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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)
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.
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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.
On April 2011

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
On Jan 2020

Important Notice

Case report
Year : 2007 | Month : April | Volume : 1 | Issue : 2 | Page : 61 - 64 Full Version

Solitary Plasmocytoma of Bone

Published: April 1, 2007 | DOI:

St.John’s Medical college Hospital Bangalore- 34, India

Correspondence Address :
Dr. Karuna Rameshkumar, Department of Clinical Pathology St.John’s Medical college Hospital
Bangalore- 34
Email: karuna ramesh


Within the plasma cell dyscrasias, solitary plasmacytoma is rare. Solitary plasmacytoma of bone (SPB) is defined as a single bony lesion caused by a monoclonal plasma cell infiltrate, with no evidence of myeloma elsewhere.

All cases reported as multiple myeloma/plasmacytoma, from January 1999 to August 2002 at St. John’s Medical College and Hospital, were reviewed. After applying the diagnostic criteria, three cases conformed to the diagnosis of solitary plasmacytoma (7.5%). In the three cases of SPB, two occurred in males and one in female. The site of occurrence was in the thoracic vertebrae. Although radiotherapy alone is considered adequate, as two patients presenting in the vertebral region had neurological dysfunction, laminectomy was done in addition to radiotherapy. Light microscopy of all three cases showed a dense infiltrate of sheets of plasma cells.

The present study highlights the salient features of SPB. The frustrating aspect in the management of the SPB is the development of peripheral neuropathy, which was present in all three cases and was the presenting symptom in two of the cases as part of POEMS syndrome. Careful microscopy is required in EMP, as it can be confused with other malignancies, particularly lymphomas.


Solitary plasmacytoma, multiple myeloma

Within the monoclonal B-cell proliferations, solitary plasmacytomas are rare. They can present as either extramedullary plasmacytoma or a solitary lesion involving a bone – solitary plasmacytoma of bone (SPB). These entities account for 3% and 5% of all plasma cell myeloma, respectively (1).

SPB is defined as a single bony lesion caused by a monoclonal plasma cell infiltrate, with no evidence of myeloma elsewhere. Despite their rarity, these variants of traditional multiple myeloma are seen
regularly in a general oncologic practice, and they require specific diagnostic approaches and therapies that differ from that of standard multiple myeloma The most common site of SPB is the spine. At presentation, pain is the most common symptom. Patients can present with polyneuropathies alone or as a part of variable constellation of features including polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes that has been termed as the POEMS syndrome or Crow–Fukase syndrome.

We undertook the present study to determine the frequency with which solitary plasmacytomas (SPB) are encountered and to analyse the clinical and laboratory features to emphasise the need for specific diagnostic approach.

Material and Methods

Source of data
Forty reported cases of multiple myeloma or plasmacytoma at the Department of Pathology, St. John’s Medical College, from January 1999 to July 2002, were reviewed. Clinical data and laboratory results were retrieved from the medical records. The following diagnostic criteria were used to define the cases of SPB (1):

1. Single area of bone destruction that showed monoclonal plasma cell infiltrate on biopsy
2. Normal bone marrow aspirate and biopsy
3. Negative skeletal survey
4. Low concentration of serum or urine monoclonal protein and preserved levels of uninvolved immunoglobulins
Three patients fulfilled the criteria and were diagnosed as SPB.


Clinical profile
Among 40 cases of multiple myeloma reviewed, three cases (7.5%) conformed to the diagnostic criteria. Among them two were males and one was a female. All the cases presented clinically as polyneuropathy. The clinical features are summarised in (Table/Fig 1).

On examination, none of the patients had anaemia; serum calcium levels were normal with preserved renal function. Radiological examination revealed solitary lesion in the thoracic vertebra in all the three, with rest of the skeletal survey being normal. Two of the patients had visceral organ involvement in the form of splenomegaly and hepatomegaly. Diabetes mellitus was noted in two patients.

Biopsy from the affected site revealed sheets of plasma cells (Table/Fig 2). Serum electrophoresis was normal except for one patient who had polyclonal increase in gammaglobulins.

Follow up
Among the three patients, one had a follow-up of 3 years. After the laminectomy, which was followed by radiotherapy, there was no improvement. The patient was referred to rehabilitation department. During the follow-up for 3 years, he did not develop any other lesions.

