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

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



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




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



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




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
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.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



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

Important Notice

Case report
Year : 2009 | Month : April | Volume : 3 | Issue : 2 | Page : 1441 - 1444

A Rare Case Of Adenoid Cystic Breast Carcinoma In A 19-Year-Old Girl

AITHALA PS*, Rai RA**, SWETHADRI G K***, NAIK R****, KUDASOMANNAVAR R B*****

*M.S(GeneralSurgery), Prof. and HOD, Dept of General Surgery, **M.S(GeneralSurgery), Asst. Prof., Dept of General Surgery, ***M.D(Pathology), Prof., Dept of Pathology, ****M.D(Pathology), Prof. and HOD, Dept of Pathology, *****M.B.B.S, Postgraduate, Dept of General Surgery, Father Muller Medical College, Manglore

Correspondence Address :
Dr. Raghavendra B. K. Room. No.001,
Gents’ Hostel (P.G.Block) Father Muller Medical College,
Kankanady,Mangalore-3.Ph:+919964214219,
Email:drraghavendrabk@gmail.com

Abstract

A 19-year-old-girl presented to us with a lump in the right breast. The FNAC of the lump was reported as a benign disorder. Wide local excision was performed and histopathological examination of the specimen revealed an adenoid cystic carcinoma of the breast. Subsequently, she underwent axillary nodal dissection which was found to be free of metastases. As adenoid cystic carcinoma breast has a favourable prognosis compared to other histological types, the specific characteristics and diagnostic criteria are to be adhered to, for early and accurate detection and subsequent management.

Keywords

Adenoid cystic carcinoma, perineural invasion, breast

Introduction
Adenoid cystic carcinoma of the breast is a rare neoplasm. It has a biological course of slow progression and a near absence of Iymph node metastasis. In contrast to extramammary adenoid cystic carcinoma, the prognosis of adenoid cystic carcinoma of the breast is excellent. Adenoid cystic carcinoma can be confused with other more common breast cancers such as intaductal carcinoma with a cribriform pattern. It is important to distinguish this cancer from other forms of breast cancer because of its excellent progrosis.

A 19-year old girl presented to the outpatient clinic in June 2008, with a six year old lump in the right breast. On examination, a firm nodule suggestive of fibroadenoma, was palpable in the central quadrant of the right breast. The FNAC of the lump (done elsewhere) showed benign epithelial hyperplasia, with a mild degree of nuclear atypia. Wide local excision was performed. A segment of breast tissue measuring 8 X 5 X 3 cm was removed and the cut surface showed a well circumscribed yellowish white nodule measuring 3 X 3 cm, with areas of haemorrhage. The specimen was fixed in formalin and processed routinely. Histological examination showed a circumscribed tumour with cribriform groups of epithelial cells (Table/Fig 1), separated by fibrocollagenous tissue. These groups were seen to surround the mammary ducts. Tumour nests showed a cribriform pattern with amorphous eosinophilic secretions that were focally PAS-positive. The cells showed mild atypia with vesicular nuclei and sparse mitosis. Perineural invasion (Table/Fig 2) was also noted. Immunostaining was negative for the oestrogen and progesterone receptors. Adenoid cystic carcinoma (ACC) of the breast of the cribriform subtype and low grade was diagnosed. The surgical margins were free of tumour. Axillary dissection was performed, which was found to be free of nodal metastases. Staging investigations including chest X-ray and abdominal and pelvic ultrasonography were performed and showed no evidence of metastatic disease. The patient made good recovery after surgery. The patient received no adjuvant therapy and is well till date.

Discussion

Adenoid cystic carcinoma of the breast is a rare neoplasm, accounting for less than 0.1% of all breast carcinomas. Nevertheless, its early recognition is mandatory as it has a favourable prognosis (1),(2). ACCs of the breast occur predominantly in women and at a mean age of 50-60 years (3).

There has been only a single case reported previously of this type of tumour in a patient as young as 19-years of age (4). The clinical features were, a well-circumscribed palpable mass, which was occasionally tender on palpation (2). The tumour is rarely fixed to the overlying skin, nipple, or pectoral muscle. Although any part of the breast may be involved, most ACCs are centrally located.

On mammography, these tumours often appear as moderately circumscribed, lobulated nodules (3). The histological appearance of ACCs in the breast is similar to that of ACCs of the skin adnexa and of the salivary glands, but most authors agree that ACCs of the breast have a much better prognosis than ACCs of the salivary glands (1),(2).

