
1997
1997-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/(SICI)1096-8644(199704)102:4%3C481::AID-AJPA5%3E3.0.CO;2-V" target="_blank" rel="noreferrer noopener">10.1002/(SICI)1096-8644(199704)102:4%3C481::AID-AJPA5%3E3.0.CO;2-V</a>
Recognition Of Sickle Cell Anemia In Skeletal Remains Of Children
anemia; Anthropology; arthritis; beta-thalassemia; bone pathology; bone-disease; children; Evolutionary Biology; features; iron deficiency; pathogenesis; porotic hyperostosis
The present study discusses in detail the osteological changes associated with sickle cell anemia in children and their importance in differential diagnosis. Posterior calcaneal and specific articular surface disruptive metacarpal lesions are diagnostic for sickle cell anemia. Calvarial thickening, tibial and femoral cortical bone thickening, and bowing are of more limited utility in differential diagnosis. Granular osteoporosis, pelvic demineralization and rib broadening are nonspecific. Localized calvarial ''ballooning,'' previously not described, may have diagnostic significance. Bone marrow hyperplastic response (porotic hyperostosis) in sickle cell anemia produces minimal radiologic changes contrasted with that observed in thalassemia and blood loss/hemolytic phenomenon. Two other issues, the osteological criteria for discriminating among the anemias and the purported relationship between porotic hyperostosis and iron deficiency anemia, are also discussed. There is sufficient information to properly diagnose the four major groups of anemias, and further, to establish that iron deficiency is only indirectly associated with porotic hyperostosis. The hyperproliferative bone marrow response (manifest as porotic hyperostosis) to blood loss or hemolysis exhausts iron stores, resulting in secondary iron deficiency. (C) 1997 Wiley-Liss, Inc.
Hershkovitz I; Rothschild B M; Latimer B; DuTour O; Leonetti G; Greenwald C M; Rothschild C; Jellema L M
American Journal of Physical Anthropology
1997
1997-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/(sici)1096-8644(199710)104:2%3C213::aid-ajpa8%3E3.0.co;2-z" target="_blank" rel="noreferrer noopener">10.1002/(sici)1096-8644(199710)104:2%3C213::aid-ajpa8%3E3.0.co;2-z</a>
Serpens Endocrania Symmetrica (ses): A New Term And A Possible Clue For Identifying Intrathoracic Disease In Skeletal Populations
Anthropology; dura mater; endocranial changes; Evolutionary Biology; hypertrophic osteoarthropathy; skeletal population; tuberculosis
This paper describes a phenomenon in the endocranial plate, which we have termed "serpens endocrania symmetrica" (SES), and discusses its value as a diagnostic tool. The affected discolored bone area exhibits disruption of the endocranial surface, lending it a maze-like appearance. Histological sections demonstrate that the process is limited to the most superficial portion of the endocranium, with no diploic and ectocranial involvement (sinus areas excepted). Adult skulls (n = 1,884) from the Hamann-Todd collection (HTH), housed at the Cleveland Museum of Natural History, were utilized for the present study. SES was recognized in 32 of the 1,884 skulls studied (1.7%). The frequency of SES among individuals reported to have died from tuberculosis (TB) was 4.4%. The rate of SES in the non-TB sample was only 0.53%. The locations were as follows: limited to sinus area, 28.1%; calvarium (excluding the sinuses), 46.9%; sinus + calvarium, 25.0%. SES was bilateral in 90.9% of cases. Twenty-five of the 32 individuals (78.1%) with SES in the HTH collection had tuberculosis specifically listed as the cause of death. Six of the other 7 individuals had infections other than TB. In 29 of the 32 individuals with SES, infection involved structures within the thorax. As SES was also associated with another osteological phenomenon known to represent pulmonary disease, i.e., hypertrophic osteoarthropathy (HOA; 68.0% of SES individuals also had HOA), SES may be of diagnostic value in paleopathology for the recognition of intrathoracic disease, and perhaps tuberculosis. (C) 2002 Wiley-Liss, Inc.
Hershkovitz I; Greenwald C M; Latimer B; Jellema L M; Wish-Baratz S; Eshed V; DuTour O; Rothschild B M
American Journal of Physical Anthropology
2002
2002-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/ajpa.10077" target="_blank" rel="noreferrer noopener">10.1002/ajpa.10077</a>
Serpens Endocrania Symmetrica (ses): A New Term And Possible Sign Of Cranial Tuberculosis
Anthropology; Evolutionary Biology
Greenwald C M; Latimer B; Jellema L M; Hershkovitz I; DuTour O; Rothschild B M
American Journal of Physical Anthropology
1999
1905-06
Journal Article or Conference Abstract Publication
n/a
Spondyloarthropathy identified as the etiology of Nubian erosive arthritis.
Africa; African Continental Ancestry Group; Ancient; Arthritis; Bone and Bones/pathology; Diagnosis; Differential; Egypt; Ethnic Groups; History; Humans; Museums; Northern; Paleopathology; Rheumatoid/diagnosis/*history; Spinal Osteophytosis/diagnosis/*history; Sudan
Slight variation in manifestation of different diseases may allow a single individual with one disease to mimic the "classic" appearance of another, as evidenced by the frequent confusion of spondyloarthropathy with rheumatoid arthritis. Analysis of population occurrence of arthritis (rather than isolated skeletons) facilitates more precise diagnosis. Northeast Africans living around 2,000 years before present were clearly afflicted with a form of spondyloarthropathy. Lack of inclusion of spondyloarthropathy in the differential diagnosis of erosive arthritis led to past misclassification of Nubians as having rheumatoid arthritis. While evidence of spondyloarthropathy abounds in the literature of human skeletal disease, pre-Columbian Old World rheumatoid arthritis is still elusive. The current study further documents the absence of rheumatoid arthritis in Nubians, supporting the hypothesis that rheumatoid arthritis began in the New World.
