luna et al. 2008 (bioarqueología)

International Journal of OsteoarchaeologyInt. J. Osteoarchaeol. 18: 492–506 (2008)Published online 14 November 2007 in Wiley InterScience

50
(www.interscience.wiley.com) DOI: 10.1002/oa.9
* Correspondence to: CONICsetti, Facultad de Filosofıa yMoreno 350 (1091), Ciudad Ae-mails: [email protected];

Copyright # 2007 Joh

A Case of Multiple Metastasisin Late Holocene Hunter-Gatherersfrom the Argentine PampeanRegion

L. H. LUNA,a* C. M. ARANDA,b L. A. BOSIOc AND M. A. BERONd

a CONICET, Museo Etnografico J. B. Ambrosetti, Facultad de Filosofıa y Letras, Universidad

de Buenos Aires, Moreno 350 (1091), Ciudad Autonoma de Buenos Aires, Argentinab Museo Etnografico J. B. Ambrosetti, Facultad de Filosofıa y Letras, Universidad de Buenos

Aires, Ciudad Autonoma de Buenos Aires, Argentinac Servicio de Antropologıa Forense, Catedra de Medicina Legal, Facultad de Medicina,

Universidad de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentinad CONICET, Museo Etnografico J. B. Ambrosetti, Facultad de Filosofıa y Letras, Universidad

de Buenos Aires. INCUAPA, Facultad de Ciencias Sociales, Universidad del Centro de la

Provincia de Buenos Aires, Argentina

ABSTRACT Chenque I site is a prehistoric cemetery located in Lihue Calel National Park (La Pampaprovince) in the Western Pampean region of Argentina. Hunter-gatherer societies made use ofthis site during the Final Late Holocene for at least 700 years (1030–370 BP). Currently 41burial structures have been excavated, and more than 150 individuals have been recovered.There is great variability in mortuary patterns at the site (simple, multiple, primary, secondaryburials, and also a variant not previously observed in the region).

The life-ways of this population have been investigated through the evaluation of severalbiological and cultural factors. Several pathological conditions have also been identified in thiscemetery. Burial no. 12 contains a skeleton of an adult male that shows multiple pathologicallesions, compatible with a neoplastic disease. These lesions have been analysed usingseveral methodological strategies: macroscopic, radiological and microscopic. This is the firsttime that this kind of disease has been identified from a prehistoric burial in Argentina.

In this paper the location and characteristics of the lesions are evaluated, and the differentneoplastic diseases that could have produced them are discussed. Since the people buried inthis cemetery belonged to highly mobile societies, a key issue is to infer the consequencesthat this disease would have had on the dynamics of the group in which this person lived,because of the gradual deterioration of his health and physical strength. Copyright � 2007John Wiley & Sons, Ltd.

Key words: bioarchaeology; palaeopathology; multiple metastasis; cancer; hunter-

gatherers; Pampean region; Argentina

.

Introduction

This paper describes and interprets lesions identi-fied in the bones recovered from Burial no. 12

ET, Museo Etnografico J. B. Ambro-Letras, Universidad de Buenos Aires,utonoma de Buenos Aires, [email protected]

n Wiley & Sons, Ltd.

from the Chenque I site. This site is a prehistoriccemetery located in Lihue Calel National Park(La Pampa province), in the western Pampeanregion, Argentina (Figure 1). The results obtainedare discussed, with an attempt to identify the typeof disease that could have caused these lesions,the symptomatology suffered by this individual,and the potential biosocial consequences.

Received 15 March 2006Revised 20 April 2007

Accepted 25 April 2007

Figure 1. Location of the Lihue Calel National Park, and the Chenque I site. This figure is available in colour online atwww.interscience.wiley.com/journal/oa.

