A Probable Case of Osteosarcoma: A Differential Diagnosis of Cancers in the Ancient World

Ongoing archaeological investigations at the North Tombs Cemetery, Tell El-Amarna, Egypt, have, to date, yielded a skeletal sample of 141 graves and at least 252 individuals that have been recovered, representing the non-elite responsible for erecting, and inhabiting a new city (c. 1353 BCE) (Dabbs, 2020) . Recent data on the recovered remains show a trend toward pathological changes in the skeletons attributable to occupational stress-related injuries, specifically those associated with demanding physical labor. One individual (Individual 1154), who was buried wrapped in textile, as is typical of the cemetery exhibited an abnormal bony abnormal bony proliferative lesion on the fifth right metatarsal. The skeleton was in excellent condition, and other pathological lesions including spinal degenerative joint disease of the fourth thoracic vertebrae, thoracic vertebrae six through twelve, and the first lumbar vertebrae (as well as porotic lesions on the spine), non-spinal fractures of the proximal phalanx of a first-hand digit (side unknown) and of an intermediate hand phalanx of unknown position and side, and an abnormal bony abscess on the fifth right metatarsal. The irregular morphology in question is described, and a complete differential diagnosis is considered. The differential diagnosis rules out several other probable causes of the peculiar morphology of the fifth right metatarsal, including benign tumors such as osteochondroma, osteoma, osteoblastoma, and malignant bone such as chondrosarcoma, Ewing\u27s Sarcoma, and metastatic tumors. Given the location, morphology involving the surrounding bony changes leads the authors to conclude Individual 1154’s fifth right metatarsal morphology is consistent with osteosarcoma