宁夏石砚子墓地颅骨缺损个体的古病理学

doi:10.16359/j.cnki.cn11-1963/q.2020.0050

摘要/Abstract

摘要：

本文对出土于宁夏东汉时期的石砚子墓地中一例罕见颅骨病理性损伤个体进行了古病理学诊断分析,该男性个体颅骨上可见不规则形大面积骨质破坏,累及额骨、左侧顶骨、左侧颞骨以及右侧顶骨,缺损周缘可见成骨性、溶骨性反应混合特征,呈向内、外翻卷状,边缘伴有骨膜反应,颅内壁可见较深血管压迹。通过CT影像分析骨骼损伤形态、骨骼损伤区域特征,并结合临床医学资料进行鉴别诊断,排除了朗格汉斯细胞组织细胞增生症、骨血管瘤、Gorham-Stout综合征、骨髓瘤和非特异性感染,推测该病例的病理诊断为甲状腺癌导致的继发性颅骨转移癌。

关键词: 转移癌, 颅骨缺损, CT技术, 石砚子墓地, 汉代

Abstract:

This study reports a paleopathological differential diagnosis on the skeleton from Shiyanzi Cemetery site of Han Dynasty(2040 BP) in Ningxia. This specimen shows bone lesion on most part of the calvarium. Margins of lesion demonstrate scalloped borders with osteoblastic marginal uplift. The irregular and inward to outward-like beveled margins shows a possible neoplasm from the inside out. The combination of macroscopic observation and CT scanning provides more comprehensive information about ancient human disease and improves the credibility of diagnosis. According to the previous clinical reports, based on the morphology, distribution of the lesion, this individual may suffered from a severe metastatic carcinoma.

Key words: Metastatic carcinoma, Cranial lesion, CT, Shiyanzi Cemetery, Han Dynasty

中图分类号:

Q983

张群, 王晓阳, 叶惠媛, 张全超. 宁夏石砚子墓地颅骨缺损个体的古病理学[J]. 人类学学报, 2020, 39(04): 586-598.

ZHANG Qun, WANG Xiaoyang, YEH Huiyuan, ZHANG Quanchao. Paleopathological study on the skeleton with cranial lesion from the Shiyanzi Cemetery in Ningxia[J]. Acta Anthropologica Sinica, 2020, 39(04): 586-598.

图/表 7

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	转移癌 Metastatic carcinoma	朗格汉斯细胞组织细胞增生症Langerhans cell histiocytosis	骨血管瘤Hemangiomas	Gorham-Stout 综合征 syndrome	骨髓瘤 Multiple myeloma	非特异性感染（骨髓炎）Osteomyelitis	本病例 Present case
好发年龄 Age of onset	中老年	青年(80%低于30岁)	可发生于任何年龄(30-50岁高发)	儿童和青年(5-25岁高发)	40岁以上	可发于任何年龄	35-40岁
性别Sex incidence	无差别	男性多于女性	女性多于男性	无差别,男性略多于女性	男性较多	男性略多于女性	男性
累及部位 Skeletal elements affected	颅骨、椎骨、骶骨、肱骨近端、股骨近端、肋骨、胸骨、骨盆	颅骨、下颌骨、椎骨、盆骨、股骨、肋骨、	可发生于任何骨骼,以脊柱、颅面骨多见	全身各骨,肩胛骨肋骨、脊柱、骨盆、四肢骨多见,颅骨少见	椎骨最为常见,也可见于颅骨、肋骨、盆骨、肩胛骨、锁骨、长骨	累及骨骼的任何部位,在颅骨上多见于额骨、顶骨	仅保存颅骨
损伤尺寸 Lesion size	尺寸和形态变化,可成片形成大型骨损伤	尺寸一般介于10-50mm²,可成片	尺寸范围较大	尺寸范围较大	尺寸一般为0.5-20mm²的卵圆形损伤	尺寸范围较大	大面积不规则缺损
损伤特征 Lesion composition	多发性、溶骨性、成骨性或混合,穿凿样、鼠咬状骨质破坏	单发较多,穿凿样溶骨性损伤	单发或多发,以单发者多见,溶骨性卵圆形骨质破坏	多发性,溶骨性,无成骨性反应	常见多发性溶骨性损伤、弥漫性骨量减少	单发或多发不规则溶骨性骨破坏,可见骨性窦道	溶骨性与成骨性混合特征、边界清晰,大型骨质缺损
影像学表现 Radiographic appearance	边界清晰,可见大小不等的扇形或锯齿状边缘,甚至略微抬升、翻卷的新生骨边缘,骨膜反应可见	边界清晰,无骨膜反应,可见虫蚀样骨损伤,可见“纽扣样”死骨,扇形圆齿状边缘	边缘清晰锐利,呈细齿状,且可有硬化缘,内外板变薄,病变区骨皮质膨胀变薄,呈“栅栏状”、“网眼状”或“日光放射状”骨质破坏	边缘无骨质硬化	可见虫蚀样骨损伤和锐利的非硬化边缘,以及骨膜内扇形圆齿状边缘	边界清晰伴有薄层高密度的硬化边缘,可见死骨或“骨柩”征象,颅骨外板一般无骨膜反应	鼠咬状骨质破坏,边界可见扇形、锯齿形硬化翻卷边缘、边缘板障部分地被致密骨封闭、可见新骨生成及骨膜反应
参考文献 References	1,14,17	26-27,49-50	28-31	35-38	41-43	46-48