A Case of Metastasis in Hunter-Gatherers from Argentina 493

Hunter-gatherer societies made use of theChenque I site during the end of the LateHolocene,between 1030 and 370BP. This chronologicalrange was obtained from nine radiocarbon dates(Table 1). So far, 49 square metres have beenexcavated, about 23% of the total area. Thiscemetery has two units clearly defined, each withvery different characteristics. The Superior Unit(0–30 cm depth) contains thousands of bony anddental remains of different degrees of fragmenta-tion, commingling, arrangement and anatomicassociation. These characteristics are the con-sequence of the intensive reutilisation of the

Copyright # 2007 John Wiley & Sons, Ltd.

cemetery over 700 years. In the Inferior Unit(below 30 cm), 41 burials were found. Most ofthese burials are clearly defined because of twocircumstances: the presence of stone structuresabove or under the corpses, and/or the lack ofarchaeological items around them. We haverecorded a great deal of variability of inhumationsat this site: simple, multiple, primary, secondaryburials, as well as a variant not previouslyregistered in the country, called disposition. Thisterm refers to a situation in which the anatomicalstructure of the corpse is modified immediatelyafter death, with an intentional arrangement. It

Int. J. Osteoarchaeol. 18: 492–506 (2008)DOI: 10.1002/oa

Table 1. Radiocarbon dates from the Chenque I site

Sample origin Lab source Radiocarbon date (BP) Material

Superior Unit AA 35950 1029� 43 Third upper left molarAA 35951 869� 43 Third upper left molarUGA 10627 740� 70 First upper left molarUGA 10628 730� 70 Second lower left premolar

Burial 7 AA 35952 904� 43 Third upper left molarBurial 8 AA 35953 901� 43 Third upper right molarBurial 14 UGA 10624 700� 40 Lateral upper left incisorBurial 15 UGA 10625 830� 40 Proximal foot phalangeBurial 16 UGA 10626 370� 40 Proximal hand phalange

Source: Adapted from Beron and Baffi (2004: 392).

494 L. H. Luna et al.

occurs prior to the skeletonisation process, whensoft tissues are still present. Different skeletal partsof the body (skull, trunk, apendicular skeleton,etc.) were disarticulated and reordered, forming afunerary package with definite limits (Beron et al.,2000, 2005; Beron, 2004; Luna et al., 2004).Due to the multiple forms of evidence and

the great quantity of recovered information,Chenque I site is one of the most importanthunter-gatherer mortuary sites in Argentina. Inboth units, a great deal of cultural material hasbeen identified. The majority of the artefacts arebeads manufactured from different raw materials(mollusks, bone, stone, etc.), but other ornamentshave been also found (e.g. metal pendants). TheMNI (minimum number of individuals) identifiedso far for the Superior Unit is 53, and for theInferior Unit 105, for a total of 158 individuals,including adults and subadults, males and females.The methodological procedures employed toobtain the MNI value are described in Bokonyi(1970), Orchard (2005) and Ubelaker (1974). Itcan then be stated that at this site several hundredbodies have been buried, which is a significantpoint because the societies that buried thecorpses here were hunter-gatherer groups witha high degree of mobility, long-distanceexchange and interaction networks (Beron et al.,2000, 2002, 2005; Beron, 2003, 2004, 2005a,b;Luna, 2003; Luna et al., 2004; Beron & Luna,2005a,b).

Osteological analysis

Burial no. 12 contains a skeleton of an adultmale approximately 40–50 years old, buried in a


primary flexed position (Figure 2). Estimation ofsex was obtained through the metrical evaluationof the humeral and femoral heads and themorphological analysis of the fragments of theos coxae (Bass, 1987; Buikstra & Ubelaker, 1994).Age-at-death was estimated by evaluating thecharacteristics of the pubic symphysis (Todd,1921a,b; Katz & Suchey, 1986). This man’s staturein life is estimated at 185� 9 cm. This burial islocated in the outermost southwest end of thesite, and only two valve beads were associatedwith the bones. Direct radiocarbon dating wasnot possible because of the lack of bone collagen,but this burial is included in the chronologicalrange of the site, as mentioned above.

The skeleton shows numerous pathologicallesions at a number of sites. The bones recovered,shown in Figure 3, were analysed macroscopically,radiographically and microscopically. Theskeleton is incomplete (about 70% of the boneswere recovered), with a number of missing bones:the skull, teeth (except the first right lowerpremolar), sternum, left scapula, clavicle, radiusand ulna; right humerus, patella and tibia, andalmost all the bones of both hands. These bonescould be absent because of the action of multipletaphonomic agents (Di Donato, 2005). In thespecific case of the skull, its absence may also berelated to a particular mortuary behaviour. In fact,three cases of isolated skulls have been found at thesite (Beron & Luna, 2005b). The burial of isolatedanatomical parts has also been recorded at othersites in the Pampean Region (Mazzia et al., 2004).The elements that present the lesions describedbelow have a high degree of fragmentation.

