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

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On Sep 2018




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"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."



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Lucknow
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On Aug 2018




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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.
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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.


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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.
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.
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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
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

Miscellaneous
Year : 2010 | Month : June | Volume : 4 | Issue : 3 | Page : 2641 - 2644 Full Version

Fine Needle Aspiration Cytology diagnosis of the Eccrine Variant of Chondroid Syringoma- Case Report of a Rare Entity with Review of Literature


Published: June 1, 2010 | DOI: https://doi.org/10.7860/JCDR/2010/.784
BHASIN T S *** , MANNAN R ***, BHATIA P K ****, SHARMA M ***, BHALLA A ***

***Assistant Professor, Department of Pathology, SGRDIMSR, Amritsar (Punjab); ****Senior Resident, Department of Pathology, Gian sagar Medical College, Bannur (Punjab).India.

Correspondence Address :
Dr Rahul Mannan
C/O Dr V. K Rampal
5-Court Road, Amritsar-143001
Punjab (India)
Ph- +919781613285 (O), 091-0183-2504062 (R)

Abstract

Chondroid syringomas (CS) are rare mixed tumours of sweat-gland origin which were first described by Billroth in 1859, that have both benign and malignant forms. They are also known as mixed tumours of the skin and are composed of both epithelial and mesenchymal components. A 40-year-old female presented to the surgical outpatient department with a gradually increasing swelling over the side of the nose, of 1 year duration. FNAC was done and the aspirate was thick and mucoid. Microscopic examination revealed clusters of epithelial and myoepithelial cells, embedded in a metachromatic, chondromyxoid ground substance. Based on these features, a diagnosis of chondroid syringoma was made and histopathological examination was advised. On histopathological examination, it was found that there were numerous nests of polygonal cells and interconnecting tubuloalveolar structures whicha were lined by a single layer of cuboidal epithelial cells. The stroma consisted of cells in a bluish chondroid matrix. Based on these findings, a diagnosis of the eccrine variant of CS was given. The patient was well after excision and no recurrence was reported. CS is a rare primary skin tumour; the incidence is < 0.098% and affects middle aged and older men. The most common sites are the head and neck region, the hand, foot, the axillary region, the abdomen, penis, vulva and the scrotum. Fine needle aspiration cytology has been used for diagnostic purposes and may prove to be useful to determine the pathology before excision of the tumour. However, examination of excised tissue is most reliable in establishing a definitive diagnosis.

Keywords

Chondroid syringoma, eccrine, FNAC.

Introduction
A chondroid syringomas (CS) are rare mixed tumours of sweat-gland origin which were first described by Billroth in 1859, that have both a benign and malignant form. They are also known as mixed tumours of the skin and are composed of both epithelial and mesenchymal components. Hirsch and Helwig gave them the appellation chondroid syringoma, because of the presence of sweat gland elements which are set in a cartilaginous stroma (1).

The incidence of CS is low and has been reported at 0.01-0.098 percent. The lesions are typically located on the head and neck and are non-ulcerating, slow-growing, subcutaneous, or dermal nodules (1), (2), (3). We present here, a rare case of the eccrine variant of chondroid syringoma, occurring on the side of the nose in a 40 year old woman. There are only a few case reports describing the fine needle aspiration cytological (FNAC) features of chondroid syringoma and that too, the eccrine variant, which itself is very rare. The diagnosis was established by FNAC and confirmed by histopathology.

Case Report
A 40-year-old female presented to the surgical outpatient department with a gradually increasing swelling over the side of the nose, of 1 year duration. Physical examination revealed a mobile, firm swelling that measured 0.8 cm in diameter. FNAC was done with the help of 22 G needles. Two to three passes at two different sites were done. The smears prepared, were stained with May-Grunwald-Giemsa (MGG) and Papanicolaou stains. Grossly, the aspirate was thick and mucoid. Microscopic examination revealed clusters of epithelial and myoepithelial cells embedded in a metachromatic, chondromyxoid ground substance (Table/Fig 1). The epithelial cells had round, monomorphic nuclei having dispersed chromatin, with a moderate to abundant amount of cytoplasm. Based on these features, a diagnosis of chondroid syringoma was made and histopathological examination was advised.
At the time of excision, gross pathological analysis revealed well-encapsulated tan coloured tissue. No areas of haemorrhage or necrosis were noted. The histopathological examination revealed a well-circumscribed proliferation of epithelial cells, interspersed with foci of myxoid stroma. There were numerous nests of polygonal cells and interconnecting tubuloalveolar structures lined by a single layer of cuboidal epithelial cells (Table/Fig 2). The stroma consisted of cells in a bluish chondroid matrix. Based on these findings, a diagnosis of the eccrine variant of CS was given. The patient was well after excision and no recurrence was reported.

