A probable malignant neoplasm in an adolescent male from the historic First Baptist Church of Philadelphia burial ground (1722-1859, USA).

OBJECTIVE

To evaluate a suite of lesions in the skeletal remains of an adolescent from historic Philadelphia.

MATERIALS: The well-preserved skeleton excavated from the historic burial ground of the First Baptist Church of Philadelphia (1722-1859) following disturbance by construction.

METHODS

Lesions were identified and described using macroscopic visual assessment aided by low-power magnification. A differential diagnosis was conducted that considered taphonomy and multiple possible disease categories.

RESULTS

The individual was estimated to be a 15-19-year-old male. A combination of primarily osteolytic and mixed osteolytic/osteoblastic lesions was observed throughout the axial skeleton, as well as on the left scapula, and the innominates.

CONCLUSIONS

The distribution and morphological characteristics of the lesions are highly consistent with a malignant neoplasm involving the hematopoietic marrow.

SIGNIFICANCE: This probable case adds to the scant paleopathological evidence for childhood and adolescent cancer in North America broadly, and in the eighteenth to nineteenth century mid-Atlantic specifically. Contextualization of the results provides a broader understanding of the experience of cancer in historic Philadelphia.

LIMITATIONS: The examination of lesions was limited to macroscopic visual analysis. Incorporating radiologic techniques would have permitted the observation of additional features and, possibly, may have narrowed the diagnostic options for the pathological process.

SUGGESTIONS FOR FURTHER RESEARCH: Lesion characteristics in this individual overlap with several malignancies. The case study underscores that paleopathologists should continue to exercise caution in the differential diagnosis of neoplastic disease, especially if relying on visual analysis.