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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 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
Original article / research
Full Version
Evaluation of Histopathological Findings in Lymph Node Lesions
Correspondence Address :
Dr. Ashish Ashoksingh Shiledar,
Senior Resident, Department of Medicine, Government Medical College, Miraj, Maharashtra, India.
E-mail: dramitpandav@live.in
Introduction: Enlargement of lymph nodes is one of the most common presentations in inflammatory and neoplastic disorders. Persistent enlargement of lymph nodes requires detailed investigations to reveal an underlying pathology. Clinical features and radiology images may not be sufficient for diagnosing lymph node lesions. Hence, histopathology has become a mandatory tool to arrive at a definitive diagnosis.
Aim: To evaluate histopathological patterns of various lymph node lesions.
Materials and Methods: The present prospective study was undertaken in the Department of Pathology, Maharashtra Institute of Medical Sciences and Research, Latur, Maharashtra, India, from October 2016 to September 2018. Information regarding clinical history, and examination was noted from case sheet of patients. Total 104 lymph nodes were grossly examined and processed in routine paraffin technique and then stained with Haematoxylin and Eosin (H&E). Meticulous histopathological examination was done in each case to arrive at correct histopathological diagnosis. Special stains and immunohistochemistry were performed wherever mandatory or indicated. Qualitative data was presented as frequency and percentages.
Results: Total 104 patients were studied, majority were males {n=56 (53.8%)} and mean age was 46 years. Reactive lymphadenitis was the most common cause of lymphadenopathy forming 60 (57%) cases. The metastatic lesions were in 23 (21.1%) cases. Other lesions encountered were tubercular lymphadenitis in 15 (14.3%) cases, diffuse large B-cell lymphoma in 3 (2.9%) cases, 58 (55.7%) patients had cervical lymphadenopathy and 35 (33.6%) patients had axillary lymphadenopathy.
Conclusion: Reactive lymphadenitis was the most common cause of lymphadenopathy in present study. Causes of lymphadenopathy can be suspected on clinical grounds, but histopathological examination is gold standard for early diagnostic and prognostic purpose. Special stains and immunohistochemistry should be done, wherever mandatory, or when indicated.
Immunohistochemistry, Lymphadenitis, Lymphoma, Reactive, Tuberculous
Enlargement of lymph nodes is a common clinical condition encountered by clinicians. A normal sized lymph node is <1 cm in diameter. Lymphadenopathy is the term used to describe the conditions in which lymph nodes become abnormal in size, consistency, or number, caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the nodes (1). Persistent enlargement of lymph nodes necessitates detailed investigations to reveal an underlying pathology. Although a reasonably accurate diagnosis can be made clinically, histopathological examinations are mandatory to establish and confirm the diagnosis (2).
It is important to take careful history to consider a variety of diseases, which may be a clue to the underlying pathology. The cervical region is the most frequent site involved in peripheral lymphadenopathy at any age. Lymphadenopathy is generally due to infections, but most often the supraclavicular lymphadenopathies are associated with malignancy (3).
Easy accessibility of acquiring a sample for cytological and histopathological examination has made it important component of practices of pathologists. Even though, fine needle aspiration cytology has been introduced in the laboratory diagnosis since last two to three decades, there are still many situations, where excisional biopsies are mandatory, especially in suspected cases of lymphoproliferative disorders. Aim of the present study was to evaluate histopathological patterns of various lymph node lesions.
This prospective cohort study was undertaken in the Department of Pathology, Maharashtra Institute of Medical Sciences and Research, Latur, Maharashtra, India, from October 2016 to September 2018. The study was approved by the Ethical Committee of the Institute in the meeting held on 03/10/2016 (approval number-MIMSR/EC/28/2016, dated 08/11/2016).
Inclusion and Exclusion criteria: The patients of all age and sex diagnosed with lymphadenopathy with confirmation done on lymph node biopsy were included in the study. Inadequate specimen and individuals, where only Fine Needle Aspiration Cytology (FNAC) was done without biopsy were excluded from the present study.
