Enlarged vascular foramina and lytic lesions in vertebral bodies: a diagnostic dilemma

Among the skeletal material from the sites of Alghero, Mesumundu and Sant’Antioco di Bisarcio (Sassari, Sardinia) and dated back to the period comprises between the 13th and the late 16th century 5 subadult individuals aged between 5 and 15 years and a mature male showed peculiar osteolytic phenomena of the vertebral bodies. These lesions have the appearance of enlarged vascular foramina, affecting several vertebrae mainly of the thoracic and lumbar spine, sometimes with involvement of the sacrum; on the same vertebral body several lesions are generally visible. In the literature similar features have been attributed to brucellosis or tuberculosis. As for the Sardinian skeletal material, an imaging study on the vertebrae of the adult individual was carried out in order to evaluate the appearance of the lesions within the body. Computed Tomography evidenced internal irregular elongated cavitations, sometimes joined together; erosive rounded lesions, whose presence is not detectable externally, were also showed. The molecular analysis has so far been performed on the subadult from Sant’Antioco di Bisarcio, but at initial analysis the DNA resulted degraded. Therefore, the nature of these lesions remains unclear, as it is not sure if they should be referred to tuberculosis, brucellosis or other pathological conditions [hemolytic anemias (eg. Thalassemia), lymphomas, multiple myeloma and infection by Echinococcus]. Further molecular analyses will be carried out on the remains belonging to the other five individuals in an attempt to clarify the etiology of the above mentioned lesions