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

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Sanjay Gandhi institute of trauma and orthopedics,
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Dr. Mamta Gupta,
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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.
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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.

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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)
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.
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 : 2009 | Month : October | Volume : 3 | Issue : 5 | Page : 1801 - 1804

Malignant Melanoma Of Maxillary Sinus: A Rare Entity

GUPTA S *, SINGH P A **, MISRA V ***, JAIN S ****

*(M.B.B.S.),**(M.D),***(M.D.),****(M.S.),M.L.N.Medical College,Allahabad,(India)

Correspondence Address :
Dr.Stuti Gupta,
Dept. of Pathology, M.L.N.Medical College,
Allahabad,(U.P.), (India).Ph -09935448449
Email id-


Malignant melanoma of the nose and paranasal sinuses is an aggressive disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. Melanomas are tumours arising from melanocytes which are neuroectodermally derived cells located in the basal layers of the skin, adnexa and some of the mucosal membranes. Malignant melanomas developing from maxillary sinuses are extremely rare. Their diagnosis can be confirmed by immunohistochemistry by using anti-S100 and HMB-45 antibodies.


Malignant melanoma, Maxillary sinus, HMB-45

Malignant melanoma is a relatively rare malignancy and constitutes approximately about 1-2 % of all malignancies arising in the body. 90% of these occur in the skin. Primary malignant melanoma arising in nasal and paranasal sinuses are rare¹, accounting for less than 1% of all melanomas and have a poor prognosis. In 1965, Kully and Shreedharan² reported the first case of melanoma in India. Ravid and Esteeves³ reported that Lucke in 1869, operated on a 52 year old man suffering from melanotic sarcoma of the nasal mucosa. The first case in American literature was reported by Lincoln in 1885. One third of these melanomas are usually amelanotic lesions. Malignant melanoma of the nose and paranasal sinuses is rare. It accounts for less than 1% of all malignant melanomas and less than 3% of all nasal malignancies. It is also rare for melanoma to metastasize to this anatomical site .The tumour mostly occurs in the 4th decade of life. Clinically, the patients present with complaints of nasal mass, bloody discharge, obstruction and rhinorrhoea. Grossly, melanoma can present as a firm, gray-white or pink-to-black, ulcerated mass. Black colouration is a rarity, and its absence does not rule out melanoma. Histologically, melanoma is variable in appearance and it has been said that it may look like anything; therefore, it is in the differential diagnosis of almost everything. It is identified because of its junctional activity, prominent melanin pigmentation, marked cytological atypia, nuclear grooves, folds and pseudoinclusions, large eosinophilic nucleoli and abundant mitotic figures. The cells can be epithelioid, spindle shaped or extremely bizarre. Their size can range from small (lymphocyte like) to that of giant multinucleated forms. The cytoplasm can be eosinophilic, basophilic, foamy, of the signet ring type, oncocytic, or completely clear (balloon cell melanoma). Melanin can be abundant, scanty, or absent (amelanotic melanoma). Immunoperoxidase studies are extremely useful and include the use of HMB-45, S100, Melan A, and one of the newest diagnostic markers, pigment epithelium–derived factor (PEDF). Immunohistochemically, sinonasal malignant melanomas are positive for S100 and markers for melanomas including HMB45, Mart-1, and tyrosinase. Most of them do not produce significant amounts of melanin. P16 is expressed in a significant number of these tumours and is mainly related to the deletion of the 9p21 region.

A case of malignant melanoma of the maxillary sinus is documented here, due to its rarity.

Case Report

A 60-year-old male presented with complaints of a mass in the nose, nasal blockage, nasal discharge, epistaxis and fullness over the left cheek. The symptoms increased rapidly over a period of two months. On clinical examination, a fleshy, pinkish white, firm and tender mass was present in the left nasal cavity, which was completely blocking the nasal passage and bled on touch. The left ala was stretched out. The septum was markedly deviated to the right side by the mass. On posterior rhinoscopy, a whitish growth was seen in the nasopharynx. Examination of the throat, ears and larynx were normal.