The majority of the lesions, when viewedmacroscopically, are numerous, well-defined


Figure 2. Burial 12. Note the primary modality and the absence of several bones (i.e. the skull).


osteolytic images, located only in specific areas ofthe skeleton: the thorax (dorsal arches ofvertebrae and diaphyses of ribs) (see Figure 4),the pelvis (os coxae and sacrum) and scapula(body and coracoid process) (Figure 5), andproximal epiphyses of both femora, left humerus(Figure 6) and right ulna. The long bonediaphyses, their distal epiphyses, and the bonesof feet are unaffected. The shape of the lesions isrounded/elliptical, in several cases irregularlyshaped, or geographical (Rothschild et al., 2002),confluent, with blunt borders. In all the cases, themaximum diameter does not exceed 8mm.X-ray images were taken of the pathological

bones. They show similar images, that is, severalosteoclastic lesions with well-defined limits andwithout sclerotic borders. They are clearlyidentified in the vertebrae (Figure 7), the rightscapula (Figure 8), and the proximal third of thefemora (Figure 9). Many small circular and ovoidlesions, several medium to small oval foci, and


some large pseudocircular areas of lucidity wereidentified radiographically in all the bones thatwere externally affected. Practically all the innerfoci penetrate the outer lamina, so there areexternal manifestations in the form of roughlycircular and oval foci of different dimensions inthe cortical bone in all cases.Some of the bones were observed in a scanning

electron microscope (SEM). The images aresimilar to the macroscopic observations. Thetrabeculae of the spongy bone show multipledestructive cavities, which areHowship’s lacunae,irregularly-located products of osteoclasticactivity. The borders of the osteolytic imagesare smooth, without new bone formation(Figures 10 and 11). Some images show earliersteps in the destructive process (Figure 10), whileothers show the latest manifestation of osteo-clastic activity (bottom of Figure 11).Moreover, several osseous exostoses were

identified in different zones of the skeleton. For


Figure 3. The bones recovered from Burial no. 12. Thosethat present the lytic lesions are drawn in dark grey.

Figure 5. Coracoid process of the right scapula withseveral osteoclastic lesions. This figure is available incolour online at www.interscience.wiley.com/journal/oa.


example, this is the case for spicular bonyreactions on the supero-dorsal face of theproximal half of the right clavicle (Figure 12).Several exostoses were also identified in the

Figure 4. Lumbar vertebral arch showing the osteolyticlesions. This figure is available in colour online at www.interscience.wiley.com/journal/oa.


spinous apophysis of many thoracic vertebrae,where the supraspinous ligament inserts(Figure 13). This ligament acts in the flexoexten-sion of the vertebral column; it is loose inextension and increases its strain during flexion ofthe trunk.

Discussion

The shape, size, absence of bone reaction, anddistribution in the skeleton of the osteolyticlesions are similar to those produced by someneoplastic diseases (cancer), such as multiplemyeloma (or myelomatosis), leukaemia ormultiple metastasis (Ortner & Putschar, 1985;Strouhal, 1991, 1993; Rothschild et al., 1997,1998; Sefcakova et al., 2001).

Multiple myeloma and leukaemia are malig-nant hematogenous diseases, considered formsof primary cancers. Their aetiology is unknownand they affect the hematopoetic cells located inbone marrow. Multiple myeloma produces anabnormal quantity of plasmocits, and generallyaffects individuals from 40 to 70 years of age.Leukaemia is characterised by the uncontrolledincrease of blood cells. It affects individuals of allages, adults and subadults. In both cases, the mostusual macroscopic manifestation is the presenceof numerous osteolytic lesions. In the case ofmultiple myeloma, these are generally spherical


Figure 6. Proximal epiphysis of the left humerus showing multiple osteolytic fossae. This figure is available in colouronline at www.interscience.wiley.com/journal/oa.

