Abstract:

In this paper, we focus on a male adolescent unearthed from the Youyilu Cemetery in Kuqa County, Aksu Prefecture, Xinjiang Uygur Autonomous Region. The individual was discovered in WM341, which is dated to the Song-Yuan Period. The estimated age is 14 to 20 years old. Considering the taphonomic context of the tomb, it is reasonable to regard this individual as the tomb owner. Only a set of skeletons has been found. At first glance of the bones, it is quite obvious that there are two osteolytic lesions on the left tibia shaft. The more intense one is located over the middle of the diaphysis, and the less intense one is close to the proximal end. Except for ossification of the ligamentum flavum (OLF) on parts of the thoracic vertebrae, there are no other lesions or degenerative changes on the other bones, including the left fibula and the contralateral tibia and fibula. We also employed an upright microscope, X-ray, and computed tomography (CT) to observe the microstructure of the two damages. In the upright microscope, we found typical moth-eaten marks and sclerotic lesions in the bone trabeculae. In X-ray and CT imaging analyses, we traced and distinguished primary and secondary lesions. Additionally, we attempted to dissect the transmission process on the left tibia. We concluded that the larger one in the midshaft is primary and it spreads towards the two epiphyses, while a secondary lesion forms near the proximal end. By integrating the pathological manifestations of the individual and typical clinical cases, we selected six kinds of diseases, which can be further divided into two groups. One group consists of bone tumors, including Ewing’s sarcoma (ES), low grade central osteosarcoma (LGCOS), solitary bone cyst (SBC), Langerhans cell histiocytosis (LCH), and malignant giant cell tumor (MGCT). The other is non-specific infection: Acute hematogenous osteomyelitis (AHO). The moth-eaten lesion shows some manifestations of central bone tumor, multiplicity, and osteometastasis. Through analyzing the epidemiology and pathological manifestations of the selected diseases, we conclude that it is more likely that the tomb owner of WM341 in the Youyilu Cemetery was a victim of ES. Due to the high-grade malignancy and the possibility of pulmonary metastasis secondary to osteolytic lesions, ES is more likely to be the cause of the individual’s death. The bone tumor occurring in the left tibia is worthy of being regarded as a typical case of ES in paleopathology. Based on reasonable analysis and discussion, this should be the first ES case found in ancient people and be published in detail in the field of paleopathology in China.

Key words: Youyilu Cemetery, paleopathology, osteolytic disease, bone tumor, Ewing’s sarcoma