Genetic skeletal dysplasias in the Museum of Pathological Anatomy, Vienna

History and highlights of the teratological collection in the Narrenturm, Vienna (Austria)

The collection of the Narrenturm in Vienna houses and maintains more than 50,000 objects including approximately 1200 teratological specimens; making it one of the biggest collections of specimens from human origin in Europe. The existence of this magnificent collection-representing an important resource for dysmorphology research, mostly awaiting contemporary diagnoses-is not widely known in the scientific community. Here, we show that the Narrenturm harbors a wealth of specimens with (exceptionally) rare congenital anomalies. These museums can be seen as physical repositories of human malformation, covering hundreds of years of dedicated collecting and preserving, thereby creating unique settings that can be used to expand our knowledge of developmental conditions that have to be preserved for future generations of scientists.

The pathological anatomical collection of the Natural History Museum Vienna

The pathological anatomical collection Vienna (Pathologisch-Anatomische Sammlung Wien; PASW) is a living and still growing research collection. It was established as early as 1796 as part of the Medical University of Vienna, acquired the status of an independent federal museum in 1971, and was assigned to the Natural History Museum Vienna in 2012. It houses a wide range of human wet and dry specimens and further objects, such as moulages, medical devices, microbiological and histological specimens, and a photo archive (approximately 50,000 objects), which, as a meaningful source, may contribute to disclosing not only aspects of the medical history and the development of corresponding museums in Vienna, but is also considered a collection of cultural and current scientific relevance, quite comparable to today's biobanks. Most of the tissue amassment represents wet organic specimens and human skeletons or skeletal elements representing, e.g., congenital and metabolic disorders, infectious diseases, injuries, neoplasms, or musculoskeletal diseases, basically collected as descriptive anatomical teaching aids. This article reviews the current medical issues on which research has been and is being conducted by including PASW specimens (hereby using the ICD-10 code), and the extent to and ethical conditions under which this important heritage could be used as a reference collection for clinical and bioanthropological (paleopathological and palaeoepidemiological) studies; finally, this article reflects on the value and future research prospects, taking into account different positions and the ongoing discussions in pathological anatomical human tissue collections.

The genealogy of dwarfs: reproduction and romantic mythology in Goethe's New Melusine

Goethe's studies of natural form have occupied generations of scholars and the discussion on the relationship between Goethe's thought and evolutionary theory has never ceased since Haeckel's claims in the late nineteenth century. In scholarship which has aimed to address the question of change in Goethe's concept of nature, the focus has been primarily on his scientific writings. Aiming for a comprehensive understanding of Goethe's thought on reproduction, this article sets out to contribute to the ongoing debate by focusing on his literary text The New Melusine, a story centred on a dwarf figure. Examining texts by naturalists such as Buffon, Humboldt, and Darwin, the article demonstrates how Goethe, in the speculative framework of a literary text, explores patterns of transformation by means of sexual reproduction which did not make it into his better known scientific writings on plant morphology and comparative anatomy. I argue that the Melusine story becomes for Goethe a space to consider a new understanding of reproduction, its transformative power, and biopolitical possibilities, while at the same time providing an opportunity to reflect critically on its consequences for the individual.

Multiple supernumerary teeth in a likely syndromic individual from prehistoric Illinois

OBJECTIVE

This paper reports the first published case of a prehistoric human with five or more supernumerary teeth. Such cases are often neglected in paleopathology, in part due to a gap between the medicodental and anthropological literature leading to the view in anthropology that supernumerary teeth are curious anomalies rather than pathologies.

DESIGN

Reconstruction and pathological description of the skeletal remains were performed according to standard osteological protocols. Each supernumerary tooth was categorized based on its morphology, location, and orientation. The dental characteristics of the individual were compared to published norms for incidences of syndromic and non-syndromic supernumerary teeth and a differential diagnosis was subsequently performed.

RESULTS

Six supernumerary teeth and one deciduous tooth were identified. Additionally, the individual suffered from impacted teeth, dilacerated roots, and extensive sutural anomalies (including retention of the metopic suture into adulthood and an unusually high number of sutural bones). The morphology and location of the supernumerary teeth, in conjunction with the suite of other symptoms, are highly unusual among non-syndromic patients and therefore are indicative of a complex genetic disorder.

CONCLUSIONS

The individual reported here almost certainly suffered from a genetic disorder or syndrome resulting in extensive dental and sutural abnormalities. Despite a lack of post-cranial involvement, a tentative diagnosis of Cleidocranial Dysplasia was made on the basis that mutations in the RUNX2 gene may cause the dental symptoms without any pathology of the clavicle.

Detection of G1138A Mutation of the FGFR3 Gene in Tooth Material from a 180-Year-Old Museological Achondroplastic Skeleton

Throughout the last four centuries, many anatomical museums across the world have collected teratological specimens that became precious objects. These can be regarded as spirits of the past which have captured the morphology of diseases through time. These valuable and irreplaceable specimens can be perfectly used in contemporary dysmorphological or genetic research. Unfortunately, due to the historical nature of these specimens and the regularly used aggressive preservation fluids, DNA degradation is often present. Furthermore, the use of material for DNA extraction is restricted to preserve the appearance of these valuable museological specimens. Thus, the most challenging part in this perspective is to harvest sufficient DNA of good quality for further testing without damaging the specimens. Besides fixated specimens, most teratological collections contain dried skeletal and teeth materials which are an excellent source to extract DNA. We here present a DNA-based method that enables genetic identification of the G1138A mutation of the FGFR3 gene in a 180-year-old achondroplastic skeleton, confirming the previously morphologically determined disease. Nuclear DNA was extracted from a premolar tooth and the mutation was found using Sanger sequencing of a small region of the FGFR3 gene.

