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An Atlas of Musculoskeletal Pathology James O Johnston M.D. Andrew Fang M.D. 5th Edition Sept 2011 By

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An Atlas of Musculoskeletal

Pathology!!!James O Johnston M.D.

Andrew Fang M.D.

5th Edition Sept 2011

By

Preface to the First Edition This large collection of nearly 5000 digital images relating the subject of musculoskeletal oncology is a sequel to the 1800 Kodachrome slide collection that I produced in 1967 as a teaching aide for my students of orthopedic surgery at UCSF. Over the past 35 years since then my ever growing student population and my many friends and fellow members of the American Musculoskeletal Tumor Society and the International Society of Skeletal Radiology have encouraged me to collect once again from my past 35 years of clinical experience as an orthopedic oncologist in the San Francisco Bay area. Most of the cases in this atlas are taken directly from my practice of orthopedics at UCSF and the Kaiser Foundation Hospital system of Northern California. Many other cases were direct referrals 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 University of Chicago back in the 1950’s. A very special thanks goes to my wife MaryBee and my research assistant at UCSF Elizabeth Jameson who taught me everything I know about computers and helped me edit the text that goes with the cases placed on the internet. Another special thanks goes to my many friends in the BIOMET CORPORATION of Warsaw Indiana who’s large educational 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 atlas into seventeen sections to dramatically increase the speed of bringing your images up on your computer screen. The second improvement was to place a complete discussion beneath each digital image that can be viewed while in the editing mode of your power point program. And the third improvement was to add one hundred new clinical cases marked with decimal point case numbers and taken from the combined experience of myself and Dr Andy Fang working with a base pool of 3.5 million 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 edition and 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 point in 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 placed following a tumor case that it looks like. Please note that the program on the internet (www.tumor library.com) has not 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 bone diseases and congenital disorders. This includes the slides that I put out in 1967 as a teaching set for resident training plus 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 Northern California Kaiser. This brings the collection up to 7000 digital images with 2.5 gigabits of memory. Hope you will enjoy 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 finalize a complete comprehensive teaching atlas on orthopedic pathology that includes 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 played a 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 this current 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 51-94 Osteofibrous dysplasia-------------------------Case 95-101 Ossifying 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 & 499-503 Parosteal osteosarcoma-----------------Case111 & 504-510 Periosteal osteosarcoma----------------Case 112 & 511-517 Pagetic sarcoma-------------------------Case 113 & 518-528 Low grade intramedullary OGS------Case 114 & 528.1-530 Radiation induced OGS---------------Case 115 & 531-537 Multicentric osteosarcoma------------Case 116 & 538-542 Soft tissue osteosarcoma--------------Case 118 & 543-545 Intracortical osteosarcoma------------Case 119 & 546-547

Volume 4 Benign Chondroid Tumors

Enchondroma---------------------------Case 120 & 548-567 Multiple enchondromatosis-----------Case 568-583 Maffucci’s syndrome------------------Case 584-586 Periosteal chondroma------------------Case 121 & 587-607 Osteochondroma-----------------------Case 122 & 608-624 Multiple hereditary exostosis---------Case 625-631 Chondroblastoma-----------------------Case 123 & 632-646 Chondromyxoid fibroma--------------Case 124 & 647-651

Volume 5

Malignant Chondroid Tumors

Primary central chondrosarcoma----------Case 125 & 652-678 Secondary peripheral chondrosarcoma---Case 126 & 679-686 Dedifferentiated chondrosarcoma---------Case 127 & 687-689 Clear cell chondrosarcoma-----------------Case 128 & 690 Mesenchymal chondrosarcoma------------Case 129 & 691 Cartilaginous pseudotumors--------------- Case 692-699

Volume 6 Fibrous Tumors of Bone

Fibrous cortical defects------------Case 130-131 & 700-702 Non-ossifying fibroma-------------Case 132-133 & 703-713 Fibrous dysplasia Monostotic------------------------Case 134-135 & 714-748 Polyostotic------------------------Case 136 & 749-757 Mazabraud syndrome-----------Case 758-759 Albright’s disease---------------Case 137 & 760-764 Desmoplastic fibroma-------------Case 138-139 & 765-771 Fibrosarcoma-----------------------Case 140-141 & 772-783 Malignant fibrous histiocytoma--Case 142-143 & 784-800 Leiomyosarcoma-------------------Case 144-5

