title: 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.
authors.affiliation: Department of Biological Anthropology, University of Szeged, Közép fasor 52, Szeged, H-6726, Hungary. balinte@bio.u-szeged.hu.
authors.forename: Erika
authors.initials: E
authors.lastname: Molnár
authors.affiliation: Department of Anatomy, University Medical School Göttingen, Kreuzbergring 36, D-37075, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schultz
authors.affiliation: Department of Anatomy, University Medical School Göttingen, Kreuzbergring 36, D-37075, Göttingen, Germany.
authors.forename: Tyede H
authors.initials: TH
authors.lastname: Schmidt-Schultz
authors.affiliation: Department of Biological Anthropology, University of Szeged, Közép fasor 52, Szeged, H-6726, Hungary.
authors.forename: Antónia
authors.initials: A
authors.lastname: Marcsik
authors.affiliation: Department of Botany, Hungarian Natural History Museum, Könyves Kálmán körút 40, Budapest, H-1097, Hungary.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Buczkó
authors.affiliation: Health Center, Kaposvár University, Guba Sándor utca 40, Kaposvár, H-7400, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Zádori
authors.affiliation: Health Center, Kaposvár University, Guba Sándor utca 40, Kaposvár, H-7400, Hungary.
authors.forename: Gergely
authors.initials: G
authors.lastname: Biró
authors.affiliation: Department of Anthropology, Hungarian Natural History Museum, Ludovika tér 2, Budapest, H-1083, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Bernert
authors.affiliation: Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, D-, 4031, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Baumhoer
authors.affiliation: Department of Anthropology, Hungarian Natural History Museum, Ludovika tér 2, Budapest, H-1083, Hungary.|Department of Biological Anthropology, Institute of Biology, Eötvös Loránd University, Pázmány Péter sétány 1/c, Budapest, H-1117, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Hajdu
mesh_terms: D000328:Adult; D000071298:Body Remains / Q000473:pathology*; D001859:Bone Neoplasms / Q000473:pathology*; D005260:Female; D049690:History, Ancient; D006801:Humans; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D012516:Osteosarcoma / Q000473:pathology*; D012886:Skull / Q000473:pathology
keywords: Craniofacial osteosarcoma; Incomplete trephination; Paleopathology