Metastatic cancer and endentulism: Exploring comorbidity to assist with differential diagnosis in a case from Vico nel Lazio (Fr, Italy), 13th-15th century CE

Objective To differentially diagnose cranial lesions noted on a medieval skeleton and explore the importance of comorbidity. Materials A skull of an adult female with osteolytic and osteoblastic lesions, edentulism, and an ectopic tooth from an ossuary of the Church of Santa Maria in Vico del Lazio, Frosinone Italy, dating to the Middle Ages. Methods Macroscopic observations of the remains, CT scan, and differential diagnosis was undertaken. Results A diagnosis of metastatic cancer (potentially breast cancer) or metastatic neuroblastoma (NBL) is offered. Conclusions Considering the noted comorbidities, this case might represent a rare case of metastatic neuroblastoma. Significance The exploration of comorbidity, in this case the presence of metastatic carcinoma and edentulism, has tremendous potential to expand our knowledge about cancer in the past. Limitations Lack of postcranial elements. Suggestions for Further Research Clinical and paleopathological investigation of comorbidity in modern and archeological populations to develop an evolutionary perspective on the presence of cancer in the past.