Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2007 | Month : February | Volume : 1 | Issue : 1 | Page : 3 - 9 Full Version

Histopathological Spectrum of Paediatric Hodgkin´s Lymphoma


Published: February 1, 2007 | DOI: https://doi.org/10.7860/JCDR/2007/.46
PAYAL K, RAJLAKSHMI T, RAMESH R K

Department of Pathology, St John’s Medical College, Bangalore, India

Correspondence Address :
Payal K. Dept. of Pathology, St John’s Medical College, Bangalore, India. Tel:080-25634854,

email: payalsriks@yahoo.co.in

Abstract

Background: Hodgkin’s lymphoma (HL) accounts for 5 per cent of the malignancies in the pediatric age group and is potentially curable. However, early diagnosis is essential for timely management. The diagnosis and classification of Hodgkin’s lymphoma was considered to be relatively simple and straightforward earlier, but the characteristic Reed-Sternberg cells (R-S cell) that occur within an inflammatory milieu and are required for the diagnosis can also be seen in other reactive conditions, such as infectious mononucleosis and other malignant lesions, such as nonHodgkin’s lymphomas. The advances in phenotyping, molecular characteristics, histogenesis and possible mechanisms of lymphoma genesis, have led to a change in the classification into the Revised European American Lymphoma (R.E.A.L) classification followed by the World Health Organization (WHO) scheme. This has been done with a view to reflect the differences in clinical presentation, prognosis, and management. In the process, while the borders between some histological types of lymphoma became sharper, others continue to remain ill defined.

Material and Methods: Paraffin sections and medical records of the diagnosed cases of HL were retrospectively studied during the period between Jan 1992 and Dec 2003. The sections were studied to assess the architecture, the presence of R-S cells and its variants, background infiltrate, and fibrosis.

Results: 29 cases of pediatric HL were encountered out of a total of 106 cases of Hodgkin’s lymphoma. The age range was 3-14 years with an M: F ratio of 24:5. The most common clinical presentation was lymphadenopathy in 18 cases. Histologic sub typing of 29 cases revealed mixed cellularity to be the predominant subtype.

Conclusions: Pediatric HL accounts for 27.3 % of all cases of Hodgkin’s Lymphoma in our study. The mean age at presentation was 8.5 years with a male predominance. Mixed cellularity was found to be the most common subtype.

Keywords

Hodgkin’s lymphoma, paediatrics

Paediatric cases account for 10% of all cases of Hodgkin’s lymphoma (HL) (1), with a higher incidence in developing countries. Male preponderance is observed in children less than 10 years of age. Most common presentation is cervical lymphadenopathy (2). . In Western literature, nodular sclerosis is the most common subtype followed by mixed cellularity and predominant nodular lymphocyte. Lymphocyte depletion is the rarest. 96 per cent cases of mixed cellularity are associated with EBV infections.

In literature, especially in the Indian context, the references generally pertains to case studies of variants of Hodgkin’s lymphoma, application of molecular markers, or treatment modalities in assessing the outcome. The literature available on the significance of different histological features in the diagnosis as well as on the prognosis of Hodgkin’s lymphoma is inadequate. With the aim of facilitating a histologic diagnosis of Hodgkin’s lymphoma, a comprehensive review has been undertaken on the various histologic parameters.

Material and Methods

Source of data

The study included those cases of Hodgkin’s lymphoma that were presented to the departments of pediatrics at St. John’s Medical College Bangalore The study was both retrospective and prospective. The clinical features and other laboratory parameters were studied from the medical records of the hospital and archives of the department of Pathology retrospectively from January 1992 to December 2001 and prospectively from January 2002 to December 2003. A total of 29 cases were studied.

Paraffin sections were reviewed. Haematoxylin and Eosin stain was used to study the basic morphology.

A. The following histologic parameters were studied:

1. The architecture of the lymph node: It was marked as total diffuse or partial effacement of the architecture. Other than these two, nodular pattern was also observed.

2. The composition of background infiltrate: The presence of neutrophils, eosinophils, plasma cells, and lymphocytes was studied.

3. Fibrosis: It was graded according to the density as mild, moderate, and severe. Wherever possible, Reticulin stain was used to highlight the fibrosis.

Based on these features, each case was assigned to any one of the following histologic subtypes:

• Nodular lymphocyte predominant
• Mixed cellularity
• Lymphocyte rich
• Nodular sclerosis
• Lymphocyte depleted

If the case did not fit into any of the above subtypes, it was labelled as unclassified.(Table/Fig 1)

B. Demographic details
The age and sex of the patients were retrieved from the records and were tabulated to see the prevalence of the different histologic subtypes in this age group.

Results

Clinical profile

In the present study, a total 29 cases of HL diagnosed in a period from January 1992 to December 2003 were included (<14 years of age). In this age group M:F ratio was 24:5.

The common clinical presentation was lymphadenopathy in 18 cases and fever in 15 cases. The lymphadenopathy was cervical (17), axillary (5), or inguinal (2). Together with lymphadenopathy, hepatosplenomegaly was present only in 10 cases.

Histological features
The architecture was diffuse in 16 cases, nodular in nine cases, and partially preserved in four cases. Out of the 29 cases, one case had extra nodal involvement (liver).
Based on the histological features, the cases were subtyped and the distribution is as follows:

• Lymphocyte rich—6
• Mixed cellularity—13
• Lymphocyte depleted—3
Two each from nodular sclerosis and nodular lymphocyte were predominant. Three cases could not be classified including the one in the liver.