Study Procedure
Total 104 lymph nodes were studied. Relevant patient data regarding age, sex, clinical details, results of imaging studies, and provisional diagnosis were retrieved from the patient request forms and records. The specimens were grossly examined for size, appearance, matting, consistency, and details of cut section and then fixed in 10% formalin for 24 hours. The tissues were processed in routine paraffin technique and then stained with H&E. Slides were prepared and meticulous histopathological examination was done in each case to arrive at correct histopathological diagnosis. Finally, all data was subjected to analysis and interpretation to draw conclusions. Special stains and immunohistochemistry were performed wherever mandatory or indicated.
Statistical Analysis
All the collected data were entered in Microsoft Excel sheet and then transferred to Statistical Package for Social Sciences (SPSS) software version 17.0 for analysis. Qualitative data was presented as frequency and percentages.
A total of 104 patients with lymph node lesions were included. Majority of the patients were from 41 to 60 years of age group 36 (34.6%), followed by 29 (27.9%) from 21-40 years of age group. Mean age was 46 years. Overall, 56 (53.8%) were males and 48 (46.2%) were females (Table/Fig 1). Out of the 104 lymph nodes received for histopathological evaluation, a majority were from the cervical region comprising 58 (55.7%) cases followed by 35 (33.6%) cases in axillary region. The most common diagnosis was that of reactive lymphadenitis, followed by metastasis (Table/Fig 2). In present study, reactive lymphadenitis was common cause of lymphadenopathy in all age group. While proportion of metastasis was found to be more in age group above 40 years i.e. 20 (64%) as compared to 3 (15%) below 40 years age (Table/Fig 3). Reactive lymphadenitis (sinus histiocytosis) shows dilated sinuses containing increased macrophages and sinus lining cells (Table/Fig 4). Out of the 15 cases of tubercular lymphadenitis, 6 (40%) were Acid-Fast Bacillus (AFB) positive. Tubercular lymphadenitis shows multiple caseating granulomas, among these few cases (40%) were AFB positive (Table/Fig 5). Out of the 5 cases of lymphoma, 1 was Hodgkin’s lymphoma (1%) [Table/Fig-6a] and the rest 4 were of NonHodgkin’s lymphoma (4%). All the cases of lymphoma were confirmed using immunohistochemistry. Hodgkin’s lymphoma showed CD30 positivity [Table/Fig-6b]. Among the Non-Hodgkin’s lymphoma, 3 cases (2.9%) were of diffuse large B-cell lymphoma [Table/Fig-7a] which showed B-cell Lymphoma (BCL-6) and CD10 positivity [Table/Fig7b,c]. One case was of follicular lymphoma (1%) [Table/Fig-8a] which showed CD 20 positivity [Table/Fig-8b]. Single case of Castleman’s disease (1%) was seen (Table/Fig 9). Out of 23 cases of metastasis majority of cases had infiltrating duct carcinoma (30.4%), followed by squamous cell carcinoma 6 (26.2%) cases (Table/Fig 10), 7(30.4%) cases of metastatic IDC showed nests and sheets of malignant ductal ceils within lymph node. (Table/Fig 11). Six cases (26.2%) of metastatic squamous cell carcinoma showed nests and clusters of atypical keratinised squamous cells within lymph nodes (Table/Fig 12). Five cases (21.7%) of metastatic adenocarcinoma showstumour cells arranged in glandular pattern within lymph node (Table/Fig 13). One case (4.3%) of metastatic anaplastic carcinoma thyroid shows atypical large, bizarre cells within lymph node (Table/Fig 14). Single case (4.3%) of metastatic poorly differentiated nasopharyngeal carcinoma showed diffuse sheets of tumour cells with round vesicular nuclei, prominent nucleoli and moderate amount of eosinophilic cytoplasm (Table/Fig 15).