Figure 7. RX image of a dorsal vertebra with osteoclasticlesions with well-defined limits and without sclerotic bor-ders (arrows).



and homogeneous in size with clearly definedborders, whereas in leukaemia they are moreelliptical and irregular. In both diseases, the mostaffected parts of the skeleton are those thathave active bone marrow, especially the skull,vertebrae, ribs and long bone epiphyses (Ortner &Putschar, 1985; Rothschild & Rothschild, 1995;Rothschild et al., 1997, 1998, 2002; Roberts &Manchester, 1999).Neoplasia is a term that defines a mass of

localised tissue whose cellular reproduction is notnormal. Benign neoplasias cannot destroy sur-rounding cells or migrate to other parts of thebody, while malignant neoplasias destroy normaltissues and produce new malignant outgrowths indifferent parts of the body, called metastases. Inother words, multiple metastasis is a secondarymanifestation of a neoplasia. Spreading can occurvia the lymphatic system, but it is more frequentlyhematogenous. In the case of multiple metastases,those osseous areas with more vascularisationare the most affected (Morse, 1978; Aufderheide& Rodrıguez-Martın, 1998; Eisenberg, 1998;Roberts & Manchester, 1999; Campillo, 2001;Ortner, 2003).


Figure 8. RX image of the right scapula. The radiolucentzones are clearly defined (arrows).


In the majority of the cases it is not possible toidentify precisely the disease that caused thelesions. Nevertheless, careful analysis of the typeand distribution of the lesions, together withinformation about the sex and age of theindividual, can sometimes contribute to theidentification (Strouhal, 1991, 1993; Andersonet al., 1992; Rothschild et al., 1998, 2002; Ortner,2003).There are a number of features that allow us to

discard leukaemia as the main cause of thedisease, such as for example the precisemorphology and location of the lesions. Inaddition, intracortical reabsortion and radiolu-cent bands in the metaphyses are featuresgenerally present in skeletons with leukaemia(Steinbock, 1976; Rothschild et al., 1997; Eisen-berg, 1998). Both are absent in this case. Inreference to radiolucent bands, Rothschild et al.


(1997: 491) stated that ‘as the presence ofmetaphyseal bands has not been reported inmetastatic cancer, then they may be helpful indistinguishing leukemia and metastatic cancer’.Moreover, it is possible to differentiate myelomaand leukaemia from secondary tumours becausethe two former conditions hardly ever affect thevertebral pedicle, especially in dorsal and lumbarvertebrae, due to its lack of bone marrow. On theother hand, metastatic cancer affects this areavery frequently (Steinbock, 1976; Rothschildet al., 1997; Eisenberg, 1998), as in this skeleton(Figure 14). All of this evidence supports theinterpretation that the lesions found in thisindividual are the product of some kind ofneoplasia or cancer that produced secondarymanifestations or metastasis in the skeleton, andthat this was probably the cause of death of thisman.

Moreover, it can be stated that this manundertook activities that required strong use ofseveral parts of the body during his healthy life.This can be inferred from the presence of manybony exostoses located in zones of muscularinsertions. The enthesoexostoses identified (sensuCampo Martın, 1998) are located at the insertionof the sternocleidomastoideus muscle (Rouviere,1980; Stone & Stone, 1990), and may be theconsequence of muscular or subperiostic lesions,due to violent efforts and/or a systematic use ofthe muscles. The irritation could have producedthe calcification of the hematoma adjacent to thelesion (Rogers & Waldron, 1995; Larsen, 2000).Other groups of lesions, identified in vertebrae,are compatible with systematic movements offlexoextension of the musculoskeletal complex ofthe column (Rouviere, 1980; Stone & Stone,1990), and the presence of all the hypertrophiclesions of entheses suggests recurrent mechanicstress around the neck, pectoral girdle and trunk.

