journal article·2026-05-10Open access

Plasma cell myeloma: multiple calvarial lytic lesions of an individual from the Middle Ages, Poland

Dorota Lorkiewicz-Muszyńska, Szymon Rzepczyk, Marta Andrzejewska, Katarzyna Derwich, Marcin Krzepkowski, Iwona Sobkowiak-Tabaka

npj Heritage Science· Volume 14· Issue 1

Abstract

Abstract A partially preserved cranium affected by multiple lytic lesions was discovered accidentally by a farmer during fieldwork in Rgielsko village, Poland. The discovery was reported to the Prosecutor’s office and the police. Macroscopic and microscopic examinations, medical imaging methods, and radiocarbon dating were conducted. The main aim of the study was to diagnose lytic lesions and to study the archaeological context. The biological profile assessment results indicated the cranium belonged to an adult female. Computed tomography, common in clinical practice, enabled the diagnosis of the lesions as Plasma Cell Myeloma (PCM). Radiocarbon dating results showed that the individual dates to the 11th–12th centuries AD. The examined cranium may help expand the limited paleopathological literature on PCM in Poland and contribute to the global number of reported cases. The clinical examinations were limited to medical imaging studies because other diagnostic tests, such as blood/urine and bone marrow analyses, were not possible.
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Research context

OpenAlex topics: Multiple Myeloma Research and Treatments · Forensic Anthropology and Bioarchaeology Studies · Genital Health and Disease

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

References (72)