The most striking histological feature of this neoplasm is the presence, at least focally, of cribriform nests of cells. These nests are typically composed of two cell types: small basaloid myoepithelial cells and ductal epithelial cells. The cribriform gland-like spaces are filled with homogenous amorphous eosinophilic PAS-positive material or granular basophilic material (5). A variety of microscopic growth patterns can be found in ACCs. These configurations have been described as cribriform, solid, glandular (tubular), reticular (trabecular) and basaloid. ACCs of the breast are usually receptor negative, the prognostic significance of this feature remaining uncertain. Immunohistochemical stains are positive for S-100 protein and actin in the basaloid cells and positive for cytokeratin in the ductal epithelial cells. A previous study (2) suggested that histological grading of the breast, as described for salivary gland ACCs, has some prognostic value, but this has not been confirmed by two other studies (6),(7). The origin of the tumour is unknown, with evidence of both ductal epithelial and myoepithelial cell derivation.

Differential diagnoses include cribriform intraductal carcinoma and invasive ductal carcinoma with a cribriform pattern, and benign collagenous spherulosis. If a fine needle aspiration is performed, the differential diagnosis between ACCs and collagenous spherulosis is rather difficult. ACCs show small aggregates with occasional larger sheets, in which a cribriform appearance can sometimes be recognized. Sparse epithelial tubules are seen, and myoepithelial cells are present in most of the tumour cells. The diagnostic feature is the finding of eosinophilic hyaline globules (Table/Fig 3) of basement membranes surrounded by tumour cells. These cytological findings can also be seen in collagenous spherulosis, although the cells of ACCs usually show moderate nuclear enlargement and hyperchromatasia, while in collagenous spherulosis the cells are more regular. The spherules in collagenous spherulosis contain elastin, periodic acid-Schiff(PAS)-positive material, and type IV collagen. Collagenous spherulosis occurs most often in ducts involved by hyperplasia, but it can also develop in papillomas and sclerosing adenosis. It has been reported that calponin and CD117 could also be helpful in the differential diagnosis of collagenous spherulosis from adenoid cystic carcinoma. Calponin was present in the myoepithelial cells of collagenous spherulosis, but not in adenoid cystic carcinoma. Moreover, expression of CD117 was seen in the epithelial cells of adenoid cystic carcinoma, but not in simple collagenous spherulosis (8).

Despite well-defined gross borders, more than half of these tumours show microscopic infiltration of the adjacent adipose tissue and breast parenchyma, (Table/Fig 4) making complete tumour resection difficult (5).

Guidelines for treatment of this neoplasm are not well-established in the literature. It’s rarity makes the comparison of treatment options difficult. Recurrence in the breast has been described after treatment by local excision alone. Therefore, these types of tumours are best managed by wide excision or quadrantectomy. A low axillary dissection or sentinel lymph node mapping should be performed if the clinical examination suggests lymph node involvement, if the breast contains another type of invasive carcinoma, for high-grade adenoid cystic lesions, and for tumours larger than 3 cm. Systemic adjuvant chemotherapy is recommended for patients with axillary lymph metastases and may be considered in patients with high-grade lesions, or if the tumour is larger than 3 cm.

Conclusion

In conclusion, other more common forms of breast cancer such as intraductal carcinoma may mimic the appearance of adenoid cystic carcinoma. Adenoid cystic carcinoma of the breast has a favourable prognosis.
Therefore, the accurate diagnosis and treatment is clinically important. Although it is rare, local recurrence and distant metastases may occur long after initial treatment and close follow-up is mandatory .

References

1.
. Ro J Y, Silva E G, Gallager H S. Adenoid cystic carcinoma of the breast. Hum Pathol 1987; 18: 1276–81.
2.
. LeemingR, Jenkins M, Mendelsohn G. Adenoid cystic carcinoma of the breast. Arch Surg 1992; 127: 233–35
3.
. Rosen P P. Adenoid cystic carcinoma of the breast: a morphologically heterogenous neoplasm Pathol Annu 1989; 24: 237–54..
4.
. Delanote S , Van den Broecke R , Schelfhout V R J , Serreyn R. Adenoid cystic carcinoma of the breast in a 19-year-old girl. The Breast 2003; 12 : 75-77
5.
. Kleer C G, Oberman H A. Adenoid cystic carcinoma of the breast. Value of histologic grading and proliferative activity. Am J Surg Pathol 1998; 22: 569–75.
6.
. Foschini M P, Eusebi V. Carcinomas of the breast showing myoepithelial differentiation. A review of the literature. Virchows Arch 1998; 432: 303–10.
7.
. Trendell-Smith N J, Peston D, Shousha S. Adenoid cystic carcinoma of the breast: a tumour commonly devoid of oestrogen receptors and related proteins. Histopathology 1999; 35: 241–48.
8.
. Swain RS, Zaloudek C, Chase DR, et al. Adenoid cystic carcinoma of the breast is distinguished from collagenous spherulosis and cribriform ductal carcinoma in situ by CD117 and calponin immunohistochemistry [Abstract 224]. Mod Pathol. 2005;18(suppl 1):51A.

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