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An Atlas of An Atlas of Musculoskeletal Musculoskeletal

PathologyPathology

James O Johnston M.D.James O Johnston M.D. Andrew Fang M.D.Andrew Fang M.D.

5th EditionSept 2011

By

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 the American 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

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

In this second edition to the first Atlas completed in Sept.2005, I have made several helpful improvements. The first improvement 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 each digital 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 of myself and Dr Andy Fang working with a base pool of 3.5million Kaiser Foundation Hospital patients in Northern California. Jim Johnston July 2007

Preface to the Second Edition

Preface to the Third Edition

Two more years have flown by since the last editionand I have continued to add 100 new cases each year which means 200 new cases have been added to this third edition that can be recognized by a decimal pointin the power point CD program case numbers. These new cases will be added following a similar diagnostic case 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 library.com) hasnot been upgraded with new cases because of the expense involved doing so. I hope you all enjoy my work of love. Jim Johnston March, 09

Preface to the Fourth Edition

In this fourth edition I have finally added three completely new sections on infectious diseases of bone, metabolic bonediseases and congenital disorders. This includes the slides that I put out in 1967 as a teaching set for resident trainingplus an update and includes the great slides taken from Dr. Howard Steele’s collection on orthopedic dysplasias.In addition there are another 100 new cases from the last two 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

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 more recent addition of 3000 images covering none neoplastic pathology including infections, metabolic bone diseases, congenital defects and now this year I have included the final section on arthropathies, osteo-necrosis and osteochondroses a total of 2.6 GBs of memory. For the past 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 a decimal 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 original neoplastic vols 1-18 are still on the internet(www.tumorlibrary.com)and we are considering an upgrade to the current fifth edition. Jim Johnston MD Sept. 2011

Contents for Volume 1

Osteoid osteoma--------------------------------Case 1-50 Osteoblastoma----------------------------------Case 51-94Osteofibrous dysplasia-------------------------Case 95-101Ossifying fibroma of jawbone----------------Case 102-107

Volume 2

Classic osteosarcoma-----------------Case 108-9 & 451-490 Bone forming pseudotumors------Case 491-498

Volume 3

Osteosarcoma Variants

Hemorrhagic 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

Volume 4

Benign Chondroid Tumors

Enchondroma---------------------------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

Volume 5

Malignant Chondroid Tumors

Primary 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

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

Volume 7Vascular Tumors of Bone

Hemangioma---------------------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

Volume 8

Round Cell Tumors of Bone

Ewing’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

Volume 9

Bone 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

Volume 11 & 12

Metastatic carcinoma----------Case 225-248 & 1107-1169

Volume 13

Adamantinoma----------------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

Volume 14

Fibrous Soft Tissue Tumors

Desmoid 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

Volume 15Lipid Soft Tissue Tumors

Superficial 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

Vascular Soft Tissue Tumors

Hemangioma---------------------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

Volume 16

Neurogenic 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

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

Volume 18 Orthopedic Infections

Hematogenous osteomyelitis Pyogenic spondylitis Pyarthrosis TBc infections & Sarcoidosis Leprosy Luetic infections Viral osteomyelitis Fungus infections Gas forming infection

Volume 19Volume 19Metabolic Bone diseasesMetabolic 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.

Volume 20Volume 20Congenital Defects (Part Congenital Defects (Part

1)1) Dysplasias classificationDysplasias classification Epiphyseal defectsEpiphyseal defects

Stippled epiphysesStippled epiphyses

Multiple epiphyseal dysplasia MED tardaMultiple epiphyseal dysplasia MED tarda

Spondyloepiphyseal dysplasia SED tardaSpondyloepiphyseal dysplasia SED tarda

Metatrophic dwarfismMetatrophic dwarfism

Volume 21Volume 21Congenital Defects (Part Congenital Defects (Part

2)2)

MucopolysacharidosesMucopolysacharidoses Diastrophic dwarfismDiastrophic dwarfism Tarsal epiphyseal aclasiaTarsal epiphyseal aclasia AchondroplasiaAchondroplasia HypochondroplasiaHypochondroplasia Achondrogenesis & Thanatophoric Achondrogenesis & Thanatophoric

dwarfismdwarfism

Volume 22Volume 22Congenital Defects (Part Congenital Defects (Part

3)3) Ellis VanCreveld syndromeEllis VanCreveld syndrome Metaphyseal dysplasias (JansenMetaphyseal dysplasias (Jansen’’s & Schmid)s & Schmid) OsteopetrosisOsteopetrosis Craniometaphyseal dysplasia (Pyles disease)Craniometaphyseal dysplasia (Pyles disease) Osteopathia striataOsteopathia striata OsteopoikilosisOsteopoikilosis MelorheostosisMelorheostosis EngelmanEngelman’’s dysplasias dysplasia PyknodysostosisPyknodysostosis MarfanMarfan’’s Syndromes Syndrome Ehlers-Danlos SyndromeEhlers-Danlos Syndrome

Volume 23Volume 23Congenital Defects (Part Congenital Defects (Part

4)4) Osteogenesis ImperfectaOsteogenesis Imperfecta Cleidocranial dysplasiaCleidocranial dysplasia ProgeriaProgeria Proximal femoral focal deficiency Proximal femoral focal deficiency

disordersdisorders Coxa vara & congenital bowing of Coxa vara & congenital bowing of

femurfemur Congenital anemias - SS diseaseCongenital anemias - SS disease

Volume 24Volume 24Congenital Defects (Part Congenital Defects (Part

5)5) ApertsAperts Hind foot defectsHind foot defects Tibial pseudarthrosisTibial pseudarthrosis Mesomelic dwarfism (MadlungMesomelic dwarfism (Madlung’’s)s) Misc.Misc. Iliac horn syndromeIliac horn syndrome Klippel Feil & SprengelKlippel Feil & Sprengel’’s deformitys deformity Mongolism-DownMongolism-Down’’s Syndromes Syndrome ArthrogryposisArthrogryposis Congenital absence of boneCongenital absence of bone Hand deformitiesHand deformities Congenital genu recurvatumCongenital genu recurvatum

Volume 25Arthritis

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