The other two patients are being followed up till date. They are being treated for other systemic complaints such as hypertension and diabetes mellitus.

The clinical features and the results of investigations and the follow-up details are summarised in (Table/Fig 1) and (Table/Fig 3).


Solitary plasmacytomas account for 3% of all plasma cell myelomas. Patients presenting with SPB tend to be younger, as compared to the patients with multiple myeloma. The median age of presentation (2) is 37 + 12 years, with a male predominance similar to the present series. A distinction between solitary plasmacytoma and multiple myeloma is essential, since the treatment protocols, prognosis and course of the disease differ.

The most common presenting symptom of SPB is pain in the area surrounding the lesion. But all the three cases in the study presented with polyneuropathy, which is often found in spinal involvement by myeloma. One of the patients had both sensory and motor loss; other two had isolated sensory or motor loss. Polyneuropathy was associated with organomegaly involving liver, spleen and lymph nodes, with two of the patients having diabetes mellitus. Thus, all the three patients fulfilled at least three criteria for the POEMS syndrome. Therefore, it is evident that it warrants a systemic search for a solitary bone lesion and M component in a case of unexplained polyneuropathy (3).

The polyneuropathy associated with plasma cell dyscrasia is mainly of the demyelinating type, in which pain and autonomic involvement is rare. Although the pathogenesis of the nerve damage is unclear, recent reports suggest that the nerve injury may be mediated by complement (4). The organ involvement in POEMS syndrome is heterogeneous, with normal liver histology, Castleman disease-like picture in lymph nodes and spleen (3),(4). Endocrine involvement is diverse, with hypothyroidism being the frequent abnormality encountered (4), but two of the patients had diabetes mellitus. The pathogenesis of endocrinopathy remains unexplained, although it has been postulated that antibodies directed against specific endocrine organs may be involved (3). None of the patients had an M spike on serum electrophoresis.
On long-term follow-up, overt myeloma develops in approximately 50% of patients with SPB. Three patterns of failure occur: (1) development of multiple myeloma, (2) local recurrence and (3) development of bony lesions in the absence of myeloma (5),(6). Those patients who develop multiple myeloma differ from the patients of classical myeloma at presentation, in that the former present at a younger age with a male predominance. There is a high incidence of neurological symptoms in cases with spinal involvement. The osteolytic lesions frequently resemble those of giant cell tumours, with absence of any monoclonal component in the serum (2).
Definitive local RT has been the treatment of choice for SPB. Most series agree that a dose of at least 4000 cGy is necessary to eradicate the local disease (1). About two-thirds of the patients with SPB eventually develop multiple myeloma. The most common pattern of progression consists of new bone lesions, rising myeloma protein levels and development of diffuse marrow plasmocytosis, consistent with a macro-focal pattern of multiple myeloma. The median time for progression is 2 years, but occasionally patients have developed multiple myeloma as long as 15 years after radiotherapy.
Therefore, a patient of SPB should be followed up during and after treatment with serial physical examinations, SPEP and urine electrophoresis studies for evidence of dissemination or reactivation of disease. Any evidence found of a second bony lesion or progression to multiple myeloma should be evaluated fully and treated.


Dimopuolos MA, Kiamoinis C, Moulopoulos LA. Solitary plasmacytoma of bone and extramedullary plasmacytoma. Hemat/Oncol Clin North Am 1999;13:1249–57.
Bataille R, Sany J. Solitary myeloma: clinical and prognostic features of a review of 114 cases. Cancer 1981;48:845–51.
Soubrier MJ, Dubost JJ, Sauvezie BJM, and the French study group on POEMS syndrome. POEMS syndrome: a study of 25 cases and a review of literature. Am J Med 1994;97:543–53.
Miralles GD, O’Fallan JR, Talley NJ. Plasma cell dyscrasia with polyneuropathy. The spectrum of POEMS syndrome. N Engl J Med 1992;327:1919–23.
Kyle RA. Monoclonal gammopathies of undetermined significance and solitary plasmacytoma. Implications for progression to overt multiple myeloma. Hemat/Oncol Clin North Am 1997;11:71–87.
Lasker JC, Bishop JO, Willibanks JH, et al.: Solitary myeloma of the talus bone. Cancer 1991;68:202–5.

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