Radiographic and macroscopic dry bone manifestations of childhood leukemia in case of known cause of death from mid-20th century Portugal

Objective: This study examines the radiological and dry bone manifestations of diagnosed leukemia in a child who lived prior to the advent of modern cancer treatment.

Materials: The skeleton of a 9-year-old girl who died of myeloid leukemia in Lisbon, Portugal in the 1940s.

Methods: Lesions were identified and documented through macroscopic analysis. Selected skeletal elements were imaged using radiography, mammography, and computed tomography.

Results: Osteolytic lesions were observed on the petrous portion, humerus, ilia, ischia, pubis, sacrum, tibiae, femora, and humeri. New bone formation was observed at the margins of osteolytic lesions on some bones including both ilia. Diffuse porosity on the frontal bone, the palate, several vertebrae, and the tarsals was also noted.

Conclusions: The lesions present in the child, both osteolytic and porotic, as well as new bone formation, are consistent with the clinically known radiological and dry bone effects of childhood leukemia.

Significance: This case is one of the few examples of potentially diagnosed childhood leukemia with observable dry bone lesions prior to the modern era of cancer treatment and can serve as a reference for diagnosis of suspected cases in the archaeological record.

Limitations: While the cause of death was documented as myeloid leukemia, it is possible that the medical diagnosis was incorrect.

Suggestions for future research: Further research using confirmed dry bone cases of leukemia and the environmental and societal factors potentially associated with the disease in the past.