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  • 1. An Atlas ofMusculoskeletal Pathology By James O Johnston M.D. Andrew Fang M.D. 5th Edition Sept 2011
  • 2. Preface to the First Edition This large collection of nearly 5000 digital images relatingthe subject of musculoskeletal oncology is a sequel to the1800 Kodachrome slide collection that I produced in 1967 as ateaching aide for my students of orthopedic surgery at UCSF.Over the past 35 years since then my ever growing studentpopulation and my many friends and fellow members of theAmerican Musculoskeletal Tumor Society and the InternationalSociety of Skeletal Radiology have encouraged me to collectonce again from my past 35 years of clinical experience as anorthopedic oncologist in the San Francisco Bay area. Most ofthe cases in this atlas are taken directly from my practice oforthopedics at UCSF and the Kaiser Foundation Hospitalsystem of Northern California. Many other cases were directreferrals from my many friends in the field around the world.Most of the macro section slides were given to me by Dr Howard
  • 3. Hatcher and reflect his great experience while at the Universityof Chicago back in the 1950’s. A very special thanks goes to my wife MaryBee and myresearch assistant at UCSF Elizabeth Jameson who taught meeverything I know about computers and helped me edit thetext that goes with the cases placed on the internet. Another special thanks goes to my many friends in theBIOMET CORPORATION of Warsaw Indiana who’s largeeducational grant made the production of this atlas possible. Jim Johnston September 2005
  • 4. Preface to the Second Edition In this second edition to the first Atlas completed in Sept.2005, I have made several helpful improvements. The firstimprovement was to break up the original eight volume atlasinto seventeen sections to dramatically increase the speed ofbringing your images up on your computer screen. The secondimprovement was to place a complete discussion beneath eachdigital image that can be viewed while in the editing mode ofyour power point program. And the third improvement was toadd one hundred new clinical cases marked with decimal pointcase numbers and taken from the combined experience ofmyself and Dr Andy Fang working with a base pool of 3.5million Kaiser Foundation Hospital patients in NorthernCalifornia. Jim Johnston July 2007
  • 5. Preface to the Third Edition Two more years have flown by since the last editionand I have continued to add 100 new cases each yearwhich means 200 new cases have been added to thisthird edition that can be recognized by a decimal pointin the power point CD program case numbers. Thesenew cases will be added following a similar diagnosticcase or in the case of pseudotumors, they will be placedfollowing a tumor case that it looks like. Please note thatthe program on the internet (www.tumor hasnot been upgraded with new cases because of the expenseinvolved doing so. I hope you all enjoy my work of love. Jim Johnston March, 09
  • 6. Preface to the Fourth Edition In this fourth edition I have finally added three completelynew sections on infectious diseases of bone, metabolic bonediseases and congenital disorders. This includes the slidesthat I put out in 1967 as a teaching set for resident trainingplus an update and includes the great slides taken fromDr. Howard Steele’s collection on orthopedic dysplasias.In addition there are another 100 new cases from the lasttwo year experience working with Dr. Andy Fang at NorthernCalifornia Kaiser. This brings the collection up to 7000digital images with 2.5 gigabits of memory. Hope you willenjoy the new sections of none neoplastic conditions. Jim Johnston MD Sept. 2010
  • 7. Preface to the Fifth Edition With this fifth edition I have now reached my original goal to finalizea complete comprehensive teaching atlas on orthopedic pathology thatincludes 5000 digital images of musculoskeletal neoplasms and the morerecent addition of 3000 images covering none neoplastic pathologyincluding infections, metabolic bone diseases, congenital defects andnow this year I have included the final section on arthropathies, osteo-necrosis and osteochondroses a total of 2.6 GBs of memory. For thepast ten years Dr. Andy Fang of Kaiser South San Francisco has playeda major role in the addition of new cases that can be identified by adecimal point case number in the neoplastic sections vol. 1 through 18.In the immediate future we are working on a new PDF version of thiscurrent power point atlas with a word search capability. The originalneoplastic vols 1-18 are still on the internet( we are considering an upgrade to the current fifth edition. Jim Johnston MD Sept. 2011