	转移癌 Metastatic carcinoma	朗格汉斯细胞组织细胞增生症Langerhans cell histiocytosis	骨血管瘤Hemangiomas	Gorham-Stout 综合征 syndrome	骨髓瘤 Multiple myeloma	非特异性感染（骨髓炎）Osteomyelitis	本病例 Present case
好发年龄 Age of onset	中老年	青年(80%低于30岁)	可发生于任何年龄(30-50岁高发)	儿童和青年(5-25岁高发)	40岁以上	可发于任何年龄	35-40岁
性别Sex incidence	无差别	男性多于女性	女性多于男性	无差别,男性略多于女性	男性较多	男性略多于女性	男性
累及部位 Skeletal elements affected	颅骨、椎骨、骶骨、肱骨近端、股骨近端、肋骨、胸骨、骨盆	颅骨、下颌骨、椎骨、盆骨、股骨、肋骨、	可发生于任何骨骼,以脊柱、颅面骨多见	全身各骨,肩胛骨肋骨、脊柱、骨盆、四肢骨多见,颅骨少见	椎骨最为常见,也可见于颅骨、肋骨、盆骨、肩胛骨、锁骨、长骨	累及骨骼的任何部位,在颅骨上多见于额骨、顶骨	仅保存颅骨
损伤尺寸 Lesion size	尺寸和形态变化,可成片形成大型骨损伤	尺寸一般介于10-50mm²,可成片	尺寸范围较大	尺寸范围较大	尺寸一般为0.5-20mm²的卵圆形损伤	尺寸范围较大	大面积不规则缺损
损伤特征 Lesion composition	多发性、溶骨性、成骨性或混合,穿凿样、鼠咬状骨质破坏	单发较多,穿凿样溶骨性损伤	单发或多发,以单发者多见,溶骨性卵圆形骨质破坏	多发性,溶骨性,无成骨性反应	常见多发性溶骨性损伤、弥漫性骨量减少	单发或多发不规则溶骨性骨破坏,可见骨性窦道	溶骨性与成骨性混合特征、边界清晰,大型骨质缺损
影像学表现 Radiographic appearance	边界清晰,可见大小不等的扇形或锯齿状边缘,甚至略微抬升、翻卷的新生骨边缘,骨膜反应可见	边界清晰,无骨膜反应,可见虫蚀样骨损伤,可见“纽扣样”死骨,扇形圆齿状边缘	边缘清晰锐利,呈细齿状,且可有硬化缘,内外板变薄,病变区骨皮质膨胀变薄,呈“栅栏状”、“网眼状”或“日光放射状”骨质破坏	边缘无骨质硬化	可见虫蚀样骨损伤和锐利的非硬化边缘,以及骨膜内扇形圆齿状边缘	边界清晰伴有薄层高密度的硬化边缘,可见死骨或“骨柩”征象,颅骨外板一般无骨膜反应	鼠咬状骨质破坏,边界可见扇形、锯齿形硬化翻卷边缘、边缘板障部分地被致密骨封闭、可见新骨生成及骨膜反应
参考文献 References	1,14,17	26-27,49-50	28-31	35-38	41-43	46-48