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ATLAS OF TUMOR PATHOLOGY
Third Series
Fascicle 8
TUMORS OF THE BONES AND JOINTS
by
ROBERT E. FECHNER, M.D.
Professor of Pathology
University of Virginia
Health Sciences Center, Box 214
Charlottesville, Virginia 22908
and
STACEY E. MILLS, M.D.
Professor of Pathology
University of Virginia
Health Sciences Center, Box 214
Charlottesville, Virginia 22908
Published by the
ARMED FORCES INSTITUTE OF PATHOLOGY
Washington, D.C.
Under the Auspices of
UNIVERSITIES ASSOCIATED
FOR RESEARCH AND EDUCATION
IN PATHOLOGY, INC.
Bethesda, Maryland
1993
Accepted for Publication
1992
Available from the American Registry of Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
ISSN 0160-6344
ISBN 1-881041-08-5
ATLAS OF TUMOR PATHOLOGY
EDITOR
JUAN ROSAI, M.D.
Department of Pathology
Memorial Sloan-Kettering Cancer Center
New York, New York 10021-6007
ASSOCIATE EDITOR
LESLIE H. SOBIN, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
EDITORIAL ADVISORY BOARD
Jeffrey Cossman, M.D.
Georgetown University School of Medicine
Washington, D.C. 20007
Ronald A. DeLellis, M.D.
Tufts University School of Medicine
Boston, Massachusetts 02111
Glauco Frizzera, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
Leonard B. Kahn, M.D.
Long Island Jewish Hospital
New Hyde Park, New York 11042
Richard L. Kempson, M.D.
Stanford University Medical School
Stanford, California 94305
Paul Peter Rosen, M.D.
Memorial Sloan-Kettering Cancer Center
New York, New York 10021
Robert E. Scully, M.D.
Harvard Medical School and
Massachusetts General Hospital
Boston, Massachusetts 02114
Steven G. Silverberg, M.D.
The George Washington University
School of Medicine
Washington, D.C. 20037
Sharon Weiss, M.D.
University of Michigan School of Medicine
Ann Arbor, Michigan 48109-0602
EDITORS' NOTE
The Atlas of Tumor Pathology has a long and distinguished history. It was
first conceived at a Cancer Research Meeting held in St. Louis in September
1947 as an attempt to standardize the nomenclature of neoplastic diseases.
The first series was sponsored by the National Academy of Sciences-National
Research Council. The organization of this Sisyphean effort was entrusted to
the Subcommittee on Oncology of the Committee on Pathology, and Dr. Arthur
Purdy Stout was the first editor-in-chief. Many of the illustrations were
provided by the Medical Illustration Service of the Armed Forces Institute of
Pathology, the type was set by the Government Printing Office, and the final
printing was done at the Armed Forces Institute of Pathology (hence the
colloquial appellation "AFIP Fascicles"). The American Registry of Pathology
purchased the Fascicles from the Government Printing Office and sold them
virtually at cost. Over a period of 20 years, approximately 15,000 copies
each of nearly 40 Fascicles were produced. The worldwide impact that these
publications have had over the years has largely surpassed the original goal.
They quickly became among the most influential publications on tumor
pathology ever written, primarily because of their overall high quality but
also because their low cost made them easily accessible to pathologists and
other students of oncology the world over.
Upon completion of the first series, the National Academy of Sciences-National
Research Council handed further pursuit of the project over to the newly
created Universities Associated for Research and Education in Pathology
(UAREP). A second series was started, generously supported by grants from the
AFIP, the National Cancer Institute, and the American Cancer Society. Dr.
Harlan I. Firminger became the editor-in-chief and was succeeded by Dr.
William H. Hartmann. The second series Fascicles were produced as bound
volumes instead of loose leaflets. They featured a more comprehensive coverage
of the subjects, to the extent that the Fascicles could no longer be regarded
as "atlases" but rather as monographs describing and illustrating in detail
the tumors and tumor-like conditions of the various organs and systems.
