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An Atlas of
Musculoskeletal
  Oncology
           by

  James O Johnston M.D.
        3rd Edition
         March 09
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
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
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
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
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
 Neurolemoma-----------------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
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

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Table of Contents

  • 1. An Atlas of Musculoskeletal Oncology by James O Johnston M.D. 3rd Edition March 09
  • 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. 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
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. 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 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
  • 17. 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
  • 18. Volume 16 Neurogenic soft tissue tumors Neurolemoma-----------------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
  • 19. 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