A case report of solitary osteochondroma from 4th c. BC Pontecagnano (southern Italy) and review of the literature.

Osteochondroma is one of the most common benign bone tumors in current clinical medicine; by contrast, their evidence in paleopathology is scant. The aim of this study is twofold: 1) to present a new case of solitary osteochondroma in an individual from the necropolis of Pontecagnano (southern Italy) dated to the 4th century BC; 2) to provide a literature review concerning paleopathological evidence of solitary osteochondromas in osteoarchaeological collections globally in order to assess the current state of research on this topic. Macroscopical examination revealed the presence of a large exophytic formation located that arises from the anteromedial portion of the proximal metaphyseal region and extends to the posteromedial aspect of the proximal diaphysis extremity of the right tibia belonging to an adult male individual. The radiological analysis revealed its structure being composed of regular trabecular bone tissue with cortico-medullary continuity, features that are diagnostic for a sessile osteochondroma. A review of primary peer-reviewed literature allowed us to ascertain a total of 12 cases of solitary osteochondromas, ranging from prehistory to the post-medieval period. A critical appraisal of diagnosis performed in published cases of osteochondromas is a valuable tool for detecting the limitations of some case reports, in particular those lacking imaging technique (e.g. radiology) which is crucial for confirming the diagnosis of osteochondroma. Finally, we advocate that paleo-oncology should not be limited to malignant neoplasms, rather it should incorporate the neglected area of benign tumors as they may provide additional information on their presence and natural history in bioarchaeological contexts.