MALIGNANT TUMOURS IN THE ARAGONESE SERIES OF SAINT DOMENICO MAGGIORE OF NAPLES (15th- 16th CENTURIES)

Cancer nowadays represents the second cause of death in advanced countries. However, there are only five cases of malignant soft tissue tumors in the paleopathological literature.1 The rarity of cancer in Antiquity is a highly debated problem and the main reasons are apparently the short life span of past populations, the scarcity of mummified remains and the technical difficulties for detecting neoplastic lesions in mummified tissues. Three ancient malignant tumors were identified in the Renaissance mummies of the Aragonese court (15th-16th centuries), that are preserved in the Basilica of Saint Domenico Maggiore in Naples. The autopsy performed on the natural mummy of Ferrante I of Aragon (1424-1494), revealed a well-preserved rectum. Histology showed crowded epithelial tumour cells, disposed in cords and glands, typical of a moderately differentiated mucinous adenocarcinoma. Strong immunoreactivity for pan-cytokeratin was shown and DNA analysis of K-RAS exons 1-2 demonstrated the presence of a mutation characteristic of sporadic colorectal cancer and associated with exposure to natural carcinogens present in the diet. The histological study of the natural mummy of Prince Luigi Carafa (1511-1576) revealed an extraordinarily well-preserved colon mucosa with an evident villous adenoma and strong immune-positivity for keratins and p53. In some points, clear invasion of the polyp stalk or of the submucosa was evident: this histological picture is that of a well differentiated adenocarcinoma at stage T1. The natural mummy of Duke Ferdinando Orsini (ca1490-1549), showed a wide destructive lesion of the right orbit and nose. Bone histology revealed large lacunae destroying the normal lamellar bone, containing clusters of cells with solid epithelial-like aspects and a darker margin “at palisade” (Fig. c, arrow), with strong positivity for pan-cytokeratin, typical of a destructive basal cell carcinoma. The small series of mummies from Naples, composed of eleven adults (10 males and 1 female) with well three cases of cancer in individuals between 55 and 71 years of age, is very important. Despite the limited number of specimens, the cancer prevalence of 27.0% that was found is similar to the 30.9% rate in modern countries. We can hypothesize that cancer must have been frequent after 50-60 years of age, at least in the Renaissance elite classes with peculiar alimentary and life style habits, as in this series of Spanish nobles. In conclusion, the statements according to which cancer was an extremely rare event in the past populations should be revised. Future accurate autoptic studies of mummies will be essential not only to diagnose new paleopathological cases, but also to clarify the mechanisms of ancient neoplastic progression.