  • 8. Contents for Volume 1 Osteoid osteoma--------------------------------Case 1-50 Osteoblastoma----------------------------------Case 51-94 Osteofibrous dysplasia-------------------------Case 95-101 Ossifying fibroma of jawbone----------------Case 102-107 Volume 2Classic osteosarcoma-----------------Case 108-9 & 451-490 Bone forming pseudotumors------Case 491-498
  • 9. Volume 3 Osteosarcoma VariantsHemorrhagic osteosarcoma------------Case 110 & 499-503Parosteal osteosarcoma-----------------Case111 & 504-510Periosteal osteosarcoma----------------Case 112 & 511-517Pagetic sarcoma-------------------------Case 113 & 518-528Low grade intramedullary OGS------Case 114 & 528.1-530Radiation induced OGS---------------Case 115 & 531-537Multicentric osteosarcoma------------Case 116 & 538-542Soft tissue osteosarcoma--------------Case 118 & 543-545Intracortical osteosarcoma------------Case 119 & 546-547
  • 10. Volume 4 Benign Chondroid TumorsEnchondroma---------------------------Case 120 & 548-567Multiple enchondromatosis-----------Case 568-583Maffucci’s syndrome------------------Case 584-586Periosteal chondroma------------------Case 121 & 587-607Osteochondroma-----------------------Case 122 & 608-624Multiple hereditary exostosis---------Case 625-631Chondroblastoma-----------------------Case 123 & 632-646Chondromyxoid fibroma--------------Case 124 & 647-651
  • 11. Volume 5 Malignant Chondroid TumorsPrimary central chondrosarcoma----------Case 125 & 652-678Secondary peripheral chondrosarcoma---Case 126 & 679-686Dedifferentiated chondrosarcoma---------Case 127 & 687-689Clear cell chondrosarcoma-----------------Case 128 & 690Mesenchymal chondrosarcoma------------Case 129 & 691Cartilaginous pseudotumors--------------- Case 692-699
  • 12. Volume 6 Fibrous Tumors of BoneFibrous cortical defects------------Case 130-131 & 700-702Non-ossifying fibroma-------------Case 132-133 & 703-713Fibrous dysplasia Monostotic------------------------Case 134-135 & 714-748 Polyostotic------------------------Case 136 & 749-757 Mazabraud syndrome-----------Case 758-759 Albright’s disease---------------Case 137 & 760-764Desmoplastic fibroma-------------Case 138-139 & 765-771Fibrosarcoma-----------------------Case 140-141 & 772-783Malignant fibrous histiocytoma--Case 142-143 & 784-800Leiomyosarcoma-------------------Case 144-5
  • 13. Volume 7 Vascular Tumors of BoneHemangioma---------------------Case 146-151 & 801-832Cystic angiomatosis-------------Case 152Hemangiomatosis----------------Case 833-834Lymphangiomatosis-------------Case 835-838Gorham’s disease----------------Case 153 & 839-840Hemangioendothelioma---------Case 154-158 & 841-847High grade angiosarcoma-------Case 159 & 848-851Hemangiopericytoma------------Case 160-162 & 852-855 Lipid Tumors of BoneParosteal lipoma------------------Case 163-165 & 859-60Intramedullary lipoma-----------Case 166-168 & 856-858Intracortical lipoma--------------Case 860.3
  • 14. Volume 8 Round Cell Tumors of BoneEwing’s sarcoma-----------------Case 169-175 & 861-900Large cell lymphoma------------Case 176-178 & 901-933Hodgkin’s lymphoma-----------Case 179-180 & 934-936Leukemia-------------------------Case 181 & 937-944Plasma cell tumors Solitary plasmacytoma-------Case 182-185 & 946-957 Multiple myeloma------------Case 186-188 & 958-976Metastatic neuroblastoma------Case 189 & 977-983
  • 15. Volume 9Bone cysts Unicameral bone cyst--------Case 190-197 & 984-996 Aneurysmal bone cyst-------Case 198-204 & 997-1039 Epidermoid cyst--------------Case 205-206 Volume 10Giant cell tumor of bone-------Case 207-213 & 1040-1093
  • 16. Volume 11 & 12Metastatic carcinoma----------Case 225-248 & 1107-1169 Volume 13Adamantinoma----------------Case 214-218 & 1094-1098Chordoma----------------------Case 219-224 & 1099-1106Histiocytoses Eosinophillic granuloma--Case 417-444 Hand-Schiller-Christian --Case 445-446 Letter Siwe disease--------Case 447-450 Sinus histiocytosis---------Case 450.1 Rosai-Dorfman’s disease
  • 17. Volume 14 Fibrous Soft Tissue TumorsDesmoid tumors---------------------Case 250-253 & 1170-1Aponeuratic fibroma----------------Case 1172-1173Infantile fibromatosis---------------Case 254Elastofibroma------------------------Case 255Nodular fascitis----------------------Case 256Plantar fibroma-----------------------Case 257Malignant fibrous histiocytoma----Case 258-265 &1174-75Low grade fibromyxoid sarcoma---Case 1178Fibrosarcoma--------------------------Case 266-7 & 1179-1181Dermatofibrosarcoma protuberans-Case 268-269Leiomyosarcoma----------------------Case 1182