Show source-provided references
1. Anderson, T., Wakely, J. & Carter, A. R. Medieval example of metastatic carcinoma: a dry bone, radiological, and SEM study. Am. J. Phys. Anthropol. 89, 309–323 (1992).10.1002/ajpa.1330890305 ↗
2. Rothschild, B. M., Hershkovitz, I. & Dutour, O. Clues potentially distinguishing lytic lesions of multiple myeloma from those of metastatic carcinoma. Am. J. Phys. Anthropol. 105, 241–250 (1998).10.1002/(SICI)1096-8644(199802)105:2<241::AID-AJPA10>3.0.CO;2-0 ↗
3. Alaggio, R. et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia 36, 1720–1748 (2022).10.1038/s41375-022-01620-2 ↗
4. Ortner, D. J. Identification of Pathological Conditions in Human Skeletal Remains, 2nd edition. Academic Press, San Diego. https://doi.org/10.1016/B978-0-12-528628-2.X5037-6. (2003).10.1016/B978-0-12-528628-2.X5037-6 ↗
5. Ellington, T. D., Henley, S. J., Wilson, R. J., Wu, M. & Richardson, L. C. Trends in solitary plasmacytoma, extramedullary plasmacytoma, and plasma cell myeloma incidence and myeloma mortality by racial-ethnic group, United States 2003-2016. Cancer Med. 10, 386–395 (2021).10.1002/cam4.3444 ↗
6. Raab, M. S., Podar, K., Breitkreutz, I., Richardson, P. G. & Anderson, K. C. Multiple myeloma. Lancet 374, 324–339 (2009).10.1016/S0140-6736(09)60221-X ↗
7. Turesson, I., Velez, R., Kristinsson, S. Y. & Landgren, O. Patterns of Multiple Myeloma During the Past 5 Decades: Stable Incidence Rates for All Age Groups in the Population but Rapidly Changing Age Distribution in the Clinic. Mayo Clin. Proc. 85, 225–230 (2010).10.4065/mcp.2009.0426 ↗
8. Raab, M. S., Podar, K., Breitkreutz, I., Richardson, P. G. & Anderson, K. C. Multiple myeloma. Lancet. 374, 324–339 (2009).10.1016/S0140-6736(09)60221-X ↗
9. Lloret, I., Server, A. & Taksdal, I. Calvarial lesions: a radiological approach to diagnosis. Acta Radiol. 50, 531–542 (2009).10.1080/02841850902795274 ↗
10. Landgren, O. & Kazandjian, D. Diagnosed with myeloma before age 40. Blood 138, 2601–2602 (2021).10.1182/blood.2021013539 ↗
11. Bertamini, L., D’Agostino, M. & Gay, F. MRD Assessment in Multiple Myeloma: Progress and Challenges. Curr. Hematologic Malignancy Rep. 16, 162–171 (2021).10.1007/s11899-021-00633-5 ↗
12. Holstein, S. A., Grant, S. J. & Wildes, T. M. Chimeric Antigen Receptor T-Cell and Bispecific Antibody Therapy in Multiple Myeloma: Moving Into the Future. J. Clin. Oncol. 41, 4416–4429 (2023).10.1200/JCO.23.00512 ↗
13. Manier, S. et al. Current state and next-generation CAR-T cells in multiple myeloma. Blood Rev. 54, 100929 (2022).10.1016/j.blre.2022.100929 ↗
14. Rocchi, S., Zannetti, B. A., Marconi, G. & Lanza, F. Multiple Myeloma: The Role of Autologous Stem Cell Transplantation in the Era of Immunotherapy. Cells 13, 853 (2024).10.3390/cells13100853 ↗
15. Scott, K., Hayden, P. J., Will, A., Wheatley, K. & Coyne, I. Bortezomib for the treatment of multiple myeloma. Cochrane Haematological Malignancies Group. Cochrane Database Syst. Rev. 4, CD010816 (2016).
16. Brawańska-Maśluch, K. et al. Diagnostic Methods Used in Detecting Multiple Myeloma in Paleopathological Research—A Narrative Review. Heritage 8, 166 (2025).10.3390/heritage8050166 ↗
17. Kondracki, J. Regional geography of Poland [Geografia regionalna Polski], Warszawa (2009).
18. Bednarczyk, J. Archaeological site record card. Rgielsko-Karolin, Wągrowiec commune, Wągrowiec district, site 4, AZP 44-31/32 [Karta ewidencyjna stanowiska archeologicznego. Rgielsko-Karolin, gm. Wągrowiec, pow. Wągrowiecki, stan. 4, AZP 44-31/32] (https://mapy.zabytek.gov.pl/nid, accessed 20.11.2024 r.) (1986).
19. Wyrwa, A. M. The gords at site Ł3 in Łekno and their chronology [Grody na stanowisku Ł3 w Łeknie i ich chronologia]. Stud. i Materiały do Dziejów Pałuk 6, 93–125 (2006).
20. Kowalenko, W. Gords and the gord settlement of early historical Greater Poland (7th to 12th century) [Grody i osadnictwo grodowe Wielkopolski wczesnohistorycznej (od VII do XII wieku)], Poznań (1938).
21. Hensel, W., Hilczer-Kurnatowska, Z. Studies and materials on the settlement of early historical Greater Poland, vol. 5 [Studia i materiały do osadnictwa Wielkopolski wczesnohistorycznej, t. 5], Wrocław-Warszawa-Kraków-Gdańsk (1980).
22. Cnotliwy, E. Early medieval hillforts in the southern part of the Piła woyevodship. Results of verification research [Grodziska wczesnośredniowieczne w południowej części województwa pilskiego]. Slavia Antiq. 32, 171–240 (1990).
23. Wyrwa, A. M. Zbylut’s foundation document for the Cistercian monastery in Łekno from 1153 [Dokument fundacyjny Zbyluta dla klasztoru cysterskiego w Łeknie z 1153 roku], Poznań-Gniezno (2016).