Radiological imaging of teratological fetuses: what can we learn?

Objectives

To determine the advantages of radiological imaging of a collection of full-term teratological fetuses in order to increase their scientific and educational value.

Background

Anatomical museums around the world exhibit full-term teratological fetuses. Unfortunately, these museums are regularly considered as “morbid cabinets”. Detailed dysmorphological information concerning the exhibited specimens is often lacking. Moreover, fetuses with severe and complex congenital anomalies are frequently diagnosed incompletely, incorrectly or not at all.

Methods

In order to verify diagnoses and to enrich their educational and scientific value, we imaged 41 out of the 72 teratological specimens present in the collection of our Anatomy and Pathology Museum in Nijmegen (The Netherlands) by means of magnetic resonance imaging (MRI) and computed tomography (CT). Additionally, contemporary dysmorphological insights and 3D models are implemented in the teratology education of medical students and residents.

Conclusions

Full-term teratological fetuses have become increasingly rare and deserve a prominent place in every anatomical museum; they are suitable for contemporary teratological research and education. Modern radiological techniques markedly enhance their scientific and didactic value.

Teaching Points

• To explore the scientific and educational potential of institutionalised teratological collections

• To understand the additional value of radiological imaging in diagnosing teratological specimens

• To learn about the specific settings of MRI parameters when scanning fixed specimens

• To recognise specific internal dysmorphology in several congenital anomalies

[Karl Alfons Portele, Pathologist and first director of the Federal Pathologic-anatomical Museum Vienna]

The importance of the work of Karl Alfons Portele (1912-1993) in his position as director of the Federal Museum of Pathology is discussed. Portele was commissioned with the museum in 1946 and separated it from university in 1974. The history of the Pathologic-anatomical Museum in Vienna is closely connected with the history of pathology.

Cleidocranial dysplasia: complete clinical, radiological and histological profiles

Cleidocranial dysplasia is an autosomal-dominant condition characterised by widely patent calvarial sutures, clavicular hypoplasia, supernumerary teeth and short stature. Though it is not a very uncommon occurrence, its histopathological features are not frequently reported. This paper presents a similar case with complete clinical, radiological, histological and treatment profiles.

Cleidocranial dysplasia: a review of the dental, historical, and practical implications with an overview of the South African experience

Cleidocranial dysplasia (CCD) is an uncommon but well-known genetic skeletal condition. Several hundred affected persons are members of a large extended family in the Cape Town Mixed Ancestry community of South Africa. The clinical manifestations are often innocuous, but hyperdontia and other developmental abnormalities of the teeth are a major feature and may require special dental management. Over the past 40 years, the authors have encountered more than 100 affected persons in Cape Town. Emphasis has been on dental management, but medical, genetic, and social problems have also been addressed. In this article, we have reviewed the manifestations of the disorder in the light of our own experience, and performed a literature search with emphasis on the various approaches to dental management and treatment options in CCD. Advances in the understanding of the biomolecular pathogenesis of CCD are outlined and the international and local history of the disorder is documented.

Dural ectasia: a likely cause of inadequate spinal anaesthesia in two parturients with Marfan's syndrome

We report two cases of Caesarean section in patients with Marfan's syndrome where continuous subarachnoid anaesthesia failed to provide an adequate surgical block. This was possibly because of dural ectasia, which was confirmed by a computed tomography scan in both cases.

[Surgical treatment of cardiovascular manifestations of Marfan's syndrome]

Patients with Marfan's syndrome suffer mainly from the cardiovascular manifestations of the disease, in particular the acute dissection or rupture of the dilated aorta. Due to improved diagnostic and early surgical intervention the life expectancy of these patients could be considerably improved. However, rupture is still the most frequent and dissection the second frequent cause of death. Life threatening complications of aortic dissection are pericardial effusion, aortic insufficiency and malperfusion syndrome, due to obstruction of aortic branches. Dissection of the ascending aorta is treated by implantation of a valved conduit with reimplantation of the coronary arteries. Some surgeons favor the complete replacement of the ascending aorta with preservation of the aortic valve, although long-term results show some development of aortic insufficiency after this procedure. Based on the experience of the last years, most surgeons prefer the prophylactic replacement of the aorta in Marfan patients, i.e. before complications have occurred. A special treatment algorithm helps to define the indication for the operative treatment in different manifestations of the disease. The low mortality of the elective replacement of the ascending aorta in contrast to replacement in emergency cases speaks in favor of the early operative treatment. For the long-term prognosis of the patient a closed and continuous cardiologic surveillance is mandatory. The patient should be close to a center with the necessary diagnostic tools and with sufficient experience with the medical and surgical treatment, in order to further improve the life expectancy in the future.

Bone dysplasias of infancy in the Vienna collection

The Vienna Museum of Pathological Anatomy contains a vast collection of abnormal skeletons. We have appraised this material and attempted to establish firm diagnoses of specific genetic disorders in terms of modern syndromic concepts. A number of the skeletons in the museum are those of deceased neonates; in many instances it was impossible to reach a diagnosis on the basis of the outward appearance but radiographic investigations confirmed diagnoses including osteogenesis imperfecta type II, thanatophoric dysplasia, achondroplasia and achondrogenesis. The Vienna collection represents a priceless resource for the investigation of genetic skeletal disorders of this type.