1
SITE CODE REW92
Palaeopathology
PBR
_____________________________________________________________________
Osteologist: R.N.R. Mikulski
Date: 27/07/2005
6
_____________________________________________________________________
Context
Summary: REW92 6 represents an individual of probable male sex, most likely
in his early 40s, exhibiting a case of probable metastatic carcinoma, likely to
have arisen in the prostate or alternatively the lungs. There is also a very well
healed fracture to the left femoral shaft and a second healed fracture to the
medial malleolus of the right tibia.
Cranial:
There are similar lesions to the posterior of both orbits, which appear almost bilateral
and are essentially lytic in nature, although there is evidence of slight new bone
formation around the margins of the lesions. There is also marked pitting to the
supraorbital region of the frontal and to the palate.
There is slight pitting to the ectocranial surface of the parietals in the epipteric
regions, just behind the lateral margins of the orbits. In the left side, this pitting is
contiguous with and therefore appears to be directly related to the lytic lesion within
the posterior orbit.
The sphenoid also appears to exhibit possible evidence of a lytic process, although
there is post-mortem damage and it is not directly visible.
Mandible: There appears to be a lytic lesion to the lingual aspect of the right
mandibular ramus at the position of the mylohyoid foramen. Though essentially lytic
in nature, as with the orbits there is slight new bone formation evident around the
margins of the lesion, both on the lingual aspect and on the buccal aspect of the ramus
through which the lesion is in the process of penetrating. The lingual aspect of the left
mandibular ramus also exhibits slight pitting in the same region.
There is also noticeable bilateral pitting to the anterior aspects of the mandibular
condyles, just below the articular surfaces and posterior aspect of the right mandibular
condyle appears to exhibit a large lytic lesion also, penetrating deeply into the
trabeculae; although this may in fact be the result of post-mortem damage.
Pathology Codes
congenital
infection
211
joints
trauma
4210
metabolic
endocrine
neoplastic
74
circulatory
other
2
SITE CODE REW92
Palaeopathology
PBR
_____________________________________________________________________
Osteologist: R.N.R. Mikulski
Date: 27/07/2005
6
_____________________________________________________________________
Context
Postcranial:
Scapulae: There are numerous deposits of bulbous, ’mossy’ new bone to both
scapulae. These appear focussed on the inferior and superior aspects of the acromions,
the glenoid tubercles and along the axes of the lateral borders of the blades. There is
also some regular large pitting evident, in particular to the dorsal aspects of the
acromions and to the dorsal aspect of the inferior blade of the left scapula; this is
similar to the pitting seen in the ribs.
In addition, the left scapula appears to exhibit osteolytic changes with destructive
lesions at the base of the acromion in the suprascapular fossa and to the ventral aspect
of the inferior blade.
Clavicles: The right clavicle exhibits marked new bone deposition to the superior
posterior aspect of the lateral shaft. The new bone is porous and organised into a
‘mossy’, bulbous architecture at its main focus.
Both clavicles demonstrate lytic changes with symmetrical lytic foci located on the
anterior inferior aspects of the midshafts and again distinctive regular large pitting
evident at the lateral ends.
Vertebrae: Many of the vertebrae exhibit osteoblastic changes. There does not appear
to be any focus for new bone growth in the spine, rather small ‘mossy’, bulbous
deposits are observed on almost all vertebrae from C1 down to the lower thoracics
and lumbar vertebrae, which are highly fragmented. L5 exhibits new bone to the
anterior wall of the vertebral body and a significant mass of irregular ‘mossy’ new
bone to the posterior wall, which appears to have invaded the interior of the body via
the blood supply.
In addition, several vertebrae exhibit lytic changes, especially to the neural arches. In
the majority of cases, there is the distinctive regular large pitting; but in T4 and T5,
the neural arches appear to exhibit large lytic foci. T6 also shows a very large abscess
to the centre of the superior intervertebral surface that is continuous with a large
Schmorl’s node to the inferior surface; the interior of the cavity exhibits either
sclerosis of the trabeculae.
Sternum: There is some new bone deposition to the ventral aspect of the manubrium,
again with a ‘mossy’ bulbous appearance. There is also marked regular large pitting to
the manubrium and sternal body.
Ribs: The majority of the ribs exhibit ‘mossy’ bulbous new bone deposits, mostly
concentrated in the region of the angle but also along both aspects of the shafts, in
particular the ventral aspect. Virtually all the ribs also exhibit regular large pitting,
which in some cases, appears to be associated with larger lytic foci.
Pathology Codes
congenital
infection
211
joints
trauma
4210
metabolic
endocrine
neoplastic
74
circulatory
other
3
SITE CODE REW92
Palaeopathology
PBR
_____________________________________________________________________
Osteologist: R.N.R. Mikulski
Date: 27/07/2005
6
_____________________________________________________________________
Context
Pelvis: There is profuse irregular ‘mossy’ new bone deposition to the left ilium,
mainly focussed just anterior to the sacroiliac joint on the ventral surface and just
posterior to the acetabulum on the external surface. This ‘mossy’ new bone is also
present within the trabecular, where it seems to be replacing the trabeculae, (as in L5
and T11 vertebrae), possibly indicating a lytic process. The right ilium also exhibits
‘mossy’ bulbous new bone deposits to the external surface of the blade, mainly close
to the iliac crest. There is also some slight new bone formation to the ventral surface.
Both ilia exhibit pitting, but this is particularly evident in the right side, where at
least one area of focussed large pitting appears to indicate a lytic focus.
The ventral aspect of the medial left pubis appears to exhibit a possible lytic focus
also.
The sacrum exhibits changes similar to those observed in the vertebrae, with new
bone to the external surfaces of the S1 and S2 segments and replacement/intrusion of
the trabecular bone of the vertebral bodies at least by denser ‘mossy’ new bone.
Left Femur: There is slight irregular new bone deposition just superior to the lesser
trochanter. The left femoral neck (broken post-mortem?) exhibits
intrusion/replacement of the trabeculae by ‘mossy’ new bone. A post-mortem break to
the proximal shaft also shows large bulbous nodules of new bone developing within
the medullary cavity.
There is also a well-healed fracture to the midshaft of the left femur. The bone is
very well remodelled, although there is some medial displacement of the distal end
due to malalignment of the shaft. There appears to be only slight foreshortening of the
shaft.
Right Tibia: The talocrural surface of the right tibia exhibits a linear discontinuation
to the articular surface at the base of medial malleolus. It’s likely this is due to an
incomplete fracture as there is also some remodelling and osteophytic lipping to the
medial aspect of the medial malleolus evident.
There is also lamellar/striated compact new bone to the lateral anterior aspect of
the proximal and midshaft, with remodelling to the tibial tuberosity. There is an area
of focussed porosity to this new bone at the midshaft.
Pathology Codes
congenital
infection
211
joints
trauma
4210
metabolic
endocrine
neoplastic
74
circulatory
other