A case of Paget from a Northern Italy medieval necropolis

An excavation conducted in 2002 by the Lombardy Archaeological Heritage in the St. Giulio Church (Cassano Magnago-Northern Italy) revealed an adult skeleton with an important alteration of the left femur. The femur, longer than the contralateral, exhibited an expansion of the full diaphysis; the surface was coarsened and porous. In cross section, it appeared that almost all the cortical bone had been converted into cancellous bone. Macroscopic and radiological alterations are suggestive of the monostotic form of Paget's disease, a chronic disorder, characterized by focal areas of excessive osteoclastic bone resorption followed by a secondary increase in osteoblastic bone formation. Differential diagnosis is complex for Paget's disease, requiring histological analysis, which revealed a thickened and disorganized trabecular pattern with thick cement lines. Such features, resembling to a mosaic pattern, are typical of Paget's disease.