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

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Dr. Mamta Gupta,
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Dr. Mamta Gupta
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Aug 2018

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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

Year : 2008 | Month : June | Volume : 2 | Issue : 3 | Page : 892 - 898 Full Version

Malignant Fibrous Histiocytoma Of The Anterior Maxilla

Published: June 1, 2008 | DOI:
Correspondence Address :
Sanjay Rastogi Assistant Professor (Unit Chief)Department of Dental Manipal Teaching Hospital Pokhra, Nepal


Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma, but is relatively uncommon in head and neck area. Histologically, it is difficult to distinguish this tumor from other sarcomas and carcinomas. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumor in the head and neck is low in comparison with MFH of the extremities and trunk. Around 61 cases reported in the international literature since 1974. We present a rare case of primary MFH of the maxilla in the unusual location of maxilla in a 20-year-old female. The tumor was located in the maxillary anterior region mimicking periodontal ulcer. We have described the difficulty in diagnosing the tumor along with differential diagnosis, histopathological diagnosis, and current methods in diagnosing the tumor i.e. immunohistochemical analysis. The literature was reviewed briefly along with treatment guidelines.


Histiocytoma, Dental, Maxilla

Tumors which are composed of cells differentiating as both fibroblasts and histiocytes have been designated fibrous histiocytomas, although only a small percentage of these lesions behave in a malignant fashion; they are called malignant fibrous histiocytoma, MFH.(2),(4) MFH arises predominantly in soft tissue, especially in the trunk and extremities,(5) and is one of the most common malignant tumors among the elderly, with a peak incidence in the fifth through the seventh decades of life.(6)

The term was introduced in 1963, (1) as it was believed that the tumor arose from histiocytes acting as facultative fibroblasts. Although current thinking is that the term histogenesis is related to fibroblasts themselves, the term, malignant fibrous histiocytoma has been retained for convenience, as it is descriptive of a clinico-pathological entity. The etiology of MFH is unknown. However, in long bones, there is a strong association between medullary bone infarcts and the subsequent development of osteosarcoma and malignant fibrous histiocytoma.

Malignant fibrous histiocytomas can arise from soft tissue or bone. Their occurrence is most common in the soft tissues of the abdomen and extremities, while 23% of histiocytomas occur at osseous sites. Although they can be found in the head and neck region, their occurrence is uncommon, accounting for 3–8.5% of the cases.(6),(7) The peak occurrence is in persons aged 50–70 years. A slight male predominance is observed. They can occur everywhere, owing to their mesenchymal origin.(2),(3) The most common sites of occurrence in the head and neck, are the sino-nasal tract,(8)soft tissues of the neck, craniofacial bones, and salivary glands. A literature search showed around 61 well-documented cases of malignant fibrous histiocytoma arising at the maxilla, maxillary sinuses and zygoma.(11)-(40)

We describe an interesting case of unusual location of tumors that had been diagnosed at a late stage, in the maxilla (anterior). The present case demonstrates the typical difficulty in recognizing this tumor.

Case Report

A 20 year old female came to the Department of Oral Medicine with a complaint of a 4 month old ulcer in the upper jaw, in the front region of the gums. The patient gave a history of tooth brush trauma in the maxillary anterior gingival area, followed by an ulcer which persisted for 4 months. There was no history of vesicle or bullae prior to the ulcer formation. A provisional diagnosis of pyogenic granuloma/chronic fungal infection was given, and the patient was referred to the Department of Periodontics.

A course of antibiotics were given to the patient, and an incisional biopsy was taken, which was not conclusive. A repeat biopsy of the lesion was taken, histopathological and special stain (Reticulin positive) studies were done, which gave the diagnosis of Malignant Fibrous Histiocytoma (Storiform Type), and the patient was referred to the Dept. of Oral Surgery for further management.

On examination of the lesion –it was observed that the gingiva was red in color and inflamed with respect to the upper central incisors, with ulceration measuring 2cm in size and extending upto the middle third of the upper central incisors and the mucogingival junction (Table/Fig 1). The lesion was severely tender on palpation, with bleeding on probing, and grade III mobility of the upper central incisors. No cervical lymph nodes were palpable. Chest radiographs and biochemical and hematological investigations showed no evidence of metastases. Axial and Coronal CT scan of the facial bones demonstrated a minimally enhancing soft tissue density mass lesion, measuring about 3x1.5 cm, seen in the midline in the superior gingivolabial sulcus. The underlying bone of the alveolar process of the maxilla showed scalloping without frank destruction (Table/Fig 2). A Bone scan revealed no abnormal skeleton uptake.

At operation under general anaesthesia, resection of the premaxilla was done, with extraction of the upper anterior canine and excision of the labial and palatal mucosa with 1.5 cm clearance margins. The BIPP pack was given into the defect, and was covered by a surgical obturator.

Histological examination of the surgical specimen showed a tumor composed of numerous fibroblasts, macrophages, and atypical cells, with evidence of numerous mitotic figures admixed with numerous proliferating blood vessels, with a lumen filled with RBC’s. The macrophages were arranged in a storiform pattern. Certain areas showed a myxomatous degeneration (Table/Fig 3).

The surgical margins were free of tumor. The diagnosis of Malignant Fibrous Histiocytoma was confirmed after routine histology and special stains like reticulin.

