Osseous lesions in chronic phlebolymphedema: pathological pattern identification in modern man and in ancient human remains.

Paleopathology is by now a well established discipline with regard to applied methodology and systematic classification of acquired scientific information. Only by integrating modern medicine with the medicine of human beings of the past can both disciplines draw fruitful and bilateral knowledge contributions. This work aims to demonstrate that paleopathological research of ancient human remains can provide very interesting information to clinical studies and investigations as concerns the pathology of chronic lymphedema. Many aspects involving Lymphology and Phlebology are often tackled in daily clinical practice. The close correlation between lymphatic system and venous circulation begins as early as during embryo development. When, during inflammation processes, lymphothrombosis or prolonged lymphangiospasm prevent lymphatics from properly draining into the interstitial space, perivenous lymphangitis is likely to develop affecting vasa lymphatica vasorum. When these conditions persist, tissues begin to become fibrotic, with subsequent increase in wall thickness and stiffness of deep, communicating, and superficial vein branches. All these conditions together can, in turn, stimulate a subperiosteal bone reaction in those areas where the vessel runs close to the periosteum, with no muscle or fibrous fascial tissue in between. Bone imprints are thus formed, as if a mould were taken of vascular structures. Through a retrospective study of current patients with phlebolymphedema, axial tomography scans could be assessed again, thus proving the presence of similar lesions. Bone imprints of vascular origin have thus always proved to be associated with chronic vessel inflammation and to be a consequence of this condition.