24. Krzepkowski, M., Podzerek, T. In the Footsteps of Ancestors. Archaeological Discoveries in the Wągrowiec Region [Śladami przodków. Odkrycia archeologiczne na ziemi wągrowieckiej], Wągrowiec (2017) .
25. Wyrwa, A. M. Skeletal cemetery in Koninek, Wągrowiec commune, Piła voivodeship. Surface verification report [Cmentarzysko szkieletowe w Koninku, gm. Wągrowiec, woj. pilskie. Sprawozdanie z weryfikacji powierzchniowej],. Wielkopolskie Sprawozdania Archeologiczne 4, 109–119 (1996).
26. Wyrwa, A. M. History and archaeological and architectural research of the Church of the Holy Cross in Łekno, site 19 [Historia i badania archeologiczno-architektoniczne kościoła pw. Św. Krzyża w Łeknie, stan. 19]. Stud. i Materiały do Dziejów Pałuk 6, 13–66 (2003).
27. Walker, P. L. Sexing Skulls Using Discriminant Function Analysis of Visually Assessed Traits. Am. J. Phys. Anthropol. 50, 39–50 (2008).10.1002/ajpa.20776 ↗
28. White, T. D., Black, M. T., & Folkens, P. Human osteology (3-th ed). Elsevier Academic Press (2012).
29. Meindl, R. S. & Lovejoy, C. O. Ectocranial suture closure: a revised method for the determination of skeletal age at death based on the lateral-anterior sutures. Am. J. Phys. Anthropol. 68, 57–66 (1985).10.1002/ajpa.1330680106 ↗
30. Brooks, S. T. Skeletal age at death: reliability of cranial and pubic age indicators. Am. J. Phys. Anthropol. 13, 557–597 (1995).
31. Barszcz, M. & Woźniak, K. Complete sagittal suture closure evaluation based on post mortem computed tomography. Leg. Med. (Tokyo) 52, 101907 (2021).10.1016/j.legalmed.2021.101907 ↗
32. Turp, J. C. & Alt, K. W. Designating teeth: the advantages of the FDI’s two-digit system. Quintessence Int. 26, 01–503 (1995).
33. Lovejoy, C. O. Dental wear in the Libben population: its functional pattern and role in the determination of adult skeletal age at death. Am. J. Phys. Anthropol. 68, 47–56 (1985).10.1002/ajpa.1330680105 ↗
34. Reimer, P., Austin, W., Bard, E., Bayliss, A. & Talamo, S. The IntCal20 Northern Hemisphere radiocarbon age calibration curve (0–55 cal kBP). Radiocarbon 62, 725–757 (2020).10.1017/RDC.2020.41 ↗
35. Bronk Ramsey, C. OxCal version 4.4.2. Available at: https://c14.arch.ox.ac.uk (accessed 19 August 2024).
36. Rajkumar, S. V. et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 15, e538–e548 (2014).10.1016/S1470-2045(14)70442-5 ↗
37. Biehler-Gomez, L., Giordano, G. & Cattaneo, C. Multiple myeloma bone lesions in skeletal remains: Report of two known cases from the 20th century CAL Milano Cemetery Skeletal Collection. Int. J. Osteoarchaeology 29, 101–107 (2019).10.1002/oa.2721 ↗
38. Bauduer, F., Bessou, M., Guyomarc’h, P., Mercier, C., & Castex, D. Multiple Calvarial Lytic Lesions: A Differential Diagnosis from Early Medieval France (5th to 7th c. AD). International Journal of Osteoarchaeology 24, 665–674 (2014).10.1002/oa.2256 ↗
39. Sheikh, Y., & Skalski, M. Raindrop skull. In Radiopaedia.org. (2013).10.53347/rID-24972 ↗
40. Morse, D., Dailey, R. & Bunn, J. Prehistoric multiple myeloma. Bull. N. Y. Acad. Med. 50, 447 (1974).
41. Riccomi, G., Fornaciari, G. & Giuffra, V. Multiple myeloma in paleopathology: A critical review. Int. J. Paleopathol. 24, 201–212 (2019).10.1016/j.ijpp.2018.12.001 ↗
42. Capasso, L. L. Antiquity of cancer. Int. J. Cancer 113, 2–13 (2005).10.1002/ijc.20610 ↗
43. Marques, C., Santos, A. L. & Cunha, E. Better a Broader Diagnosis Than a Misdiagnosis: The Study of a Neoplastic Condition in a Male Individual who Died in Early 20th Century (Coimbra, Portugal). Int. J. Osteoarchaeology 23, 664–675 (2013).10.1002/oa.1294 ↗
44. Nerlich, A. G., Rohrbach, H., Bachmeier, B. & Zink, A. Malignant tumors in two ancient populations: an approach to historical tumor epidemiology. Oncol. Rep. 16, 197–202 (2006).
45. Zink, A. et al. Malignant tumors in an ancient Egyptian population. Anticancer Res. 19, 4273–4277 (1999).
46. Ahmadzadeh, K., Vanoppen, M., Rose, C. D., Matthys, P. & Wouters, C. H. Multinucleated Giant Cells: Current Insights in Phenotype, Biological Activities, and Mechanism of Formation. Front. Cell Developmental Biol. 10, 873226 (2022).10.3389/fcell.2022.873226 ↗
47. Anastasilakis, A. D., Tsoli, M., Kaltsas, G. & Makras, P. Bone metabolism in Langerhans cell histiocytosis. Endocr. Connect. 7, R246–R253 (2018).10.1530/EC-18-0186 ↗
48. Khung, S. et al. Skeletal involvement in Langerhans cell histiocytosis. Insights into Imaging 4, 569–579 (2013).10.1007/s13244-013-0271-7 ↗