Postoperatively, patient recovery was uneventful. In the patient follow up, during the course of 4 months, healing was adequate, with no complaints. An interim obturator was given. The patient was explained about the postoperative chemotherapy, for which she was not willing. The patient remains free of disease, with minimal aesthetic deformity, and is tolerating her prosthesis well, 6 months postoperatively (Table/Fig 4)


Stout(2) coined the term malignant fibrous histiocytoma on the basis of tissue culture studies made by Margaret Murray, which purportedly showed that these pleomorphic fibroblastic tumors arose from tissue histiocytes capable of fibroblastic transformation which are called ‘‘facultative fibroblasts’’. Enzinger and Weiss subsequently defined five subtypes of MFH as follows: (1) Storiform-pleomorphic, (2) myxoid, (3) giant cell, (4) inflammatory, and (5) angiomatoid. MFH is the most common adult soft tissue sarcoma.(9)

Recently, there are controversial entities regarding tumors of fibroblastic differentiation. The ubiquitous fibroblast is capable of a wide variety of morphological and functional adaptations with respect to its body site, as well as local physiological and pathological changes. The active collagen synthesizing fibroblast is a spindle shaped or plump epithelioid cell with prominent juxtanuclear Golgi apparatus, and well developed branching rough endoplasmic reticulum (RER).(10) There is a longstanding disagreement as to whether the cell type composing MFH is a histiocyte or a fibroblast. Initially, it was proposed by Ozzello et al.(1) that the cell was ‘‘facultative fibroblast’’ (a histiocyte that could appear and function as a fibroblast). However, the majority of more recent histochemical, immunohistochemical, and ultrastructural studies of this tumor support the contention that MFH is a form of fibrosarcoma.(9),(10) Previously, the diagnosis was made on the basis of the histological appearance. Recently, distinction among these pleomorphic soft tissue tumors is best achieved by a joint immunohistochemical and ultra structural study.(10)

Malignant Fibrous Histiocytoma is the most common soft tissue sarcoma, first described by Ozzelo et al. and O’Brien and Stout(1),(2) The storiform-pleomorphic type is the most common, and is a highly cellular tumor, which can range from well differentiated to anaplastic. MFH affects individuals later in life, and occurs more often in men, with an approximate 2:1 male: female ratio.

Maxillary MFH is very rare. It was first reported in 1974.(40) The review of the literature produced 61 well-documented cases of maxillary malignant fibrous histiocytoma(11)-(40) ranging in age from 12 to 83 years, with a median age of 44.7 years. Most patients 54/61 (88.5%) showed clinical signs of primary maxillary MFH. MFH can also arise in the site of previous radiation. However, radiation induced MFH of the head and neck is exceedingly rare. A literature search showed only 7/61 cases (11.47%) of post-radiation maxilla MFH.(19)(20)(26)(33)(35) The sinonasal tract has been reported to be the commonest site (30%) of tumor involvement in the head and neck region(8) But Sabesan et al.(12) found that maxilla is the most common site (15/54 cases). This literature review of Maxilla MFH revealed that 41/61 cases (67.2%) of the lesions occurred in the maxilla(11)-(15),(17),(18),(20)-(30),(32)-(40) while only 5/61 cases (8.19%) occurred in the maxillary sinus,(14),(19),(30), and only two cases (3.2%) were reported to have occurred in the post-maxillary and alveolar ridge


Malignant Fibrous Histiocytoma is an aggressive tumor with potential for both local recurrence and hematogenous metastatic spread. Clinicians should not overlook any kind of gingival ulcer or swelling that may not appear distinct visually, and therefore consider it to be a part of the normal anatomy, an anomaly with no significance, or treat them injudiciously. An accurate diagnosis should be established prior to any surgical treatment using histological analysis and special stains. MFH should be treated aggressively with the main modality of treatment as surgery, followed by combined radiotherapy and chemotherapy.


Ozzello L, Stout A P, Murray M R. Cultural characterstics of malignant histiocytomas and fibrous xanthomas. Cancer 1963; 16: 331-343.
O’Brien JE, Stout AP. Malignant fibrous xanthomas. Cancer 1964; 17:1445-55.
Kempson RL, Kyriakos M. Fibroxanthosarcoma of the soft tissues. A type of malignant fibrous histiocytoma. Cancer 1972; 29:961–76.
Leite C, Goodwin JW, Sinkovics JG, Baker LH, Benjamin R. Chemotherapy of malignant fibrous histiocytoma. A southwest oncology group report. Cancer 1977; 40:2010-4.
Weiss SW, Enzinger FM. Myxoid variant of malignant fibrous histiocytoma. Cancer 1977; 39:1672-85.
Weiss SW, Enzinger FM. Malignant fibrous histiocytoma—An analysis of 200 cases. Cancer 1978; 41: 2250-66.
Huvos AG, Heilweil M, Bretsky SS. The pathology of malignant fibrous histiocytoma of bone. Am J Surg Pathol 1985; 9:853.
Wood SW, Enzinger FM. Malignant fibrous histiocytoma tumour cells resemble fibroblasts. Am J Surg Pathol 1986; 10:323–5.
Enzinger FM, Weiss SW. Soft tissue tumors. 3rd ed. Mosby: St. louis; 1995.
Erlandson RA, Woodruff JM. Role of electron microscopy in the evaluation of soft tissue neoplasms, with emphasis on spindle cell and pleomorphic tumors. Human pathology 1998; 29(12).
Watanabe K, Yambe M, Toh T, Ueda M. Malignant fibrous histiocytoma of the maxilla. Report of a case. Oral Oncol Suppl 2005; 1(1):203. (Abstract).
Sabesana T, Xuexi Wu, Yongfab Qi, Pingzhangb Tang, Ilankovan V. Malignant fibrous histiocytoma: Outcome of tumours in the head and neck compared with those in the trunk and extremities. British Journal of Oral and Maxillofacial Surgery, 2005
Chan Y-W, Guo Y-C, Tsai T-L, Tsay S-H, Lin C-Z. Malignant fibrous histiocytoma of the maxillary sinus presenting as toothache. J Chin Med Assoc 2004; 67:104–7.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3] [Table / Fig - 4]

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