Article
Reference
Lesions characteristic of infection or malignant tumor in Paleo-Eskimo skulls
LAGIER, René, et al.
Abstract
Study of two Paleo-Eskimo skulls found in a necropolis on St-Lawrence Island (Alaska), including radiography and histological examination, revealed the following features. One of the skulls showed a perforation with remodelled borders, considered to be due to trauma and secondary infection. The other showed areas of osteolysis characteristic of a malignant tumor (probably carcinomatous metastasis rather than myeloma). These cases illustrate the advantage of using various methods of investigating bone pathology, particularly microradiography, in skeleton paleopathology.
LAGIER, René, et al . Lesions characteristic of infection or malignant tumor in Paleo-Eskimo skulls. Virchows Archiv , 1982, vol. 395, no. 3, p. 237-243
DOI : 10.1007/BF00429350
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Virchows Arch [Pathol Anat] (1982) 395: 237-243
Virchows Archiv A
© Springer-Verlag 1982
Lesions Characteristic of Infection or Malignant Tumor in Paleo-Eskimo Skulls
An Anatomical and Radiological Study of two Specimens
R. Lagier1, C.A. Baud 2, G. Arnaud, S. Arnaud 3, and R. Menk4
Departement de Pathologie (Unite Osteoarticulaire)1 et Institut de Morphologie2, Faculte de Mede
cine, Geneve, Switzerland
Centre de Recherches Archeologiques CNRS (Laboratoire de conservation, restauration et recherches)3• Draguignan. France
Departement d'Anthropologie4, Faculte des Sciences, Geneve, Switzerland
Summary_ Study of two Paleo-Eskimo skulls found in a necropolis on St-Lawrence Island (Alaska), including radiography and histological exami
nation, revealed the following features. One of the skulls showed a perfora
tion with remodelled borders, considered to be due to trauma and secondary infection. The other showed areas of osteolysis characteristic of a malignant tumor (probably carcinomatous metastasis rather than myeloma).
These cases illustrate the advantage of using various methods of investi
gating bone pathology, particularly microradiography, in skeleton paleopath
ology.
Key words: Paleopathology - Eskimos - Frontal bone - Osteomyelitis - Bone carcinomatous metastases - Myeloma
Since skeletal changes are the primary concern of paleopathology, a thorough knowledge of bone pathology and the use of appropriate modern methodology are essential. This is illustrated in this report of two lesions observed in Paleo
Eskimo skulls.
Materials and Methods
The two cranial specimens which were of eskimoid type. were found in the Kitnepaluk necropolis in the northwest part of St-Lawrence Island (Alaska) buried in two graves that were somewhat distant from the others [Anliker-Bosshard, in press; Menk et al. in preparation]. The age of these specimens cannot be precisely determined since there is a wide range of burial dates as shown by archeological data and 14C estimations; the latter indicate that the burials took place over a period beginning with the start of the Christian era and ending at about the 14th Century A.D. From its state of preservation. specimen N° 1 would seem to date from the later part of this period; it was not possible to evaluate the age of specimen N° 2.
Offprint requests to: R Lagier, Institut de Pathologie. 40 boulevard de la Cluse, CH-1211 Geneve 4.
Switzerland
0340-1227/82/0395/0237 /$01.40
238 R. Lagier et al.
After macroscopic examination (using anthropological and anatomopathological criteria) and radiography, samples were taken from each of the two specimens and embedded in methyl methacry
late. A histological study was made of:
10 µm sections stained with alcoholic basic fuchsin or Harris' haematoxylin-eosin.
- 100 µm sections microradiographed according to the technique of Baud and Morgenthaler (1956).
The powder obtained from the sawing of the samples, which were of normal consistency.
was submitted to various physical and chemical studies: a) X-ray diffraction for determination of the crystalline type (diagrams obtained with the Guinier camera) and crystalline parameters and the size of the crystals (diffractometric recording according to Jacquet et al. (1980); b) determina
tion of the hydroxyproline content as an indication of collagen levels (method of Blumenkranz and Asboe-Hansen [1974]) and of the fluorine content (method of McCann [1968]).
The values were compared with those reported in the literature for normal bone and with those obtained for a control sample of skull taken at autopsy from a 78 year old man (A. 79/80, Department of Pathology, Geneva) with no history of skeletal disease.
Observations
Specimen N° 1 (Reference 1973-Kl2: Seminar fiir Urgeschichte der Universitat Bern, Switzerland)
This complete skull belonged to an adolescent of about 12 to 14 years of age and indeterminate sex. It was quite well preserved although somewhat deformed by the pressures of earth and showed some signs of superficial post
mortem abrasion. There was a perforation 15 to 20 mm in diameter on the median line of the frontal bone, 35 mm above the glabella whose free borders showed remodelling with bone overgrowth. The external table surrounding the perforation appears thickened by newly formed subperiosteal bone bearing im
prints of blood vessels and extending mostly in the direction of the glabella (Fig. 1 a). On the internal table, signs of hypervascularization could be observed around the perforation. The only other lesion was a superficial star-shaped scar, 1 cm in diameter on the external table of the left parietal bone. There was no sign that would indicate human intervention with an instrument.