Discussion

Lymphoma history began in 1832, when Thomas Hodgkin published a remarkable paper entitled “On Some Morbid Appearances of the Absorbent Glands & the Spleen” (3). A full description of the diagnostic cells came from Sternberg (1898) and, in particular, Dorothy Reed (1902).

Grey zones in classification and subtyping

The aims of lymphoma classification are to ensure the following(4):-
(i) Provide an international language allowing communication
(ii) Categorize into entities that must be reproducible and clinically relevant
(iii) Sufficient flexibility to incorporate new data
(iv) Base everything on histopathology

The previous lymphoma classification did not meet these criteria. In the last 10 years, much new information has been available about the lymphomas, resulting in recognition of new entities and refinement of previously recognised disease categories. Thus, the Revised European American Lymphoma (REAL) classification of lymphoid neoplasm was adopted.(Table/Fig 2)(Table/Fig 3)

Ten per cent of HL cases occur in paediatric age group in the USA (1). In developing countries, the incidence is still higher. Average annual age standardised rate (ASR) during the period 1983–1987 was 0.4/100,000 for males and 0.2/100,000 for females in Asia (7). This could be due to an infectious aetiology (8). In India, ASR has been quoted as 1.9/100,000 and 1.3/100,000, respectively, for males and females (7). The youngest patient in literature was a 5-month-old boy (9). In our study, the youngest was a 3-year-old male child. In patients younger than 10 years of age, a male preponderance is noted, whereas in adults the incidence in both sexes is almost equal. The reason, other than infectious aetiology, could be a higher preponderance of mixed cellularity, which is known to have male preponderance.

The most common presentation is a symptomatic cervical or supraclavicular lymphadenopathy (2), which was also seen in our study. Axillary and inguinal node involvement is rare [10,11]. Two-thirds of the patients also have mediastinal disease. Systemic symptoms were seen in 25–30% of children, and these indicate a poor prognosis. Ninety-six per cent of cases of mixed cellularity in paediatric age group are associated with EBV infection (12). EBV association in paediatric cases is associated with an improved prognosis (13).

Nodular sclerosis is the most common histologic type in European countries, accounting for 40–70% of cases in this age group. NLPHL accounts for 10–15% of cases and mixed cellularity for about 30%. The low-power appearance of NLPHL shares morphologic overlap with progressive transformation of germinal centres (PTGC). PTGC is a peculiar form of follicular hyperplasia, which occurs in children and young adults in contrast to NLPHL, which occurs in the fourth decade. PTGCs can precede, occur with, or follow NLPHL. PTGCs are 2–3 times larger than reactive follicles and predominantly consists of small lymphocytes, and are round, well circumscribed, and widely spaced. In contrast, NLPHL nodules are back to back arranged with angulated borders and effaced architecture with no residual normal follicle (14). In PTGC, the follicles predominantly consist of small lymphocytes, mantle cells, intermingled with some centroblasts, and follicular dendritic cells. They lack popcorn cells and are composed of a mixture of B- and T-cells, histiocytes, and follicular dendritic cells, which produce a “moth-eaten” appearance (15)

References

1.
Ahmed M, Khan AH, Saleem S, Mansoor A. Hodgkin’s disease in children. J Trop Pediatr 1992;38:176–8.
2.
Hudson MM, Donaldson SS. Hodgkin’s disease. Pediatr Clin North Am 1997;44(4):891–907.
3.
Aisenberg AC. Historical review of lymphomas. Br J Hematol 2000;109:466–76.
4.
Isaacson PG. The current status of lymphoma classification. Br J Hematol 2000;109:258–66.
5.
Harris NL, Jaffe ES, Stein H, et al. A revised European American classification of lymphoid neoplasms: a proposal from the international lymphoma study group. Blood 1994;84:1361–92.
6.
Callaghan M. Hodgkin’s disease. Semin Oncol Nursg 1998;14:262–72.
7.
Bhutani M, Vora A, Kumar L, Kochupillai V. Hematopoietic cancers in India. Advances in hematopoietic stem cell transplantation. Eighth Annual Proceedings; 2002 Feb; New Delhi. p. 11–9.
8.
Vianna NJ, Greensald P, Davies NJP. Extended epidemic of Hodgkin’s disease in high school students. Lancet 1971;1:1209–11.
9.
Bernuth VG, Minielly JA, Logan GB, Gleich GH. Hodgkin’s disease and thymic alymphoplasia in a 5 month old infant. Pediatrics 1970;45:792–9.
10.
Fraumeni JF, Li FP. Hodgkin’s disease in childhood—an epidemiologic study. J Natl Cancer Inst 1969;4681–91.
11.
Mauch PM, et al. An evaluation of long term survival and treatment complications in children with Hodgkin’s disease. Cancer 1983;51:925–32.
12.
Windebank K. Childhood lymphoma. Indian J Pediatr 1998;65:669–80.
13.
Engel M, Essop MF, Close P, et al. Improved prognosis of Epstein-Barr virus associated childhood Hodgkin’s lymphoma: study of 47 South African cases. J Clin Pathol 2000;53:182–6.
14.
Harris NL. The many faces of Hodgkin’s disease around the world: what have we learned from its pathology? Ann Oncol 1998;9:

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