Oldest epiphyseal osteochondroma in a subadult from Ancient Egypt

Abstract

Benign bone tumours are pathologies frequently encountered in archaeological human remains, with the most common being osteoma and osteochondroma. We present the case of a juvenile individual recovered from the Necropolis of Sharuna, Middle Egypt and dated to the end of Old Kingdom and First Intermediate Period of Ancient Egypt (circa 2150 BC), showing an osteochondroma arising from the proximal epiphysis of the right tibia which, in all likelihood, affected the patellar tendon in life. Osteochondromas are usually discovered during childhood and adolescence. These lesions are commonly located at the metaphysis and diaphysis of long bones and directed away from the joint, with the epiphysis being a rare location. To our knowledge, there have been no similar cases published to date from ancient times and we conclude that this is the oldest case of epiphyseal osteochondroma reported.

1. Introduction

Compared to the low prevalence of malignant bone tumours, either primitive or metastatic, benign bone tumours are not infrequent in archaeological remains. In infantile and juvenile individuals these rates decrease, mainly due to the patterns of immature bone. Along with the osteoma, osteochondroma (OC) is the most frequent benign lesion of bone present in archaeological context. Nevertheless, all of them are found in the diaphysis or metaphysis of infantile or juvenile bones. No references have been found on the epiphyseal rise in an OC in archaeological and paleontological remains.

2. Case history

Since 2006 the Spanish/German mission of the Museu Egipci of Barcelona (Spain) and the Eberhard Karls Universität in Tübingen (Germany) has been working in the Necropolis of Sharuna, Middle Egypt, 200 km south of El Cairo on the east bank of the River Nile. In this vast necropolis, a total of 438 individuals has been identified and their pathologies studied.¹

In 2010, the archaeological season was based in the UE.3601 area, where a minimum of 7 individuals were recovered and diagnosed by the presence of pelvic bones. The individuals were found dismembered at the bottom of a shaft from the Old Kingdom. The analysis of the few associated goods defined the bed as belonging to the end of the Old Kingdom – First Intermediate Period (circa 2150 BC).

The unique juvenile individual showed a clear anomaly in the proximal epiphysis of the right tibia, compatible with OC. The cartilaginous part of the lesion could not be found, so by the area of the epiphyseal bone implantation, it must have affected the patellar tendon (Fig. 1, Fig. 2). The basis of the OC was visible arising from the upper metaphysis of the right tibia.

Fig. 1.

Cranial view of the upper metaphysis of the right tibia. The basis of an osteochondroma can be seen.

Fig. 2.

Anterior view of the same piece showing the rise of the osteochondroma.

3. Discussion

The OC is the most frequent benign bone tumour. Its prevalence is more than 40% of all benign bone tumours, with around 90% being isolated. The proposed aetiology is based upon an anomalous growth of the cartilage arising from the plate tissue; this proliferation is independent form the normal growth.² The most affected area on the skeleton is around the knee: the distal metaphysis of the femur and the proximal metaphysis of the tibia (40.1% in the Dahlin's series and 37.3% in Schajowicz series). On the other hand, an OC arising from the epiphysis is very uncommon and only a few cases have been reported up to now, some of them found in individuals with Dysplasia Epiphysealis Hemimelica. The first was described by Sarmiento and Elkias in 1975,³ but this tumour mainly affected the synovium and the patellar tendon. Four years later, Chekofsky⁴ presented a case of an OC growing from the lateral femoral condyle of the femur just in the upper attachment of the anterior cruciate ligament. In 1984, Calabet⁵ studied two cases in the proximal tibial epiphysis in children. In 1998, Laflamme published seven cases of epiphyseal OC of finger phalanges in children,⁶ and finally, Devadoss et al.⁷ presented a surgical case of a 18 months female child with an OC in the proximal tibial epiphysis.

In general, archaeological specimens of OC in humans are not uncommon. In Pre-historic times, the oldest case belongs to the (OxA-4177) individual that shows an OC on the metaphysis of the tibia in a young, 17 year-old female from the Whitwell Quarry (UK)⁸ from the Neolithic Period (early V – late IV millennium BC). There are four examples of OC belonging to Ancient Egypt: an adult female from el-Lisht (North-Middle Egypt) from the 12th Dynasty, with an OC in the pelvic girdle. Another case was found in the Tomb of Pay from Saqqara (North-Middle Egypt) dated in the Late Period that shows a “kissing OC” of the ulna/radius in a male individual.⁹ The only description of two cases comes from the Tombos archaeological site on the border of the Upper and Lower Nubia dated in the 18th Dynasty until the Third Intermediate Period, in the sciatic bone.¹⁰ After these cases, a significant number of examples have been published in specialized literature, but always growing from the metaphysis and diaphysis bone.

After the study of 438 individuals from the necropolis of Sharuna a total of 18 benign tumours of the bone were found, with six OC (four from the distal metaphysis of femur, one from the proximal metaphysis of the humerus, one “kissing” OC of the radius-ulna, and one from the metaphysis of the tibia). No epiphyseal OC has been found in the paleopathological literature.

Conflict of interest

The authors have none to declare.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

We certify that all authors have participated sufficiently in the intellectual content, conception and design of this work or the analysis and interpretation of the data, as well as the writing of the manuscript, to take public responsibility for it and have agreed to have our name listed as a contributor.