There are different types of cancer that canproduce secondary bony lesions or multiplemetastasis. The most frequent types are prostateand breast cancer, although lung, kidney, thyroidgland and gastrointestinal tract cancer should alsobe taken into account, in that order (Gregg et al.,1982; Duhig et al., 1996; Roberts & Manchester,1999; Ostendorf Smith, 2002; Ortner, 2003). Inthis case, prostate and breast cancer can beexcluded as causes of these lesions, the first


Figure 9. RX image of the proximal third of the right femur with several lytic areas in the neck and the greater trochanter(arrows).


because it mainly produces osteoblastic or bothosteoblastic and osteoclastic bony reactions, verydifferent from those observed in this case(Anderson et al., 1992; Wakely et al., 1995; Mayset al., 1996; Waldron, 1997), and the secondbecause it is very uncommon for males to havebreast cancer. Because of the wide spectrum oforigins of this disease and the similarities ofosseous manifestations, it would be very specu-lative to establish a narrower palaeopathologicaldiagnosis regarding the kind of primary cancerthat caused the lesions (Morse, 1978; Dastugue,1980; Aufderheide & Rodrıguez-Martın, 1998;Ortner, 2003).Although Dettwyler (1991: 375) has consist-

ently demonstrated that ‘we are not justified indrawing conclusions either about the quality oflife for disabled individuals in the past or aboutthe motives or attitudes of the rest of the


community from skeletal evidence of physicalimpairment’, it is possible, evaluating the medicalknowledge about the symptomatology and thesequence of the corporal deterioration suffered bypeople with similar diseases, to offer a hypothesisabout the process that led to the death of thisindividual. Following Scheer & Groce (1988, inDettwyler, 1991) and the World Health Organ-ization, Dettwyler (1991) distinguished betweenthe definitions of impairment, disability andhandicap. She established that impairment is anabnormality or loss of any physiological oranatomical structure or function. Disability refersto the consequences of impairment, any restric-tion or lack of ability to perform an activityappropriate for non-impaired persons; and ahandicap is the social disadvantage that resultsfrom an impairment or disability. As a con-sequence of this, the assumption that the survival


Figure 10. SEM image showing the rounded lesions in the cortical zone. This corresponds to the beginning of thedestruction process.


of the individual provides enough evidence ofcompassion has been challenged. We couldhardly ever know with certainty anything aboutthe handicap consequence of this disability fromarchaeological records alone, but it is possible toobtain information about impairment, and then toinfer the degree of disability of the individual,from the palaeopathological analysis (Dettwyler,1991; Hawkey, 1998).Neoplastic diseases are generally long-term

illnesses. In this case, the characteristics of themetastatic lesions are compatible with a terminaldisease in the late phase of development whichthis individual suffered for a relative long periodof time, probably several months. Because he didnot receive any effective treatment, he progress-ively lost his muscular capacity, with a slow butconstant increase in fatigue, weakness and pain allover his body. His vital functions graduallycollapsed. During several years of his adult life,this individual probably undertook activities thatrequired strong and systematic use of severalmuscles, mainly of the trunk, pectoral girdle andneck. Subsequently, he suffered an increasingmuscular atrophy caused by the disease.


At the level of the broader social group, it isinteresting to explore the consequences thatthe illness this person was suffering may have hadfor the group’s dynamics and mobility. Thisaspect is especially important because the peopleburied in this cemetery belonged to hunter-gatherer groups that had a high level of mobilityand whomaintained long-distance exchanges andinteraction networks. This is supported by severalkinds of evidence. One of them is the differencein the levels of carbon and nitrogen stable iso-topes of some of the skeletons excavated, whichindicate both a continental diet and a comp-lement of about 20%marine consumption (Beron,2004; Beron & Baffi, 2004). Another indicator isthe presence of artefacts accompanying theburials, manufactured with raw materials fromvery distant areas. Among them there are lithicartefacts of orthoquartzite, a raw material whoseoutcrops are about 600 km to the east of this site.There are also pendants and beads made ofshells of molluscs from the Atlantic coast. Inaddition, metal bijou from the trans-Andeanregion was recovered with the burials, betweenthem a fragment of tupu made of silver using


Figure 11. SEM image that shows the well-defined borders of several lytic fossae, without sclerotic borders andevidence of new bone formation. Black arrows point to the lytic lesions in the earlier stages of development, and whitearrows, those at the end of the osteoclastic activity.

Figure 12. Proximal epiphysis of right clavicle, with spicular bony reaction in the supero-dorsal face. This figure isavailable in colour online at www.interscience.wiley.com/journal/oa.

