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