Once the second series was completed, with a success that matched that of the
first, UAREP and AFIP decided to embark on a third series. A new
editor-in-chief and an associate editor were selected, and a distinguished
editorial board was appointed. The mandate for the third series remains the
same as for the previous ones, i.e., to oversee the production of an eminently
practical publication with surgical pathologists as its primary audience, but
also aimed at other workers in oncology. The main purposes of this series are
to promote a consistent, unified, and biologically sound nomenclature; to
guide the surgical pathologist in the diagnosis of the various tumors and
tumor-like lesions; and to provide relevant histogenetic, pathogenetic, and
clinicopathologic information on these entities. Just as the second series
included data obtained from ultrastructural (and, in the more recent
Fascicles, immunohistochemical) examination, the third series will, in
addition, incorporate pertinent information obtained with the newer molecular
biology techniques. As in the past, a continuous attempt will be made to
correlate, whenever possible, the nomenclature used in the Fascicles with that
proposed by the World Health Organization's International Histological
Classification of Tumors. The format of the third series has been changed in
order to incorporate additional items and to ensure a consistency of style
throughout. This includes the dropping of the 's possessive in eponymic terms,
in accordance with the WHO and the International Nomenclature of Diseases.
Close cooperation between the various authors and their respective liaisons
from the editorial board will be emphasized to minimize unnecessary repetition
and discrepancies in the text and illustrations.
To its everlasting credit, the participation and commitment of the AFIP to
this venture is even more substantial and encompassing than in previous
series. It now extends to virtually all scientific, technical, and financial
aspects of the production.
The task confronting the organizations and individuals involved in the third
series is even more daunting than in the preceding efforts because of the
ever-increasing complexity of the matter at hand. It is hoped that this
combined effort — of which, needless to say, that represented by the authors
is first and foremost — will result in a series worthy of its two illustrious
predecessors and will be a suitable introduction to the tumor pathology of
the twenty-first century.
Juan Rosai, M.D.
Leslie H. Sobin, M.D.
ACKNOWLEDGMENTS
We gratefully acknowledge the expert editorial assistance of Nancy J. Kriigel
and Linda M. Mills, the photographic expertise of Ursula W. Miller, and the
artistic talents of Linda Berry.
The authors extend their special thanks to the following physicians who, since
the publication of the prior edition, generously provided material from their
own files:
Dr. L. V. Ackerman
Stony Brook, New York
Dr. H. D. Alpern
Cooperstown, New York
Dr. F. B. Askin
Baltimore, Maryland
Dr. A. G. Ayala
Houston, Texas
Dr. K. W. Barwick
Jacksonville, Florida
Dr. R. M. Belding
Barre, Vermont
Dr. R. D. Brunning
Minneapolis, Minnesota
Dr. T. E. Casey
New Orleans, Louisiana
Dr. P. E. Gates
Barre, Vermont
Dr. A. Greenspan
Sacramento, California
Dr. T. E. Keats
Charlottesville, Virginia
Dr. M. J. Klein
New York City, New York
Dr. M. Kyriakos
St. Louis, Missouri
Dr. R. W. McKenna
Dallas, Texas
Dr. T. L. Pope Jr.
Winston-Salem, North Carolina
Dr. J. A. Richman
Cooperstown, New York
Dr. T. W. Westgaard
Sandefjord, Norway
Dr. J. T. Wolfe III
Jacksonville, Florida
Dr. L. E. Wold
Rochester, Minnesota
Permission to use copyrighted illustrations has been granted by:
American Medical Association:
Arch Pathol 88:3716, 1969. For figure 100.
American Society of Clinical Pathologists Press:
Diseases of Bones and Joints. Based on the
Proceedings of the 51st Annual Anatomic
Pathology Slide Seminar of the American
Society of Clinical Pathologists, 1985.
For figures 68, 183, 238, and 239.
Appleton & Lange:
Pathol Annu 20(Pt 2):10137, 1985.
For figures 152, 153, 158160, 165, and 168.
Churchill Livingstone, Inc.:
Pathology of the Head and Neck, 1988.
For figures 264 and 265.
JB Lippincott Company:
Cancer 10:11512, 1957. For figure 230.
Cancer 39:212736, 1977. For figure 30.
Cancer 46:252533, 1980. For figure 59.
Cancer 59:496500, 1987. For figures 197 and 199.
Raven Press, Ltd.:
Am J Surg Pathol 7:42538, 1983. For figure 251.
Am J Surg Pathol 8:1816, 1984. For figures 7375.
Am J Surg Pathol 13(Suppl 1):1730, 1989. For
figure 173.
Springer-Verlag, Inc. :
Skeletal Radiol 16: 4813, 1987. For figure 299.
Skeletal Radiol 18:1857, 1989. For figure 295.
Skeletal Radiol 20:8590, 1991. For figures 911.
Virchows Arch [A] 411:2332, 1987. For figure 134.
WB Saunders Company:
Hum Pathol 17:7318, 1986. For figures 307 and 308.
Radiol Clin North Am 19:71548, 1981. For figures
1-4.
Williams & Wilkins Company:
Bones and Joints, 1976. For figures 311, 313, and
316.
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