Copyright # 2007 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. 18: 492–506 (2008)DOI: 10.1002/oa


Figure 13. Bony exostosis at the end of the spinous pro-cess of a dorsal vertebra. This figure is available in colouronline at www.interscience.wiley.com/journal/oa.


prehispanic techniques, and a pendant made ofcopper, whose morphology is reminiscent ofothers from central Chile (Beron et al., 2002;Cimino et al., 2004; Beron & Gonzalez, 2005;Cimino & Pastorino, 2005).

Figure 14. Pedicle of a lumbar vertebra, affected by osteoclwww.interscience.wiley.com/journal/oa.


It can be stated as a hypothesis that, as aconsequence of his impairment, in the latestmonths of his life this individual may have neededthe increasing assistance of other members of thesocial group in order to move and satisfy his basicneeds. During the end of his disease, his disabilitywas an impediment to participating in everydayactivities (Dettwyler, 1991; Hawkey, 1998). Thedisease process was probably very shocking to themembers of his family and his social group,because of his previous robusticity, but especiallybecause in practically all medical cases, cognitivecapacity is not affected. In the last days, theseverity of the condition surely increased, and thedependence on other people may have beencomplete, implying that he could have requiredsomeone to supply him with food.

Conclusions

Burial no. 12 from Chenque I site contains askeleton of a male that presents multipleosteolytic lesions in the vertebral column, ribs,pelvis and some long bone epiphyses. Many of

astic destruction. This figure is available in colour online at



the bones were partially destroyed by tapho-nomic agents, due to the structural debilitationcaused by the osteoclastic process. The lesionsare compatible with secondary lesions conse-quent of some kind of neoplasia or cancer thatcaused the death of this man. Moreover, somehypertrophied zones of muscular attachmenthave been identified in the clavicle and vertebralcolumn, caused by systematic mechanic stress tothe neck, shoulder girdle and upper vertebralcolumn during the life-span of this individual.There are very few cases of metastatic cancer

throughout the world identified from bioarch-aeological evidence, although the number ofpapers that evaluate this issue have substantiallyincreased during the last 20 years (Dastugue,1980; Waldron, 1987; Strouhal, 1991; Rothschild& Rothschild, 1995; Strouhal et al., 1996; Roberts& Manchester, 1999; Ostendorf Smith, 2002;Capasso, 2005). The identification of a case ofmetastatic cancer in the context of the Chenque Isite is very important since this is the first case inArgentina in which it is possible to identifyneoplastic disease in a prehistoric burial. Whenwe examine the provenance of the cases ofneoplasias in published papers from around theworld and at different periods of time, it can beseen that the majority of these investigationsidentify this condition in human remains frommedieval and modern Europe, and Predynasticand Dynastic Egypt, whereas hunter-gatherer-fisher societies are hardly ever represented(Aufderheide & Rodrıguez-Martın, 1998; Ortner,2003; Capasso, 2005). Capasso (2005) exten-sively reviewed the cases of cancer detected inarchaeological burials, and stated that the pre-valence of primary and metastatic neoplasias wasextremely low all around the world in pre-medieval times. Moreover, Strouhal (1998, 2001)stated that only during the first millennium AD,and especially after the Middle Ages, was therean increase in the frequencies of neoplasticdiseases observed in bioarchaeological samples.We wonder whether this pattern reflects the realproportion in which these diseases are present indifferent societies, or the sample biases producedby dissimilar patterns of mobility and inhumationof the bodies. We suppose that this temporalpattern also reflects the assumptions made by theresearchers, who consider the chance of detect-


ing these diseases in archaeological human bonesfrom ‘non-producer societies’ to be low. It mayalso reflect, in part, the theoretical idea, stillimplicitly held by some scholars, that hunter-gatherers were always in balance and harmonywith their environment, and that particular situa-tions of individual and population stress are onlyrelevant in societies traditionally classified asstratified or ranked by social and politicalorganisation and the existence of institutionalisedhierarchies.

Acknowledgements

Several institutions have contributed to thisresearch through grants and logistic support:the National Council of Technical and ScientificResearches (CONICET), the University of BuenosAires, the National Parks Administration (APN)and the Subsecretary of Culture of La Pampaprovince. Felix Acuto revised the translation intoEnglish. We thank Eugen Strouhal and two anon-ymous reviewers for their comments.

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