(Table/Fig 1)
Fig 1 A and B- Clusters of epithelial and myoepithelial cells embedded in a metachromatic, chondromyxoid ground substance (200 X Giemsa).
Fig 1 C- The clusters of epithelial cells and myoepithelial cells (200 X Giemsa).
Fig 1 D- Same as 1 C with higher magnification
(400 X Giemsa).

(Table/Fig 2)
Fig 2 A- Well-circumscribed proliferation of epithelial cells (100 X H&E).
Fig 2 B- Same as 2A with higher magnification (200 X H&E).
Fig 2 C- Foci of myxoid stroma (400 X H&E).
Fig 2 D- Interconnecting tubuloalveolar structures lined by single layer of cuboidal epithelial Cells (400 X H&E).

Discussion

CS is a rare primary skin tumour; the incidence is < 0.098% and affects middle aged and older men. (4),(5). The most common sites are the head and neck region, hand, foot, the axillary region, the abdomen, penis, vulva and the scrotum. CSs are a group of tumours of the salivary gland that contain varying amounts of mucoid and cartilaginous material (1). The first case of chondroid syringoma is believed to have been reported by Nasse in 1892 (6). Virchow and Minssen (2) referred to them as mixed tumours with both epithelial and mesenchymal origins. Histologically, CS consists of mixed epithelial and mesenchymal elements, with epithelial cells arranged in cords and forming tubules with a myoepithelial layer, set in myxoid or chondroid stroma (2),(7), (8), (9). Two histological variants of this tumour are described, the eccrine type with smaller lumens, lined by a single row of cuboidal epithelial cells and the apocrine variant with tubular and cystic branching lumina, lined by two rows of epithelial cells [ 2].

Headington recognized 2 types, apocrine and eccrine. The apocrine type demonstrates irregular branching tubules (tubulocystic pattern) lined by at least 2-cell-thick epithelium. The eccrine type is characterized by rather uniform, small, round tubules that are evenly spaced within a myxoid-chondroid matrix. 10 CS lesions usually were not clinically distinctive and the diagnosis was made on the basis of microscopic examination (2),(6). Also, there is limited literature on the degree of the aggressive nature and the propensity of the recurrence of the eccrine variant over the apocrine variant of CS.

The tubuloalveolar components of chondroid syringomas are composed of two layers of cells with different immunophenotypes. The inner layer expresses epithelial markers such as cytokeratin (11). The outer layers express mesenchymal markers such as vimentin, S-100 protein, neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) (11). Initially, it was thought that the chondroid area of the tumour showed ultrastructural features which were identical to myoepithelial cells, a component of the outer layer of cells (12). However, subsequent studies have concluded that the cartilaginous matrix is true cartilage produced by ultrastructurally typical chondrocytes and not by the pseudocartilage which is produced by the myoepithelial cells [ 11].

Clinically, the differential diagnosis of CS is made with other benign tumours of the epidermal or mesenchymatous appendages such as the dermoid or sebaceous cysts, neurofibroma, dermatofibroma, basal cell carcinoma, pilomatricoma, histiocytoma and seborrheic keratosis (4). Therefore, CS should be considered in the differential diagnosis of any sub cutaneous nodule in the head and neck region of a middle aged individual, especially in males.

Because of the risk of malignancy, the first-line treatment is total excision, where a cuff of normal tissue is necessary to avoid recurrence (2). This is followed by regular follow-up, to look for local recurrence and any feature of malignancy (13). The recurrent lesion can be treated by surgical re-excision (14) .Malignancy in CS is rare, with reported cases occurring in young female patients in the extremities and the torso (15) .

Fine needle aspiration cytology has been used for diagnostic purposes and may prove to be useful to determine the pathology before excision; however, examination of the excised tissue is most reliable in establishing a definitive diagnosis (16),(17).

