The mummy of Ferdinando Orsini, 5th Duke of Gravina (†1549): a paleopathological study

In the monumental Sacristy of the Abbey of Saint Domenico Maggiore, Naples, 37 wooden sarcophagi contain the well preserved bodies of ten Aragonese kings, princes and other Neapolitan nobles who died between the 15th and 16th centuries. One of the arks revealed the natural mummy of Ferdinando Orsini, 5th Duke of Gravina, identified by an epigraph with his name and date of death (1549), in good condition, with the exception of the face, completely skeletonized. The skull suffers from an extensive destructive lesion that afflicted the medial wall of the orbit right, the root of the nose and, partly, the ethmoid without osteitic reaction. The histological examination performed on the bone showed wide lacunae with, inside, epithelial-like cells, partially necrotic, positive for the immunohistochemical stain for PanCK. The border between the bone and the surrounding neoplasia were clear; the brownish fleshy appearance mass had darker margins (like a palisade) and was separated from the bone by clefting artifacts. In our opinion, the pathology that affected Orsini 500 years ago was the basal cell carcinoma in an advanced stage, in fact it is the most frequent form of skin cancer and occurs predominantly on the sun-exposed skin of adults. Microscopically the tumour tends to infiltrate the subcutaneous tissue with a peripherical palisade surrounded by loose of stroma and cleft-like retraction spaces of artifactual nature. It grows in a slow and indolent fashion, but can ulcerate and may invade skull, nares, orbit or temporal bone with wide osteolithic lesion, enough to deserve the Latin name of ‘ulcus rodens’, i.e. erosive ulcer. Immunohistochemically, the cells are positive for keratin and distant metastases are very rare. This case is very important because it represents one of the only four cases of malignant soft tissue tumor diagnosed in paleopathology.