Radiography revealed osteosclerosis around the perforation and no other lesion (Fig. 1 b). No X-ray of the rest of the skeleton was possible since the skull was an isolated piece.
The histological examination was made on a horizontal section taken from the right side starting at the free border of the perforation (Reference Numbers:
T. 11985/77, Department of Pathology, Geneva and 723, Institute of Morpholo
gy, Geneva). The sections and the microradiographs showed the bone to be well preserved, to have no signs of attack by fungi or bacteria, and to have a recognizable structure of both preexisting lamellar and newly formed woven bone (Fig. 2).
Microradiography provided a topographical view showing trabeculae of vas
cularized newly formed woven bone deposited on the endosteal and periosteal surfaces of the cortex. No other histological modifications were observed.
The mineral material gave an X-ray diffraction pattern typical of apatite.
Crystal size and/or crystalline perfection was determined by the width of the diffraction lines at half intensity: f3 (31.0)=0.457° 28 and f3 (00.2)=0.175° 28.
The dimensions of the unit cell of the crystalline lattice were a= 9 .417
A
and c=6.892A.
a
Lesions Characteristic of Infection or Malignant Tumor 239
Fig. 1 a, b. Specimen N° 1. a Macroscopic aspect of the external orifice of the frontal perforation;
overgrowth on the borders and subperiosteal thickening with imprints of blood vessels toward the lower part ( x 0.9 approx.) b X-rays AP ( x 0. 7). The slits correspond to the superimposed lambda suture
I
b
a C
Fig. 2a-c. Specimen N° 1. a Microradiography of the border of the perforation on the internal table ( x 30). This compact bone tissue (in the center) is flanked by a network of newly-formed bone on the endosteal (straight arrow) and periosteal (curved arrow) surfaces. b, c Newly-formed woven bone attached to lamellar bone trabecula (basic fuchsin stain x 75). b By ordinary light;
c by polarized light
b
a
Fig. 3a, b. Specimen N° 2 ( x 0.9 approx.). a Macroscopic aspect of the principal area of bone loss. b X-ray of the corresponding bone fragment
b
a C
Fig. 4a-c. Specimen N° 2. a Microradiography of the border of the area of bone loss of Fig. 3 a at the level of the external table ( x 30). Erosion more pronounced in the deeper part of the table. b, c Detail of the outer tip of the border of the eroded area showing the clear-cut erosion of the lamellar bone (basic fuchsin stain x 75). b By ordinary light; c by polarized light
b
Lesions Characteristic of Infection or Malignant Tumor 241
Fluorine content was found to be 0.225% and hydroxyproline content 738 nmol/mg.
Specimen N° 2 (Reference 1973-K8: Seminar fiir Urgeschichte der Universitiit Bern, Switzerland)
This fragment of cranial vault measuring 13 cm x 9 cm, had the characteris
tics of an adult male skull. It showed a rounded well-defined area of bone loss with grooved borders (Fig. 3 a). Radiography also revealed numerous smaller areas of bone loss that were not macroscopically visible (Fig. 3 b ). This cranial fragment was found along with some fragments of the jawbone and two segments of long bones, one of which was shown by radiography to have an area of bone loss.
A histological examination was made of a radial section of the cranial fragment, taken starting at the border of the principal area of bone loos (Refer
ence Numbers: T. 11984/77, Department of Pathology, Geneva and 722, Insti
tute of Morphology, Geneva). The sections and microradiographs showed the bone to be well preserved, to have no signs of attack by fungi and bacteria and to have a recognizable osteonic architecture (Fig. 4c). Microradiography showed a clear-cut erosion and no formation of new bone (Fig. 4a). This absence of new bone was confirmed by the examination of the sections by ordinary and polarized light which also showed the clear-cut erosion of the bone lamellae (Fig. 4 b-c). No other histological modifications were observed.
The mineral materials gave an X-ray diffraction pattern typical of apatite.
Crystal size and/or crystalline perfection was determined by the width of the diffraction lines at half intensity: 1) on the border of the eroded area f3 (31.0)=0.475° 28 and /3 (00.2)=0.188° 28 - 2) at a distance from the eroded area /3 (31.0)=0.477° 28 and f3 (00.2)=0.188° 28. The dimensions of the unit cell of the crystalline lattice were 1) on the border of the eroded area a= 9 .419 A and c=6.892 A-2) at a distance from the eroded area a=9.424 A and c=
6.915 A.
Fluorine content was found to be 0.166% on the border of the eroded area and 0.065% at a distance. Hydroxyproline content was 734 nmol/mg on the border and 1,018 nmol/mg at a distance.
