Italian mafia boss Bernardo Provenzano has died in a prison hospital, aged 83, BBC News reports.
Provenzano, dubbed "The Tractor" for his ruthless trait of mowing people down, was arrested and jailed in 2006 after spending 43 years on the run.
He took over command of the Sicilian Mafia in 1993 after the arrest of ex-boss Salvatore "Toto" Riina.
Provenzano was serving a life term for several murders, including the 1992 killings of top anti-Mafia judges Giovanni Falcone and Paolo Borsellino.
He was suffering from bladder cancer and serious cognitive impairment and had spent the last two years in a prison hospital ward, Italian media report.
His illnesses had forced the suspension of ongoing negotiations with the state over unresolved crimes. However, even before his health declined, he had resisted any co-operation with the justice system.
Bernardo Provenzano earned the nickname The Tractor because, as an informant put it, "he mows people down".
He reportedly committed his first murder in 1958 aged 25, when Provenzano is alleged to have been one of the gunmen who helped rising mafioso Luciano Liggio murder Corleone clan head Michele Navarra, leaving Liggio as head of the family.
In 1963 Provenzano went on the run after an arrest warrant was issued against him for the murder of one of Navarra's men.
Gangland wars and murders of top judges became bloody hallmarks of Italian life in the 1980s, when Provenzano was second-in-command to "Toto" Riina.
However, Provenzano had another side to his character.
He was a careful operator, who took few overt risks, mastered the crime empire's finances, and under whose leadership the Mafia became a less bloodthirsty, more efficient machine, commentators say.
For these reasons, he was also dubbed The Accountant.