49. Saliba, T., Simoni, P., Segers, V. & Boitsios, G. Answer: Multiple lesions of the skull in a 30-month-old girl. Skelet. Radiol. 52, 2519–2521 (2023).10.1007/s00256-023-04315-6 ↗
50. Rothschild, B. Metastatic cancer and multiple myeloma: One ancient, the other a disease of modernity?. Anthropologischer Anz. 80, 39–48 (2023).10.1127/anthranz/2022/1525 ↗
51. Gau, Y. C., Yeh, T. J., Hsu, C. M., Hsiao, S. Y. & Hsiao, H. H. Pathogenesis and Treatment of Myeloma-Related Bone Disease. Int. J. Mol. Sci. 23, 3112 (2022).10.3390/ijms23063112 ↗
52. Terpos, E., Ntanasis-Stathopoulos, I., Gavriatopoulou, M. & Dimopoulos, M. A. Pathogenesis of bone disease in multiple myeloma: from bench to bedside. Blood Cancer J. 8, 7 (2018).10.1038/s41408-017-0037-4 ↗
53. Zhang, F. & Zhuang, J. Pathophysiology and therapeutic advances in myeloma bone disease. Chronic Dis. Transl. Med. 8, 264–270 (2022).
54. Piombino-Mascali, D. et al. Dietary analysis of Piraino 1, Sicily, Italy: the role of archaeopalynology in forensic science. J. Archaeological Sci. 40, 1935–1945 (2013).10.1016/j.jas.2012.11.002 ↗
55. Chapman, M. N. et al. Sarcoidosis in the Head and Neck: An Illustrative Review of Clinical Presentations and Imaging Findings. Am. J. Roentgenol. 208, 66–75 (2017).10.2214/AJR.16.16058 ↗
56. Micarelli, I., Paine, R. R., Tafuri, M. A. & Manzi, G. A possible case of mycosis in a post-classical burial from La Selvicciola (Italy). Int. J. Paleopathol. 24, 25–33 (2019).10.1016/j.ijpp.2018.09.001 ↗
57. Ortner, D. J. Theoretical and methodological issues in paleopathology. In: Human Paleopathology: Current Syntheses and Future Options, 5–11 (1991).10.5962/bhl.title.9196 ↗
58. Miller, E., Radsgale, B. D. & Ortner, D. J. Comment on Palaeopathological Methods. Int. J. Osteoarchaeology 6, 221–229 (1996).10.1002/(SICI)1099-1212(199606)6:3<221::AID-OA267>3.0.CO;2-2 ↗
59. Komar, D. & Buikstra, J. E. Differential diagnosis of a prehistoric biological object from the Koster (Illinois) Site. Int. J. Osteoarchaeology 13, 157–164 (2003).10.1002/oa.670 ↗
60. Carotenuto, G., Bellomo, G., Lauria, G., Miccichè, R. & Sìneo, L. Problems of differential diagnosis in paleopathology. Med. Nei Secoli: J. Hist. Med. Med. Humanities 33, 315–328 (2021).
61. Steinbock, R. T. Paleopathological Diagnosis and Interpretation: Bone Diseases in Ancient Human Populations. Charles C. Thomas, Springfield, Illinois (1976).
62. Torre, O., Giacobini, G. & Sicuro, A. The skull and vertebral column pathology of ancient Egyptians. A study of the Marro Collection. J. Hum. Evolution 9, 41–44 (1980).10.1016/0047-2484(80)90040-8 ↗
63. Suzuki, T. Palaeopathological evidence suggesting multiple myeloma in a skull from the Edo Period of Japan. J. Anthropological Soc. Nippon 89, 107–114 (1981).10.1537/ase1911.89.107 ↗
64. Strouhal, E. & Kritscher, H. Neolithic case of a multiple myeloma from Mauer (Vienna, Austria). Anthropologie 28, 79–87 (1990).
65. Alt, K. W. & Adler, C. P. Multiple myeloma in an early medieval skeleton. Int. J. Osteoarchaeology 2, 205–209 (1992).10.1002/oa.1390020304 ↗
66. Dittmar, J. M., Berger, E. S., Mao, R., Wang, H. & Yeh, H.-Y. A probable case of multiple myeloma from Bronze Age China. Int. J. Paleopathol. 31, 64–70 (2020).10.1016/j.ijpp.2020.10.003 ↗
67. Nerlich, A. G., Zink, A., Hagedorn, H. G., Szeimies, U. & Weyss, C. Anthropological and palaeopathological analysis of the human remains from three “Tombs of the Nobles” of the necropolis of Thebes-west, upper Egypt. Anthropologischer Anz. 58, 321–343 (2000).10.1127/anthranz/58/2000/321 ↗
68. Siek, T. J., Rando, C., Spinek, A. E., Cieślik, A. & Waldron, T. Malignancy in three medieval Polish osteological collections. J. Archaeological Sci.: Rep. 40, 103246 (2021). Part B.10.1016/j.jasrep.2021.103246 ↗
69. Lagier, R., Baud, C. A., Arnaud, G., Arnaud, S. & Menk, R. Lesions characteristic of infection or malignant tumor in Paleo-Eskimo skulls. An anatomical and radiological study of two specimens. Virchows Arch. A, Pathological Anat. Histol. 395, 237–243 (1982).10.1007/BF00429350 ↗
70. Gładykowska-Rzeczycka, J. Neoplasms from ancient cemeteries in Poland. Anthropologie (Brno) 21, 353–364 (1982).
71. Padala, S. A. et al. Epidemiology, Staging, and Management of Multiple Myeloma. Med. Sci. (Basel) 9, 3 (2021).
72. Ludwig, H., Novis Durie, S., Meckl, A., Hinke, A. & Durie, B. Multiple Myeloma Incidence and Mortality Around the Globe; Interrelations Between Health Access and Quality, Economic Resources, and Patient Empowerment. Oncologist 25, e1406–e1413 (2020).10.1634/theoncologist.2020-0141 ↗