Radiologic/histologic discrepancies in tumour identification: The case of a “basketball‐sized” mandibular tumour in a woman from 17th century West Virginia

Objectives When initially discovered in 1963, techniques did not allow definitive diagnosis of the basketball‐sized mandibular tumour discovered in a woman from the Buffalo site dated to 17th century West Virginia. Her subsequent medical examiners stated that they “can only speculate as to the true nature of the tumor.” An interdisciplinary approach was pursued to assess ability of currently available techniques to resolve this conundrum. Materials and methods Macroscopic examination, X‐ray, computed tomography (CT), micro‐CT (7‐μ resolution), and epi‐illumination microscopy (100‐μ resolution) were utilized to identify diagnostic criteria that would allow discrimination among the possible etiologies. Results Macroscopic examination revealed a 24 by 23 by 19‐cm tumour attached to the right mandible. X‐ray examination revealed intact trabeculae of reduced size but of uniform thickness. CT examination revealed intact trabeculae of decreased size but uniform thickness. Epi‐illumination microscopy confirmed the CT findings. Trabeculae appeared to be intact, uniform in thickness, and with intact connectivity. Micro‐CT revealed significant variation in trabecular thickness with frequent areas of resorption and loss of interconnections. Discussion Osteosarcoma was considered macroscopically, on the basis of tumour size. However, the small, uniformly sized, intact trabeculae recognized on X‐ray, CT, and with epi‐illumination microscopy presented the pattern anticipated with an osteoblastoma. Micro‐CT, however, falsified that diagnosis, in favour of an osteosarcoma diagnosis. The final consideration is of an osteoblastic osteosarcoma, apparently the first recognized in the archaeologic record. The misleading nature of routine X‐ray, CT, and even microscopy (at 100‐μ resolution) in this case stands as a caveat.