This document provides prefaces for multiple editions of an atlas of musculoskeletal pathology. It describes the author's goal of creating a comprehensive teaching resource including over 10,000 digital images covering neoplastic and non-neoplastic musculoskeletal conditions. It acknowledges contributions from colleagues who provided additional cases. Each new edition expanded the scope by adding new sections, increasing the number of images, and improving the digital format.

1. An Atlas of
Musculoskeletal
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 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

3. 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

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 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

5. 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

6. 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

7. 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

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 2
Classic osteosarcoma-----------------Case 108-9 & 451-490
Bone forming pseudotumors------Case 491-498

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

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