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

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On Sep 2018

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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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On Aug 2018

Dr. Arundhathi. S
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Dr. Arundhathi. S
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Sanjay Gandhi institute of trauma and orthopedics,
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
(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.
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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)
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

Year : 2010 | Month : June | Volume : 4 | Issue : 3 | Page : 2645 - 2648 Full Version

Primary Pancreatic Lymphoma - A Diagnostic Dilemma

Published: June 1, 2010 | DOI:

*(M.D.) Associate Prof. in Dept. of Pathology in Teerthanker Mahaveer Medical College, Moradabad **(M.S.) Lecturer in Dept. of Surgery in Lala Lajpat Rai Medical College, Meerut ***(M.D.) Assistant Prof. in Dept. of Anaesthesiology in Teerthanker Mahaveer Medical College, Moradabad ****Specialist, Anti retroviral therapy centre in Lala Lajpat Rai Medical College, Meerut.

Correspondence Address :
Dr. Deepti Agarwal
Mailing Address: Department of Pathology,
Teerthanker Mahaveer Medical College,
Phone No.: +91-9837005696


Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma, mimicking the carcinoma of the head of pancreas clinically (1). Most PPLs are non-Hodgkin's lymphomas (NHLs), predominantly the diffuse large B-cell type (2). We present here, a case of primary pancreatic non-Hodgkin's lymphoma, presenting with abdominal pain and jaundice and CT scan features suggestive of cholangiocarcinoma. The patient underwent surgical resection of the tumour and the histopathology revealed the primary involvement of the pancreas by the lymphoma cells. Immunohistochemistry confirmed the diagnosis as diffuse large B-celltype of lymphoma. The patient refused chemotherapy postoperatively and expired after 6 months of follow up.


pancreas, non-Hodgkin's lymphoma (NHL), primary, B-cell, adenocarcinoma

Malignant lymphomas arising primarily from the pancreatic parenchyma or in the peripancreatic lymph nodes are extremely rare. These are mostly NHLs, the low grade B-cell types (1), (2). PPL accounts for 1% of all extranodal NHLs and 0.7% of all pancreatic malignancies (3),(4). Clinically, most PPLs are misdiagnosed as pancreatic adenocarcinomas. It is important to distinguish between PPL and pancreatic adenocarcinoma due to a marked difference in the treatment and prognosis of the two diseases.
We hereby present a case of PPL diagnosed as diffuse large B-cell type of NHL.

Case Report

A 62 year old male presented with pain in the abdomen, jaundice, anorexia, nausea and vomiting of a duration of 4 months. Per abdomen examination revealed mass and tenderness in the right hypochondrium. No palpable lymphadenopathy was observed. Chest X-ray did not reveal any hilar or mediastinal lymphadenopathy. Routine blood investigations revealed normal WBC count and morphology (TLC: 4,300 cells/mm3, DLC: P74L19M6E1). The liver function test was deranged with total bilirubin -6.4mg% and direct bilirubin -6.0mg%. Serum SGOT, SGPT and Alkaline phosphatase were 58.0 IU/L, 56.0IU/L and 886.0IU/L respectively, revealing elevated levels. S. Amylase was elevated- 267.0 U/L (reference values: 0-220 IU/L). CA 19-9 was within the normal range -32.8µ/ml. Serology was non-reactive for HIV and the Hepatits B surface antigen.

CT scan revealed an ill-defined irregular high attenuating lesion in the distal common bile duct and the diffuse enlargement of the head of pancreas, with dilatation of the proximal common bile duct and the hepatic duct on contrast enhancement. No obvious peripancreatic lymphadenopathy was observed on CT scan and the diagnosis of cholangiocarcinoma was made, based on the findings of imaging. The patient was posted for surgery and the Classical Whipple's procedure was performed, including antrectomy and pancreatoduodenectomy under general anaesthesia, augmented with epidural analgesia. Peroperatively, no definite lymphadenopathy was observed. The superior mesenteric artery, the superior mesenteric vein and the portal vein appeared unremarkable. The pancreatoduodenectomy specimen, peripancreatic lymph nodes and the gall bladder were sent for histopathological examination.

Pathological findings
Gross: The specimen consisted of the duodenum measuring 8.5cm in length, the pancreas measuring 3.8x3.2x2cm, a part of the stomach measuring 3cm and the gall bladder measuring 8x3cm. Grossly, the head and a part of the body of the pancreas appeared to be diffusely enlarged, with no abnormality in other tissues. On opening the specimen, it was observed that the common bile duct was thickened and dilated. A total of 13 lymph nodes were identified grossly in the peripancreatic tissue, the largest measuring 0.8x0.6x0.5cm.

Microscopic examination: Multiple sections from the pancreas revealed a lymphoproliferative disorder (Table/Fig 1). The individual cells were large, round, having large nuclei with a high N:C ratio and having irregular nuclear membranes and clumped chromatin.

The gall bladder showed features of cholecystitis. Sections from the duodenum and the stomach were unremarkable. The lymph nodes showed features of reactive lymphoid hyperplasia. The tumour cells expressed CD-20 positivity (Table/Fig 2) and were nonreactive for CD-3.

A final diagnosis of Primary diffuse large B-cell type of non-Hodgkin's lymphoma was made, based on Behrn's criteria and immunohistopathology reports. The patient was advised chemotherapy but he refused further treatment due to his poor financial status. He expired 6 months after surgery.


