Paleoandrology in Italian mummies (15th -19th century)

Prostatic hyperplasia, a very common condition today, was well known in the past as cause for bladder distension. At autopsy of natural or artificial mummies, the difficulty in identifying even a normal-volume prostate is likely to be due to putrefaction processes as well as dramatic reduction in size [1]. We report some ancient cases of prostatic hyperplasia observed recently in natural mummies from Italy. The first case regards Pandolfo III Malatesta (1370-1427), a leading figure of the Italian Renaissance. He was a valiant soldier and horseman with a very active life style. The tomb of Pandolfo, containing his naturally mummified body, was explored in Fano (Marche, Central Italy). After careful X-ray and videographic examination, autopsy showed good preservation of the skeletal muscles, cartilage, internal and external organs, including prostate gland and penis. Macroscopic examination revealed a staghorn calculus (calcium urate) of the left kidney and severe enlargement of the prostate, with calcifications detected by X-ray and large nodules protruding in the lumen of an ectatic urethra. Histology showed fibrous bands of connective and muscular tissue surrounding circular and oblong lacunae, with no preservation of epithelial structures. The macroscopic and histological picture allowed us to diagnose prostatic nodular hyperplasia [2]. The second case, regarding the artificial mummy of Salimbene Capacci (+ 1497), rector of the Medieval hospital of S. Maria della Scala in Siena (Tuscany, central Italy), revealed well preserved pelvic organs at X-ray and CT scan. At autopsy, the cavity appeared filled with vegetable material, but some visceral organs were still in situ, in particular, the remains of the bladder, the prostate and the terminal segment of the intestinal tract. The prostate consisted of a central fibrous structure, surrounded by perineal tissues. Histology revealed dense fibrous tissue containing muscular fibers and roundish cavities of variable size. Histological findings, distended urinary bladder, and age of the subject support the diagnosis of prostatic hyperplasia [3]. The third case (XIX century) concerns the natural mummy of an anonymous 50-60 year-oldman, recovered in an ancient friary near L’Aquila (central Italy), which underwent computed tomography and complete autopsy. Pelvic CT scans showed distended urinary bladder and a ring of fibrous dense tissue at the site of the prostate. At autopsy the bladder measured 7 x 6 x 5 cm and the prostate was 4 x 5 x 3 cm; the prostatic urethra had a 2-cm diameter. Histology revealed dense fibrous tissue containing muscular fibers and roundish cavities of variable size, filled with eosinophilic, PAS-positive material. Concretions were also present in some of these spaces. Strong immunohistochemical reactivity for PSA was observed in this material. The existence of glandular structures containing PAS-positive material, immunoreactive for PSA, confirmed the prostatic nature of the specimen, already suspected after CT scan and gross examination. The presence of the prostate, its histological appearances, the preserved and distended urinary bladder and the age of the subject support the diagnosis of prostatic hyperplasia [4]. To our knowledge, so far neither benign nor malignant forms of prostatic enlargements have appeared in paleopathology literature [1]. Therefore, the Italian cases of the Renaissance and Modern ages represent the only known reports of prostatic hyperplasia in mummies and clearly demonstrate that paleoandrological studies using diverse and modern technologies are possible. The good preservation of the external and internal genitalia of these three individuals may be related to the supine position of the bodies after death, which allowed rapid dehydration of these structures. This type of approach, currently limited to the prostate but easily extensible to other organs on a larger number of mummies, could solve some important medical problems, as for example the origin and diffusion of some sexually transmitted diseases and genital tumors, whose natural history studied by the andrologists is still unclear. References 1. Aufderheide AC, Rodriguez-Martin C: The Cambridge Encyclopedia of Human Paleopathology. Cambridge University Press, Cambridge, 1998, p. 287. 2. Ciranni R, Giusti L, Fornaciari G: Prostatic hyperplasia in the mummy of an Italian Renaissance prince. Prostate 45:320-322, 2000. 3. Giuffra V, Naccarato AG, Caramella D, Fornaciari A, Marvelli S, Fornaciari G: The rector of the hospital and his wife: two artificial mummies of the late 15th century from Siena (central Italy). Proceedings of VI World Congress on Mummy Studies 205bis, 2007. 4. Ventura L, Leocata P, Ventura T, Fornaciari G: Studio paleopatologico delle mummie naturali di Goriano Valli (L'Aquila). Risultati preliminari. De Re Medica 12:33-35, 2000