Volume 7 Vascular Tumors of Bone

Hemangioma---------------------Case 146-151 & 801-832 Cystic angiomatosis-------------Case 152 Hemangiomatosis----------------Case 833-834 Lymphangiomatosis-------------Case 835-838 Gorham’s disease----------------Case 153 & 839-840 Hemangioendothelioma---------Case 154-158 & 841-847 High grade angiosarcoma-------Case 159 & 848-851 Hemangiopericytoma------------Case 160-162 & 852-855 Lipid Tumors of Bone Parosteal lipoma------------------Case 163-165 & 859-60 Intramedullary lipoma-----------Case 166-168 & 856-858 Intracortical lipoma--------------Case 860.3

Volume 8

Round Cell Tumors of Bone Ewing’s sarcoma-----------------Case 169-175 & 861-900 Large cell lymphoma------------Case 176-178 & 901-933 Hodgkin’s lymphoma-----------Case 179-180 & 934-936 Leukemia-------------------------Case 181 & 937-944 Plasma cell tumors Solitary plasmacytoma-------Case 182-185 & 946-957 Multiple myeloma------------Case 186-188 & 958-976 Metastatic 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 10 Giant 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 & 1094-1098 Chordoma----------------------Case 219-224 & 1099-1106 Histiocytoses 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 & 1170-1 Aponeuratic fibroma----------------Case 1172-1173 Infantile fibromatosis---------------Case 254 Elastofibroma------------------------Case 255 Nodular fascitis----------------------Case 256 Plantar fibroma-----------------------Case 257 Malignant fibrous histiocytoma----Case 258-265 &1174-75 Low grade fibromyxoid sarcoma---Case 1178 Fibrosarcoma--------------------------Case 266-7 & 1179-1181 Dermatofibrosarcoma protuberans-Case 268-269 Leiomyosarcoma----------------------Case 1182

Volume 15 Lipid Soft Tissue Tumors

Superficial lipomas-------------Case 1183 Intramuscular lipomas----------Case 270-274 & 1184-1190 Spindle cell lipomas------------Case 275-276 Angiolipomas--------------------Case 277-278 & 1191-1196 Ossifying lipomas---------------Case 1196.1-1196.3 Myxolipomas--------------------Case 279 Diffuse lipomatosis-------------Case 280 Lumbosacral lipoma------------Case 281 Hibernoma-----------------------Case 1197 Liposarcoma 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 & 1204-1211 Hemangiomatosis---------------Case 299-300 & 1212 Lymphangioma------------------Case 301-304 & 1213 Glomus tumor-------------------Case 305-307 Hemangiopericytoma-----------Case 308-311 Kaposi’s sarcoma----------------Case 312-313 Angiosarcoma--------------------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 & 1230-1234 Rhabdomyosarcoma------------Case 345-349 Alveolar soft part sarcoma-----Case 350-353 Synovial sarcoma---------------Case 354-363 & 1235-1242 Granular cell tumor-------------Case 1234.1 Melanoma------------------------Case 1234.2

Volume 17 Chondroid 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 383-385 Epithelioid sarcoma------------------Case 386-389 Soft tissue Ewing’s sarcoma--------Case 390-392 Clear cell sarcoma--------------------Case 393-394 Myositis ossificans-------------------Case 395-405 Pigmented villonodular synovitis---Case 406-416 & 1249 Intramuscular myxoma---------------Case 1258 Ganglion cyst--------------------------Case 1259-60 Soft tissue lymphoma-----------------Case 1261 Metastatic 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 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.!

Volume 20"Congenital Defects (Part 1)!

 Dysplasias classification!  Epiphyseal defects! Stippled epiphyses! Multiple epiphyseal dysplasia MED tarda! Spondyloepiphyseal dysplasia SED tarda! Metatrophic dwarfism! !

Volume 21"Congenital Defects (Part 2)!

! Mucopolysacharidoses! Diastrophic dwarfism! Tarsal epiphyseal aclasia! Achondroplasia! Hypochondroplasia! Achondrogenesis & Thanatophoric dwarfism!

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!

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!

!

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!

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!