Malignant lymphomas infrequently involve the pancreas. The estimated frequency of primary non-Hodgkin's lymphomas of the pancreas is about 1% (3). The head of the pancreas is the most common location of pancreatic involvement in PPLs (1) and the diffuse large B-cell type is the most common type (3). T cell lymphomas are very uncommon and carry a poor prognosis (5). Clinically, they are confused with the more common pancreatic adenocarcinomas. A frequent occurrence of B-cell lymphoma has been reported in association with acquired immunodeficiency syndrome in recent years, though our patient was sero-negative for the Human immunodeficiency virus by the ELISA test.

In the review of literature, about 87% of cases of pancreatic lymphoma were found to be misdiagnosed clinically and radiologically as pancreatic adenocarcinoma, because there was no marked difference between the two, as regards to age, sex or symptoms. However, unlike carcinomas, PPLs are treatable and carry a comparatively better prognosis even if they are not detected at an early stage (3). Till date, nearly 150 cases of PPLs have been reported in literature, with a strong male predilection (male:female ratio is 13.3:1) and increasing age (mean age of 57.5 years), a profile similar to that of our patient (2),(6).

Behrn's et al (7) suggested the following criteria for the diagnosis of primary pancreatic lymphoma; 1) Tumour confined within the pancreas at the time of diagnosis and investigations failed to reveal any evidence of lymphoma elsewhere; 2) Lymphadenopathy confined to only the peripancreatic group of lymph nodes without any involvement of distant groups or superficial lymph nodes.No hepatic or splenic involvement; 3) Normal leucocyte count with no abnormal cells in peripheral blood and bone marrow

In our case, the tumour tissue was limited to the pancreas without any lymph node involvement or distant metastasis. The total and differential WBC counts were also within normal limits on three separate occasions, thus pointing to primary pancreatic pathology.

Data reveal that the S. carbohydrate 19-9(CA 19-9) levels in PPL patients are normal or slightly elevated, while in cases of pancreatic adenocarcinoma, they are higher in almost 80% patients (2). In our case, CA 19-9 was within the normal range.

Imaging plays a key role in the diagnosis of PPL. CT scan is the most preferred imaging technique which is used in the detection and the characterization of pancreatic tumours. The image of PPL resembles that of carcinoma on CT scan, like the enlargement of the pancreatic head and density changes (2). However, the presence of a well circumscribed mass in the pancreas without the involvement of the pancreatic duct and the enlargement of the surrounding lymph nodes rule out the diagnosis of pancreatic adenocarcinoma (8),(9). Arcari et al (10) insisted that the final diagnosis of PPL should be made, based on histopathological examination, as imaging techniques were not able to distinguish PPL from pancreatic adenocarcinoma. In our case however, there was no definite mass or lesion in the pancreas and no recognizable lymphadenopathy. But there was the presence of the dilatation of the common and the hepatic ducts. The diagnosis of cholangiocarcinoma was suggested on CT scan imaging, thus favouring surgical treatment. Histopathology revealed the features of NHL, which on immunohistochemistry, was confirmed to be of the diffuse large B-cell type. Though the treatment of choice in lymphoma cases is chemotherapy or radiotherapy, the reason for surgery in our case was the lack of definitive diagnosis before the operation. It has been proved that surgery itself does not play a role in improving the patient's survival rate, but in cases of biliary or gastrointestinal obstruction, surgery should be performed to relieve the symptoms (2).

To conclude, primary pancreatic lymphoma is a rare entity presenting with non-specific symptoms, laboratory tests and imaging results. Confirmed diagnosis can be made either by histopathology or immunohistochemistry. Chemotherapy or radiotherapy is the treatment of choice, while surgical intervention is considered to have no impact on patient survival.


Authors are highly thankful to Dr. Asheesh Jain, Consultant Histopathologist, Asheesh Pathology Labs, Meerut, for his immense support and expert opinion in diagnosis.


Nayer H, Weir EG, Sheth S, Ali SZ. Primary pancreatic lymphomas: A cytopathologic analysis of a rare malignancy. Cancer Cytopathol 2004; 102: 315-21
Lin H, Li SD, Hu XG, Li ZS. Primary pancreatic lymphoma: Report of six cases. World J Gastroenterol 2006; 12(31): 5064-5067
Luo G, Jin C, Fu D, Long J, Yang F, Ni Q. Primary pancreatic lymphoma. Tumori 2009;95: 156-159
Salvatore JR, Cooper B, Shah I, Kummet T. Primary pancreatic lymphoma: A case report, literature review and proposal for nomenclature. Med Oncol 2000; 17: 237-247
Nishimura R, Takakuwa T, Hoshida Y, Tsujimoto M,, Aozasa K. Primary pancreatic lymphoma: Clinicopathologic analysis of 19 cases from Japan and review of literature. Oncology 2001; 60: 322-329
Saif MW. Primary pancreatic lymphoma. J Pancreas 2006; 7: 262-73
Behrns KE, Sarr MG, Strickler JG. Pancreatic lymphoma: is it a surgical disease? Pancreas 1994; 9: 662-67
Merkle EM, Bender GN, Brambs HJ. Imaging findings in pancreatic lymphoma: differential aspects. Am J Roentgenol 2000; 174: 671-675
Saif MW, Khubchandani S, Walczak M. Secondary pancreatic involvement by a diffuse large B-cell lymphoma presenting as acute pancreatitis. World J Gastroenterol 2007; 13(36): 4909-4911
Arcari A, Anselmi E, Bernuzzi P, Berte R, Lazzaro A, Moroni CF, Trabacchi E Vallisa D, Vercelli A, Cavanna L. Primary pancreatic lymphoma. Report of five cases. Haematologica 2005; 90: ERC 09

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