Key Message

Key Message
1. Chondroid syringoma is rare primary skin tumour; the incidence is < 0.098% and affects middle aged and older men. Most common sites are the head and neck region, hand, foot, the axillary region, the abdomen, penis, vulva and the scrotum.
2. The aspirate on FNAC is usually thick and has mucoid like consistency. Smears reveal clusters of epithelial and myoepithelial cells embedded in a metachromatic, chondromyxoid ground substance.
3. On histology; 2 types of chondroid syringoma are recognized: apocrine and eccrine. The apocrine type demonstrates irregular branching tubules (tubulocystic pattern) lined by at least 2-cell-thick epithelium. The eccrine type is characterized by rather uniform, small, round tubules that are evenly spaced within a myxoid-chondroid matrix.
4. Immunohistochemically, the inner layer was found to express epithelial markers such as cytokeratin, whereas; the outer layers express mesenchymal markers such as vimentin.
5. Clinically, the differential diagnosis of Chondroid syringoma was made, with other benign tumours of epidermal or mesenchymatous appendages such as the dermoid or sebaceous cysts, neurofibroma, dermatofibroma, basal cell carcinoma, pilomatricoma, histiocytoma and seborrheic keratosis .
6. As there is a risk of malignancy in chondroid syringoma, the first-line treatment is total excision, where a cuff of normal tissue is necessary to avoid recurrence.

References

1.
Hirsch P, Helwig EB. Chondroid syringoma. Mixed tumor of skin, salivary gland type. Arch Dermatol 1961 Nov; 84:835-47.
2.
Yavuzer R, Basterzi Y, Sari A, Bir F, Sezer C. Chondroid syringoma: a diagnosis more frequent than expected. Dermatol Surg 2003 Feb; 29(2):179-81.
3.
Stout AP, Gorman JG. Mixed tumors of the skin of the salivary gland type. Cancer 1959 May; 12(3):537-43.
4.
Yavuzer R, Basterzi Y, Sari A, Bir F, Sezer C. Chondroid syringoma: a diagnosis more frequent than expected. Dermatol Surg 2003; 29:179-81.
5.
Villalón G, Monteagudo C, Martin JM. Chondroid syringoma: a clinical and histological review of eight cases.] Actas Dermosifiliogr 2006; 97:573-7.
6.
Nasse D. Die Geschwülste der Speicheldrüsen und verwandte Tumoren des Kopfes. Arch Klin Chir 1892. 44:233–302.
7.
Sungur N, Uysal A, Gümüs M, Kocer U. An unusal chondroid syringoma. Dermatol Surg 2003; 29: 977-9.
8.
Bates A W, Baithun S I. Atypical Mixed Tumor of the Skin: histologic, immunohistochemical, and ultrastructural features in three cases and a review of the criteria for malignancy. Am J of Dermatopathol 1998; 20:35-40.
9.
Takamitsu O, Shinichi W. Histogenesis of mixed tumor of the skin, apocrine type: immunohistochemical study of keratin expression. Am J of Dermatopathol 1997; 19:456-61.
10.
Miracco C, De Santi MM, Lalinga AV et al. Lipomatous mixed tumour of the skin: a histological, immunohistochemical and ultrastructural study. Br J of Dermatol 2002; 146: 899- 903.
11.
Argenyi ZB, Balogh K, Goeken JA. Immunohistochemical characterization of chondroid syringomas. Am J Clin Pathol 1988 Dec;90(6):662-9.
12.
Varela-Duran J, Diaz-Flores L, Varela-Nunez R. Ultrastructure of chondroid syringoma: role of the myoepithelial cell in the development of the mixed tumor of the skin and soft tissues. Cancer 1979 Jul;44(1):148-56.
13.
Headington J. T. Mixed tumors of skin: eccrine and apocrine types. Arch Dermatol 1961. 84:989–996.
14.
Mebazaa A, Trabelsi S, Denguezli M, et al. Chondroid syringoma of the arm: an unusual localization. Dermatol Online J 2006; 12:14.
15.
Barnett MD, Wallack MK, Zuretti A, et al. Recurrent malignant chondroid syringoma of the foot: a case report and review of the literature. Am J Clin Oncol 2000; 23:227.
16.
Chen AH, Moreano EH, Houston B, Funk GF. Chondroid syringoma of the head and neck: clinical management and literature review. Ear Nose Throat J 1996 Feb; 75(2):104-8.
17.
Köse R, Okur MI. Giant facial chondroid syringoma. Dermatol Surg. 2009 Feb; 35(2):294-5.

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