The routine haematological and biochemical investigations were within normal limits. CT scan revealed opacification of the left maxillary sinus by a nonspecific hypodense, mildly enhancing soft tissue mass, extending into the middle meatus and bulging into the nasopharynx. The mass displaced the nasal septum to the right side, thus thinning it. The left ethmoid, frontal and bilateral sphenoid sinuses were opacified by hypodense nonenhancing soft tissue (Table/Fig 1).

Left maxillectomy was performed and the tumour was removed piece-meal and sent for histopathological examination.

Histopathological Examination
On gross examination, multiple, irregular, friable, dark brown pieces of tissue admixed with few bony pieces ranging from 6x4 to1x1 cm in size were obtained. The cut surface was brown. Histologically, the biopsy material showed stratified squamous epithelium, fibrovascular tissue and tiny pieces of bone and mucous glands (Table/Fig 2),(Table/Fig 3). Aggregates of cells arranged in alveolar and diffuse patterns were present. The cells were moderately pleomorphic, showing anisokaryosis, round to oval nuclei, vesicular chromatin, prominent nucleoli and abundant cytoplasm. Some of these cells had eccentric nuclei (plasmacytoid) [Table/fig 4].There was evidence of an intracellular and extracellular dark brown pigment, which was later confirmed to be melanin, by S100 and HMB45 antibodies (Table/Fig 5), (Table/Fig 6).


The present case was diagnosed as malignant melanoma on light microscopy, which was later confirmed by immunohistochemistry. Before immunohistochemistry, more commonly occurring neoplasms of the nose and nasopharynx like lymphoma, sinonasal undifferentiated (anaplastic) carcinoma, olfactory neuroblastoma (esthesioblastoma) and small-cell neuroendocrine carcinoma, were also considered. However, the pattern of cell arrangement, morphology and immunohistochemistry helped in ruling out these possibilities.

In the present case, due to the advanced age of the patient, lymphoma was the nearest possible diagnosis but it was ruled out due to lack of the monomorphic appearance of cells in comparison to the present case which showed marked pleomorphism and positivity for HMB-45 and S-100 on immunohistochemistry.

Sinonasal undifferentiated (anaplastic) carcinoma usually has medium sized cells arranged in nests, lobules, trabeculae and sheets having a high mitotic rate, extensive necrosis and prominent vascular invasion, while in the present case, cells were arranged in an alveolar pattern, showing pleomorphism and had moderate cytoplasm. Sinonasal undifferentiated carcinoma is usually positive for cytokeratin and epithelial membrane antigen, but is negative for S-100, but in our case, S-100 was positive.

Olfactory neuroblastoma (esthesioblastoma) was also considered in the differential diagnosis due to its site of occurrence, but it was ruled out due to the absence of the Homer Wright rosette or Flexner-Wintersteiner rosettes, morphology, pattern of cells, prominent fibrillary or reticular background and absence of positive staining for synaptophysin.

Small-cell neuroendocrine carcinoma was considered in the differential diagnosis due to age, site and clinical presentation ( epistaxis, proptosis, and obstructive phenomenon), as in malignant melanoma. Small-cell neuroendocrine carcinoma was ruled out morphologically due to the absence of small hyperchromatic cells.


The present case highlighted the importance of malignant melanoma in differential diagnoses of tumours occurring in the nose and paranasal sinuses, as it has a very aggressive behaviour and a poor prognosis. Immunohistochemistry is also helpful in further confirming the diagnosis, especially in amelanotic melanoma and in ruling out other tumours of the nose and paranasal sinuses.


Yoshika H,Kamda T et al:MRI of mucosal malignant melanoma of the head and neck-J.Comput assistant Tommogr 1998;22(3),492-97.
Kutty MK, Shreedharan T. Malignant melanoma of the nasal septum. J Laryngol A65; 79:249-252
Ravid JM, Esteeves JA. Malignant melanoma of the nose and paranasal sinuses and juvenile melanoma of the nose. Arch Otolaryngol 1960; 72:431-444.
Pantazopoulos PE. Primary malignant melanoma of the nasal fossa. Ann Otol Rhinol Laryngol 1965; 74:604-10.
Franchi A, Alos L, Gale N, Massi D, Paglierani M, Santucci M, Zidar N, Cardesa A. Expression of p16 in sinonasal malignant melanoma. Virchows Arch. 2006 Dec; 449(6):667-72.

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