In present study, out of 104 lymph nodes received for histopathological evaluation, majority lymph nodes were from cervical region (55.7%), followed by 33.6% from axillary region and 5.8% were mesenteric lymph nodes. Study findings are consistent with the findings of Damle R et al., Shivamurthy A et al., Shokough TZ and Alireza A and Pagaro PM et al., (Table/Fig 16) (4),(5),(6),(7). In present study, histopathological diagnosis of various lesions are most comparable to study done by Damle R et al., (4). Prevalence of tubercular lymphadenitis was 14.3% (Table/Fig 11). Ziehl-Nelsen (ZN) staining was done in all the cases of tuberculous lymphadenitis and AFB positivity was shown by 40% which is comparable to Vimal S et al., (40.74%) and Chand P et al., (44.54%) studies (8),(9). The maximum AFB positivity was noted in cases with abundant necrosis (100%) comparable to Paliwal N et al., (85.5%) and Gupta AK et al., (78%) (10),(11). Out of 23 metastatic tumours, 30.4% had infiltrating duct carcinoma followed by 26.1% had squamous cell carcinoma and 21.7% had adenocarcinoma. 8.8% cases had mucinous carcinoma of rectum and 4.3% cases had each anaplastic carcinoma of thyroid, transitional cell carcinoma and poorly differentiated carcinoma Damle R et al., found that out of all metastatic lymph nodes, 34 (62.9%) cases were metastatic infiltrating breast carcinoma, 12 (22.2%) cases were metastatic squamous cell carcinoma, and 8 (14.8%) cases were metastatic adenocarcinoma (4). Mbata GC et al., found in their study that most common cause of metastasis was breast cancer affecting mostly axillary lymph nodes (12). Pagaro PM et al., found most common metastasis were metastatic squamous cell carcinoma (10.5%) followed by metastatic breast cancer (4.5%) (7). Hemant B and Surekha H, found that out of all metastatic lymph nodes, 8 (34.8%) cases were metastatic infiltrating breast carcinoma, 6 (26.2%) cases were metastatic squamous cell carcinoma, and 4 (17.4%) cases were metastatic adenocarcinoma (13). Two cases (8.7%) of metastatic papillary carcinoma of thyroid observed. One case (4.3%) each of metastatic nasopharyngeal carcinoma, small cell carcinoma of lung and undifferentiated carcinoma were observed.
Vachhani A et al., found that out of 23 metastatic lymph nodes, 9 (36%) cases were metastatic squamous cell carcinoma, 8 (32%) cases were metastatic IDC, and 3 (12%) cases were metastatic adenocarcinomas (14). In comparison to various studies in the literature present study findings were similar to findings of Damle R et al., and Vachhani A et al., (4),(14). Malignancies have been the predominant cause of lymphadenitis in developed countries than developing countries like India because of racial and genetic factors. Study by Roy A et al., and Mohan A et al., constituted 44.5% and 25.9% cases of lymphoma which were very higher incidence than the present study. Because, these studies included large number of cases and conducted in Research Centre or Oncology Institute (15),(16). The reactive lymphadenitis was most common pathologic finding observed in most of the other studies and in present study (Table/Fig 17) (4),(5),(7),(13),(16),(17),(18),(19).
Limitation(s)
As lymphadenopathy is common finding for the physician in dayto-day practice and initial test used for diagnosis is FNAC and the patients were treated accordingly, hence, the sample size of study was limited.
While evaluating the histological pattern of lymph nodes in various age groups, it was found that, in general reactive lymphadenitis was the most common cause of lymphadenopathy in all age groups but proportion of metastasis was more in age-group above 40 years. The most common groups of lymph nodes involved were cervical group of lymph nodes, followed by the axillary. Causes of lymphadenopathy can be suspected on clinical grounds, but histopathological examination helps in categorising the causes of lymph node enlargement as reactive changes, infective/ inflammatory, lymphoma, and metastasis. So it is concluded that, lymph node biopsy is an important tool for early diagnostic and prognostic purpose.
DOI: 10.7860/JCDR/2022/57112.17167
Date of Submission: Apr 15, 2022
Date of Peer Review: May 13, 2022
Date of Acceptance: Sep 27, 2022
Date of Publishing: Nov 01, 2022
Author declaration:
• Financial or Other Competing Interests: None
• as Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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