Dr. T. Tóth szerk.: Studia historico-anthropologica (Anthropologia Hungarica 21. Budapest, 1990)

ANTHROPOLOGIA HUNGARICA XXI. 1990 p. 69-80 Morphology and differential diagnosis of porotic hyperostosis on historical anthropological material By L. JÓZSA & I. PAP (Received May 14,1990) Abstract. The authors carried out macroscopic, microscopic and electron microscopic analyses of the structure of porotic hyperostosis on historical and recent autopsy material. All three types of porotic hyperostosis (porotic, cribrotic, trabecular) were examined. Clinical patterns and their differential diagnosis were discussed. With 2 tables and 15 plates. INTRODUCTION Porotic hyperostosis (PH) is an alteration of thin bones with the thinning or resorption of the cortical layer and with the proliferation of the cancellaneous bone, ft is most frequent on the frontal and parietal bones of the neurocranium. Less frequently it also turns up on other parts of the skull and on the sternum and on ribs as well. It was WELCKER (1888) who first described it. He found it on the upper part of the orbita and named it cribra orbitalia. HRDLICKA (1914) discovered the same phenomenon on the skulls of preColumbian Indians dug up in Peru and designated it osteoporosis symmetrica. Later it was detected on historical as well as on recent material and was described under various names osteoporosis cranii, cribra cranii, hyperostosis spongiosa, hyperostosis porotica (MOLLER-CHRISTENSEN & SANDISÔN 1963, ANGEL 1967, MARCSIK 1974, 1975, MARCSIK & KÓSA 1976). It is known as "hair on end" or periostitis villosa in the literature of radiology. HRDLICKA (1914) found it only with the inhabitants of coastal regions and never with people living in mountain areas. This led him to the conclusion that this disease must be the result of some toxic harm. WILLIAMS (1929) added that some local irritation and pressure atrophy could also bring it about besides toxic agents. COOLEY & LEE (1925) confirmed by clinical and X-ray examinations that PH is a constant alteration in thalassaemia major (Cooley-anaemia). HOOTON (1930) established a 66% frequency of PH on the skulls of North-American Indian children. He pointed out that there was no Cooley-anaemia at all in America in the period examined. Therefore, this lesion had to be the result of some other factor. VOGT & DIAMOND (1930) found marked bone lesions with all severe congenital anaemia cases (Cooley-anaemia, sickle-cell anaemia, spherocytosis hereditaria). Later it became evident that hyperostosis porotica could occur as a result of malaria, of milk anaemia, and of iron deficiency anaemia - quite independently whether iron deficiency was caused by