Rothschild B M; Arriaza B; Woods R J; Dutour O
American journal of physical anthropology
1999
1999-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/(SICI)1096-8644(199906)109:2%3C259::AID-AJPA10%3E3.0.CO;2-3" target="_blank" rel="noreferrer noopener">10.1002/(SICI)1096-8644(199906)109:2%3C259::AID-AJPA10%3E3.0.CO;2-3</a>
The Elusive Diploic Veins: Anthropological And Anatomical Perspective
Anthropology; Anthropology; diploic vein; discrete trait; Evolutionary Biology; humans; radiator; radiographs
Diploic veins (Canales diploicae), which were identified in dogs by Dupuytren more than 200 years ago (Hecker [1845] Die anatomische Verhaltnisse und Krankheiten der Venae diploicae und Vasa emissaria, Erfahrungen und Abhandlungen im Gebiete der Chirurgie und Augenheilkunde. Erlangen), have remained inadequately understood and scantily referenced in the anatomical and anthropological literature. The tunnels formed by diploic veins are among the few known skeletal markers of soft tissue alteration. Protected by two bony laminae, diploic vein tunnels often resist postdepositional destruction and may provide a new way to assess living and extinct hominid populations. This basic research was carried out to enable future utilization of the diploic venous channels in anthropologic research. In the present study, diploic venous channels were observed radiographically in 108 human adults aged 19 years and above, 18 infants and children aged 1-18 years (Hamann-Todd Osteological Collection), eight fetuses aged 7-9 months (the Johns Hopkins Collection), and seven nonhuman primates (Hamann-Todd Osteological Collection), In addition, seven documented cases of parents and children were radiographed for genetic evaluation (Osteological Collection of The Hungarian Natural History Museum). Five distinct diploic distribution patterns were identified and described in this study. This was at variance with the impressions reported in dissection-based studies. Independence of diploic vein pattern from demographic (gender and age) and size factors and their tendency to be symmetrical make them amenable and reliable traits for skeletal population study. Diploic vein patterns appeared to be more complicated in humans than in nonhuman primates, raising the possibility of future phylogenetic applications. (C) 1999 Wiley-Liss, Inc.
Hershkovitz I; Greenwald C; Rothschild B M; Latimer B; DuTour O; Jellema L M; Wish-Baratz S; Pap I; Leonetti G
American Journal of Physical Anthropology
1999
1999-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/(sici)1096-8644(199903)108:3%3C345::aid-ajpa9%3E3.0.co;2-s" target="_blank" rel="noreferrer noopener">10.1002/(sici)1096-8644(199903)108:3%3C345::aid-ajpa9%3E3.0.co;2-s</a>
The Elusive Petroexoccipital Articulation
age identification; Anthropology; Evolutionary Biology; jugular synchondrosis; skull base
In the present study, 1,869 skulls from the Hamann-Todd Collection were examined (macroscopically and by radiographs) for closure of the petroexoccipital articulation (jugular synchondrosis). The results demonstrated that the petroexoccipital articulation underwent closure between 20 and 50 years of age in most of the human skulls evaluated. Approximately 7-10% of the human skulls underwent complete union of the petroexoccipital articulation before 20 years of age. In 5-9% of the population, the joint remained completely open. After 50 years of age, there was no increase in the frequency of individuals with complete closure. The frequency of ''partial closure'' was similar (4-8%) for all age groups (20-25, 30-35, 40-45, 50-55, 60-65, and 70+), excluding the 30-35 year old group (17.5%). The time interval necessary for closure to occur appeared to be very short. No significant differences in closure rates due to ethnic origin, gender, or laterality were noted. The utility of the petroexoccipital articulation as an age estimator is discussed. (C) 1997 Wiley-Liss, Inc.
Hershkovitz I; Latimer B; DuTour O; Jellema L M; Wish-Baratz S; Rothschild C; Rothschild B M
American Journal of Physical Anthropology
1997
1997-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/(sici)1096-8644(199707)103:3%3C365::aid-ajpa6%3E3.0.co;2-p" target="_blank" rel="noreferrer noopener">10.1002/(sici)1096-8644(199707)103:3%3C365::aid-ajpa6%3E3.0.co;2-p</a>
Why Do We Fail In Aging The Skull From The Sagittal Suture?
age; aging; Anthropology; cranium; Evolutionary Biology; sutures; synostosis
The controversy over the reliability of ectocranial suture status (open vs. closed) as an age estimation stimulated the pursuit of Meindl and Lovejoy's suggestion (Meindl and Lovejoy [1985]Am. J. Phys. Anthropol. 68:57-66) for large scale analysis. The extent of the sagittal suture closure was assessed in 3,636 skulls from the Hamann-Todd and Terry collections. The debate over whether cranial suture ossification represents a pathologic or an age-predictable pathologic process also stimulated a comparison with age and two stress markers, hyperostosis frontalis interna and tuberculosis. Sagittal suture closure was found to be age-independent and sexually biased. The wide confidence intervals (for age) appear to preclude meaningful application of suture status for age determination. No correlation was found the tested biologic stressors. (C) 1997 Wiley-Liss, Inc.
Hershkovitz I; Latimer B; DuTour O; Jellema L M; Wish-Baratz S; Rothschild C; Rothschild B M
American Journal of Physical Anthropology
1997
1997-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/(sici)1096-8644(199707)103:3%3C393::aid-ajpa8%3E3.0.co;2-r" target="_blank" rel="noreferrer noopener">10.1002/(sici)1096-8644(199707)103:3%3C393::aid-ajpa8%3E3.0.co;2-r</a>