  • 18. Volume 15 Lipid Soft Tissue TumorsSuperficial lipomas-------------Case 1183Intramuscular lipomas----------Case 270-274 & 1184-1190Spindle cell lipomas------------Case 275-276Angiolipomas--------------------Case 277-278 & 1191-1196Ossifying lipomas---------------Case 1196.1-1196.3Myxolipomas--------------------Case 279Diffuse lipomatosis-------------Case 280Lumbosacral lipoma------------Case 281Hibernoma-----------------------Case 1197Liposarcoma Well differentiated------------Case 283 & 1198 Myxoid-------------------------Case 285-289 & 1199-1201 Round cell---------------------Case 290 Pleomorphic-------------------Case 291 & 1202-1203
  • 19. Vascular Soft Tissue TumorsHemangioma---------------------Case 292-298 & 1204-1211Hemangiomatosis---------------Case 299-300 & 1212Lymphangioma------------------Case 301-304 & 1213Glomus tumor-------------------Case 305-307Hemangiopericytoma-----------Case 308-311Kaposi’s sarcoma----------------Case 312-313Angiosarcoma--------------------Case 314
  • 20. Volume 16Neurogenic soft tissue tumors Neurilemoma----------------Case 315-321 & 1214-1220 Solitary neurofibroma--------Case 322-326 Neurofibromatosis------------Case 327-338 & 1221-1229 Malignant schwannoma------Case 339-344 & 1230-1234Rhabdomyosarcoma------------Case 345-349Alveolar soft part sarcoma-----Case 350-353Synovial sarcoma---------------Case 354-363 & 1235-1242Granular cell tumor-------------Case 1234.1Melanoma------------------------Case 1234.2
  • 21. Volume 17Chondroid tumors Synovial chondromatosis---------Case 364-370 & 1243-5 Juxtaarticular chondroma---------Case 371-377 & 1246-7 2ndary synovial chondromatosis-Case 378-382 & 1248 Myxoid chondrosarcoma----------Case 383-385Epithelioid sarcoma------------------Case 386-389Soft tissue Ewing’s sarcoma--------Case 390-392Clear cell sarcoma--------------------Case 393-394Myositis ossificans-------------------Case 395-405Pigmented villonodular synovitis---Case 406-416 & 1249Intramuscular myxoma---------------Case 1258Ganglion cyst--------------------------Case 1259-60Soft tissue lymphoma-----------------Case 1261Metastatic CA to soft tissue----------Case 1262-63
  • 22. Volume 18 Orthopedic Infections Hematogenous osteomyelitis Pyogenic spondylitis Pyarthrosis TBc infections & Sarcoidosis Leprosy Luetic infections Viral osteomyelitis Fungus infections Gas forming infection
  • 23. Volume 19 Metabolic Bone diseases Calcium, phosphate metabolism Primary hyperparathyoidism Hypo & pseudohypoparathyoidism Rachitic syndromes and renal osteodystrophy Scurvy Gaucher’s disease Gout and pseudo gout Alkaptonuria - Ochronosis Osteoporosis Thyroid disorders Paget’s disease Misc.
  • 24. Volume 20 Congenital Defects (Part 1) Dysplasias classification Epiphyseal defects Stippled epiphyses Multiple epiphyseal dysplasia MED tarda Spondyloepiphyseal dysplasia SED tarda Metatrophic dwarfism
  • 25. Volume 21 Congenital Defects (Part 2) Mucopolysacharidoses Diastrophic dwarfism Tarsal epiphyseal aclasia Achondroplasia Hypochondroplasia Achondrogenesis & Thanatophoric dwarfism
  • 26. Volume 22 Congenital Defects (Part 3) Ellis VanCreveld syndrome Metaphyseal dysplasias (Jansen’s & Schmid) Osteopetrosis Craniometaphyseal dysplasia (Pyles disease) Osteopathia striata Osteopoikilosis Melorheostosis Engelman’s dysplasia Pyknodysostosis Marfan’s Syndrome Ehlers-Danlos Syndrome
  • 27. Volume 23 Congenital Defects (Part 4) Osteogenesis Imperfecta Cleidocranial dysplasia Progeria Proximal femoral focal deficiency disorders Coxa vara & congenital bowing of femur Congenital anemias - SS disease
  • 28. Volume 24 Congenital Defects (Part 5) Aperts Hind foot defects Tibial pseudarthrosis Mesomelic dwarfism (Madlung’s) Misc. Iliac horn syndrome Klippel Feil & Sprengel’s deformity Mongolism-Down’s Syndrome Arthrogryposis Congenital absence of bone Hand deformities Congenital genu recurvatum
  • 29. Volume 25 Arthritis Osteonecrosis & Osteochondroses Rheumatoid arthritis Ankylosing spondylitis Psoriatic arthritis Reiter’s syndrome Pediatric seronegtive arthritis (Still’s disease) Scleroderma & dermatomyocytis Hemophiliac arthropathy PVNS (see Vol 17) Degenerative osteoarthritis & spondylitis Neuropathic arthropathy Gout and pseudogout (see Vol 19) Infectious arthropathies (see Vol 18) Osteonecrosis & Osteochondroses