Discussion
The histological examination demonstrated the good state of preservation of this bone material, reflected by a normal hydroxyproline (and therefore collagen) content.
No mineral deposits from the external milieu (signs of fossilisation) were observed. The values obtained for the size and/or crystalline perfection and for the unit cell dimensions were substantially the same as those obtained for control bone tissue. The bone fluorine content ( < 0.2%) found for the control subjects living in a country with low fluorine concentration in the drink
ing water [Baud et al. 1978] and that of the control sample of frontal bone (necropsy A. 79/80: 0.067% F) suggested that the difference in fluorine content found for the two specimens which were buried relatively close to each other
242 R. Lagier et al.
was due to individual vanat10n rather than to post-mortem changes due to the external milieu. The fluoride ions are located inside crystal lattice, as indi
cated by the shortening of the a value of the unit cell proportional to the fluoride level [Bang et al. 1978]. The cristal size and/ or crystalline perfection expressed as f3 values are the same as for the control sample of frontal bone (/3 (31.0)=0.492° 28; /3 (00.2)=0.194° 28).
The hydroxyproline content was also essentially the same as that of the control sample of frontal bone (966 nmol/mg).
These data indicate that both the mineral substance and the collagen organic matrix were well preserved in spite of the long period of burial in the earth.
This is in contrast with observations (both for mineral substance and collagen) reported for specimens found under other conditions in direct contact with the earth [Arnaud et al. 1980]. It would seem, therefore, that the cold climate of St-Lawrence Island protected the bone tissue from the attack by fungi and bacteria which is frequently seen under other climatic conditions especially when the bone is in direct contact with the earth [Arnaud et al. 1980; Marchia
fava et al. 1974; Morgenthaler and Baud 1956-1957].
In Specimen N° 1 both the macroscopic aspect (in particular the vascularized subperiosteal thickening) and the radiological and histological data indicate a chronic infectious condition. Based on the observations and data, a diagnosis of syphilis can be excluded without entering into the discussion of the existence of the disease in pre-Columbian America [Hackett 1976]. The histology of the newly-formed bone suggests pyogenic osteitis but if this were the only cause, the perforation could have been expected to be larger. More probably, it was a secondary infection of a primary lesion due to trauma, resulting not from trephining (considering the relatively small diameter of the perforation) but rather after damage by a weapon. This conclusion is in accord with the finding of Stewart and Quade [1969; cit. in Stewart 1979] that most frontal lesions observed in Indian skulls from archaeological sites appear to be of traumatic origin.
In Specimen N° 2, the radiological picture is characteristic of a malignant tumor, either a myeloma or more likely, in view of the diameter of the main area of bone loos, carcinomatous metastasis. Histological data indicate an actively erosive process with no osteogenic remodelling. The area of bone loss in a segment of long bone was shown by radiology to be compatible with these two diagnoses.
The joint study of these two specimens demonstrates the necessity of proceed
ing with a paleopathological study as if it were a contemporary study in patholo
gy and considering it to be the "forensic medicine" of archaeology or history.
A wide range of methods, from conventional macroscopic evaluation to biophys
ical, chemical and histological analyses, can be used. The choice of methods will vary according to the case and the technical and financial possibilities.
In Specimen N° 1, the macroscopic and histological examinations were determi
nant, while in Specimen N° 2, it was radiography that provided the crucial data.
Lesions Characteristic of Infection or Malignant Tumor 243
Histological examination, providing that certain precautions are taken, al
lows for a thorough study of the extra-cellular structures. Embedding the speci
men in methyl methacrylate insures the necessary physical properties to allow for the sectioning of fragile material (especially if it has deteriorated after attack by microorganisms) while also allowing for the use of various stains. Examina
tion by polarized light provides data concerning the bone structure. Microradio
graphy on thick sections seems to be a particularly useful technique since it provides a topographical evaluation of a quite large surface.
Acknowledgments. We wish to thank Prof. H.G. Bandi, Director of the"' Seminar fiir Urgeschichte ", Bern, Switzerland and of the St-Lawrence Island excavation for having made the specimens available to us. The X-ray diffraction analyses, the preparation of the specimens for the histological study and the fluorine determinations were respectively performed by Dr. J.M. Very, Mrs. M. Tachon
Saban and Miss C. Demeurisse (Institut de Morphologie, Geneve). The hydroxyproline determina
tions were performed by Miss J. Bornand (Laboratoire CEMO, Hopital Cantonal, Geneve).
We are grateful to Mrs Judith L. Noebels for her invaluable collaboration in the preparation of the English version of this paper.
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Accepted February 23, 1982
