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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Professor and Head
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Calcutta National Medical College & Hospital , Kolkata

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Muzaffarnagar Medical College,
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,
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
(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)
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 : 2012 | Month : June | Volume : 6 | Issue : 5 | Page : 881 - 883

Villar’s Nodule: A Rare Case Report

Kuladeepa Ananda Vaidya, Prashanth Adiga, Lakshman.I.K

1. Assistant Professor In Pathology, SIMS & RC. 2. Assistant Professor In General Surgery, SIMS & RC. 3. Assistant Professor In General Surgery, SIMS & RC.

Correspondence Address :
Dr. Kuladeepa Ananda Vaidya
Department of Pathology, SIMS&RC, Srinivas Nagar, Mukka,
Surathkal, Karnataka - 575021 (India).


Villar’s Nodule or primary umbilical endometriosis is a rare condition, with an estimated incidence of 0.5 to 1% among all the patients with endometrial ectopia. Endometriosis remains a diagnostic and therapeutic enigma even today, largely due to its variable presentations. We are hereby reporting a case of primary umbilical endometriosis due to its rarity and unusual presentation.


Umbilical, Endometriosis

Umbilical endometriosis, also known as Villar’s Nodule, was first described by Villar in 1886. It is extremely rare, the incidence being only 0.5-1% among all the women with extra gonadal or external endometriosis (1). This condition should not be mistaken for scar endometriosis which occurs in a sub-umbilical incision scar (2). Various theories with regards to its pathogenesis have been suggested, none of which can unequivocally account for the endometriosis in all the various locations in which it has been reported. The umbilicus is one of the less common sites for the localization of the ectopic endometrium. According to the literature, a total of only 109 cases of umbilical endometriosis has been reported (3). The presentation of endometriosis to the general surgeons is rare and atypical and it presents diagnostic difficulties (4),(5).

Case Report

A 30-year old woman presented with a dark brown, painless umbilical nodule of 1 year’s duration and a history of cyclical bleeding from the umbilicus during menstruation [Table/Fig-1]. Surgical excision of the lesion and reconstruction were performed and the post-operative course was uneventful. Grossly, the umbilicus showed nodularity on its surface and the cut section of the resected umbilicus showed multiple, tiny cystic structures which were filled with a brownish material (Table/Fig 2). Microscopically, the islands of the endometrial glands and the stroma were appreciated below the stratified squamous epithelium (Table/Fig 3) & (Table/Fig 4). A pathological diagnosis of umbilical endometriosis was given.


Endometriosis, which is defined as the presence of endometrial tissue (glands and stroma) outside the uterine cavity, affects 5 to 10% of the fertile women. The most pronounced symptoms are dyspareunia, pelvic pain, and infertility (6). The other symptoms may include diarrhoea or constipation (in particular, in connection with menstruation), abdominal bloating (in connection with menstruation), heavy or irregular bleeding and fatigue (7). The clinical presentations of umbilical endometriosis are an umbilical pigmented nodule and umbilical weeping, especially cyclical bleeding and cyclical pain (8). Most of the endometrial deposits are found in the pelvis, which include the ovaries, the peritoneum, the uterosacral ligaments, the pouch of Douglas, and the rectovaginal septum, but they may also rarely occur in extra pelvic locations. These include most of the body cavities, as well as organs which include the lung, gallbladder, bowel, kidney, central nervous system, extremities, perineum, and the abdominal wall. Extra pelvic endometriosis may occur in up to 12 percent of the women with endometriosis. More commonly, cutaneous endometriosis occurs in the surgical scars from abdominal or pelvic procedures, which include hysterectomies, caesarean sections, episiotomies and laparoscopy (9),(10),(11).

Umbilical endometrioma is a rare condition, with an estimated incidence of 0.5 to 1% among all patients with endometrial ectopia. The development of umbilical endometriomas can occur following laparoscopic surgical procedures which involve the umbilicus (12),(13). Several aetiological theories have been proposed for its pathogenesis, with coelomic metaplasia being the most favoured one and also, the umbilicus may act as a physiological scar with a predilection for the endometrial tissue, in the development of spontaneous umbilical endometriosis (14),(15). Umbilical endometriosis can pose a diagnostic dilemma as it can simulate a malignant melanoma or the “sister Mary Joseph nodule”— a manifestation of an intra-abdominal malignancy. Any other condition that presents with a subcutaneous mass or discolouration of the umbilical skin, such as a benign nevus, a lipoma, an abscess, a cyst, or a hernia, as well as a metastatic deposit from a systemic malignancy, should be considered in the differential diagnosis [16,17]. Primary umbilical endometriosis is defined as the presence of ectopic endometrial glands within the umbilicus without a prior history of pelvic endometriosis (17).

