The overlooked primary: bladder cancer metastases on dry bone. A study of the 20th century CAL Milano Cemetery Skeletal Collection

Presentism in paleopathology, through the lens of male breast cancer

OBJECTIVE

To highlight possible presentist biases within paleopathological differential diagnosis by calling into question the diagnostic value of the concept of clinical rarity in modern populations, with reference to male breast cancer as a case study.

MATERIALS

Published paleopathological case reports of human skeletal remains estimated to be biologically male or possibly male with lesions attributed to metastatic carcinoma and multiple myeloma. Case reports from 1909 to 2017 were sourced from the Cancer Research in Ancient Bodies (CRAB) Database (n = 275), as well as a supplemental literature search for publications from 2018 to 2023.

METHODS

Exclusion criteria were established to filter and identify paleopathological case reports published before 2024. All identified cases were assessed whether, when presented with metastatic lesions in the skeleton of a male, breast cancer was considered in the differential diagnosis or rejected, and the reasoning.

RESULTS

Eighty-five case reports were identified that included skeletal remains estimated as male with metastatic lesions. Of these, 13 case reports considered male breast cancer in the differential diagnosis. This diagnosis was reasoned against by all but one, with most citing modern clinical rarity with little to no further consideration of this disease.

CONCLUSIONS

Presentism bias and the concept of clinical rarity may be hindering paleo-oncological research, as potential diagnoses are not often fully considered.

SIGNIFICANCE

Paleopathological researchers are called on to re-examine their theoretical methodology and reflect on possible presentist biases in their investigation of diseases in the past.

SUGGESTIONS FOR FUTURE RESEARCH

Further interrogation and consideration of male breast cancer in paleopathological differential diagnosis.

Towards an integrative approach to the biological profile

One of the most important tasks in forensic anthropology is the construction of the biological profile, classically defined as a set of four basic biological descriptors: biological sex, age-at-death, ancestry, and stature. Yet, our empirical and technological abilities in reconstructing the life experiences and health from skeletal remains far exceed these four parameters and forensic anthropology could benefit from further descriptors in the search for an identity. In this paper, we propose the inclusion of two other investigations to forensic anthropology practice to implement the already known biological profile: the interpretation of bone disease and lesions, and forensic toxicology on unconventional biological matrices. These analyses can provide information regarding health, habits, and disease burden, and by implementing them in our practice of forensic anthropology, they have the potential to improve the biological profile. We also propose a new term that can include not only the classical biological profile but also further descriptors, namely, the "biocultural profile".

The Importance of Historical Medical Records Review in the Interpretation of Dry Bone Lesions on Identified Skeletal Remains: A Case Study of a Polymorbid Male (1895-1940)

ABSTRACT

The examination of documented skeletal remains provides an exceptional opportunity for biohistorical research to answer questions about an individual's life and death. Research in this area also makes it possible to assess the reliability of historical records from the period of interest, which is often the subject of discussion, especially in cases of historically known individuals. The remains of K.B.C. (1895-1940), a prominent local landowner and politician, were exhumed because of the repair of a family tomb in Jíloviště, Czech Republic. The aim of this study was to analyze pathological changes in his bones and to interpret these by comparing them with the results of a historical medical records review of private family and public archives regarding his diseases and death, thus verifying their credibility. Morphological and X-ray examinations of the bones revealed several serious pathological changes, whose presence fully corresponded to the studied documents. This showed the records' reliability, and it was thus possible to accurately interpret the lesions found. The results demonstrated the need for interdisciplinary collaboration in the analysis of such cases, including the assistance of the living descendants of the studied individuals, if possible.

Identification and Validation of the Prognostic Stemness Biomarkers in Bladder Cancer Bone Metastasis

Background

Bladder urothelial carcinoma (BLCA) is one of the most common urinary system malignancies with a high metastasis rate. Cancer stem cells (CSCs) play an important role in the occurrence and progression of BLCA, however, its roles in bone metastasis and the prognostic stemness biomarkers have not been identified in BLCA.

Method

In order to identify the roles of CSC in the tumorigenesis, bone metastasis and prognosis of BLCA, the RNA sequencing data of patients with BLCA were retrieved from The Cancer Genome Atlas (TCGA) databases. The mRNA expression-based stemness index (mRNAsi) and the differential expressed genes (DEGs) were evaluated and identified. The associations between mRNAsi and the tumorigenesis, bone metastasis, clinical stage and overall survival (OS) were also established. The key prognostic stemness-related genes (PSRGs) were screened by Lasso regression, and based on them, the predict model was constructed. Its accuracy was tested by the area under the curve (AUC) of the receiver operator characteristic (ROC) curve and the risk score. Additionally, in order to explore the key regulatory network, the relationship among differentially expressing TFs, PSRGs, and absolute quantification of 50 hallmarks of cancer were also identified by Pearson correlation analysis. To verify the identified key TFs and PSRGs, their expression levels were identified by our clinical samples via immunohistochemistry (IHC).

Results

A total of 8,647 DEGs were identified between 411 primary BLCAs and 19 normal solid tissue samples. According to the clinical stage, mRNAsi and bone metastasis of BLCA, 2,383 stage-related DEGs, 3,680 stemness-related DEGs and 716 bone metastasis-associated DEGs were uncovered, respectively. Additionally, compared with normal tissue, mRNAsi was significantly upregulated in the primary BLCA and also associated with the prognosis (P = 0.016), bone metastasis (P < 0.001) and AJCC clinical stage (P < 0.001) of BLCA patients. A total of 20 PSRGs were further screened by Lasso regression, and based on them, we constructed the predict model with a relatively high accuracy (AUC: 0.699). Moreover, we found two key TFs (EPO, ARID3A), four key PRSGs (CACNA1E, LINC01356, CGA and SSX3) and five key hallmarks of cancer gene sets (DNA repair, myc targets, E2F targets, mTORC1 signaling and unfolded protein response) in the regulatory network. The tissue microarray of BLCA and BLCA bone metastasis also revealed high expression of the key TFs (EPO, ARID3A) and PRSGs (SSX3) in BLCA.

Conclusion

Our study identifies mRNAsi as a reliable index in predicting the tumorigenesis, bone metastasis and prognosis of patients with BLCA and provides a well-applied model for predicting the OS for patients with BLCA based on 20 PSRGs. Besides, we also identified the regulatory network between key PSRGs and cancer gene sets in mediating the BLCA bone metastasis.

The synergy between radiographic and macroscopic observation of skeletal lesions on dry bone

The diagnosis of bone lesions is a fundamental part of the study of skeletal remains, both in the archeological and forensic context. On the one side, the literature proved the relevance of radiography for the detection of bone lesions; on the other side, the careful macroscopic observation of the morphology of bone lesions is often underestimated. For this study, we examined and performed plain radiography on 14 skeletons of the CAL Milano Cemetery Skeletal Collection diagnosed with rheumatoid arthritis, diabetes, multiple myeloma, metastatic cancer, and osteomalacia to compare the macroscopic morphology and radiographic visualization of bone lesions. At least 200 osteolytic lesions and 65 areas of proliferative bone reaction (either spongiosclerotic or periosteal) were studied. We realized "comparative sets" of macroscopic pictures and radiographic imaging of the same skeletal elements to allow comparisons of detection and recognition of bone lesions. As a result, while trabecular lesions may be lost through naked eye observation, many lesions can also be unperceived on radiographs due to contrast, including periosteal reactions, osteolytic lesions, and spongiosclerosis. The aim of this research was to investigate the strengths and pitfalls of digital radiography and macroscopic analysis and to demonstrate the synergy of a complementary approach between the two methods for lesion analysis in dry bone.