Some rare cases had undergone malignant transformation and they had given rise to endometrial carcinomas. The possibility of a coexisting genital-pelvic endometriosis should be investigated. Hormonal therapy may be a consideration when there is a coexistent pelvic endometriosis (21).

The treatment of umbilical endometriosis consists of medical and surgical approaches. In treating pelvic pain, both drug and surgical treatments are effective (18). Pre-operative hormone therapy may be used in patients with large mass of umbilical endometriosis, to reduce the size (19). Umbilical defects which result from the resection of umbilical endometriosis can mostly be repaired directly by using a local advancement flap, a pedicled flap or a modified unfolded cylinder flap (20).

Some rare cases had undergone malignant transformation and they had given rise to endometrial carcinomas. The possibility of a coexisting genital-pelvic endometriosis should be investigated. Hormonal therapy may be a consideration when there is a coexistent pelvic endometriosis (21).


Primary umbilical endometriosis is a rare condition with an overall incidence of around 0.5% to 1% among all the endometriosis cases, but sometimes, it poses a diagnostic dilemma. Hence, a histopathological examination is required for the confirmation of the diagnosis. Primary umbilical endometriosis usually presents as a brown coloured umbilical nodule. The other common symptoms are, pain and bleeding. Although a preoperative hormone therapy may help in reducing the size of the umbilical lesion, surgical resection remains the treatment of choice, with an extremely low recurrence rate.


Michovitz M, Baratz M, Stavorovsky M. Endometriosis of the umbilicus. Dermatologica 1983; 167: 326-30.
Panicker SCR, Pillai N, Nagarsekar U. Villar’s Nodule: A rare presentation of external endometriosis. MJAFI 2010; 66 : 70-71.
Blumenthal N.J.A. Umbilical endometriosis; a case report, SA Medical Journal 1981; 198-9.
Firilas A, Soi A, Max M. Abdominal incision endometriomas. Am Surg 1994; 60: 259-61.
Koger KE, Shatney CH, Hodge K, McClenathan JH. Surgical scar endometrioma. Surg Gynaecol Obstet 1993; 177:243-46.
Chatzikokkinou P, Thorfinn J, Angelidis IK, Papa G, Trevisan G. Acta Dermatoven APA; 2009; Vol 18 (3).
D’Hooghe TM, Hill JA. Endometriosis. In: Berek JS, Adashi EY, Hillard PA, editors. Novak’s Gynaecology. 13th ed. Lippincott Williams and Wilkins. 2002; 887-914.
Frischknecht F, Raio L, Fleischmann A, Dreher E, Luscher KP, Mueller MD. Umbilical endometriosis. Surg Endosc 2004; 18: 347.
Steck WD, Helwig EB. Cutaneous endometriosis. JAMA 1965; 191: 167-70.
Albrecht LE, Tron V, Rivers JK. Cutaneous endometriosis. Int J Dermatol 1995; 34(4): 261-62.
Geranpaye L, Fadaei-Araghi M, Irani S, Shakiba B. Spontaneous endometriosis of the abdominal wall. Acta Medica Iranica 2009; 47(2): 154-56.
Goldberg JM, Bedaiwy MA. Recurrent umbilical endometriosis after the laparoscopic treatment of minimal pelvic endometriosis: a case report; J Reprod Med. 2007;52:551-52.
Michowitz M, Baratz M, Stavorovsky M. Endometriosis of the umbilicus. Dermatologica. 1983;167:326–30.
Agarwal A, Fong YF. Cutaneous endometriosis. Singapore Med J. 2008;49(9):704-09.
Yu CY, Perez-Reyes M, Brown JJ, Borrello JA. MR appearance of umbilical endometriosis. J Comput Assist Tomogr. 1994;18:269-71.
Skidmore RA, Woosley JT, Katz VL. Decidualized umbilical endometriosis. Int J Gynaecol Obstet 1996; 52: 269-73.
Yu Hsueh Y, Shieh S, Hsueh Y-Y, Shieh S-J. Primary umbilical endometriosis. J.P.S.A.R.O.C. 2009; 18(1) :66-69.
Olive DL, Pritts EA. Treatment of endometriosis. N Engl J Med 2001; 345:266-75.
Purvis RS, Tyring SK. Cutaneous and subcutaneous endometriosis. Surgical and hormonal therapy. The Journal of Dermatologic Surgery and Oncology 1994;20:693-95.
Franco D, Medeiros J, Farias C, Franco T. Umbilical reconstruction for patients with a midline scar. Aesthetic Plast Surg 2006;30:595-98.
Shrestha NS, Pande S, Joshi M, Padhye SM. Primary umbilical endometriosis. A case report. NJOG 2011 May-June; 6 (1): 51-52.

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ID: JCDR/2012/4330:2233
Date of Submission: Mar 23, 2012
Date of Peer Review: Apr 14, 2012
Date of Acceptance: Apr 18, 2012
Date of Publishing: Jun 22, 2012

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