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

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Dr. Mamta Gupta,
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Aug 2018

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
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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 : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : ED07 - ED08 Full Version

Primary Pancreatic Squamous Cell Carcinoma: An Incidental Diagnosis of a Rare Entity

Published: December 1, 2022 | DOI:
S Sreelakshmi, Ranjana Giri, Goutami Dasnayak, Urmila Senapati, Vedavyas Mohapatra

1. Postgraduate Resident, Department of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India. 2. Professor, Department of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India. 3. Assistant Professor, Department of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India. 4. Professor and Head, Department of Pathology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India. 5. Associate Professor, Department of Surgical Gastroenterology, Kalinga Institute Medical Sciences, KIIT University, Bhubaneswar, Odisha, India.

Correspondence Address :
Goutami Dasnayak,
Assistant Professor, Department of Pathology, Kalinga Institute Medical Sciences, Kushabhadra Campus 5, Kalinga Institute of Industrial Technology, Bhubaneswar-751024, Odisha, India.


Primary Squamous Cell Carcinoma (SCC) of pancreas is a non endocrine tumour showing ductal origin which accounts for approximately 0.5-2% of all malignant pancreatic tumours. Diagnosis is usually made by tissue sampling followed by comprehensive search for primary SCC elsewhere. Hereby, authors report a rare case of primary pancreatic SCC in a young female. A 46-year-old female with history of type 2 diabetes mellitus presented with abdominal pain radiating to back associated with biliary vomiting since five months. Laboratory investigations revealed mild anaemia, neutrophilic leucocytosis and elevated blood glucose. Carcinoembryonic Antigen (CEA) and Cancer Antigen 19-9 (CA 19-9) were within normal limits. Contrast-Enhanced Computed Tomography (CECT) (abdomen and pelvis) showed pancreatic atrophy, multiple stones in head and body along with a pseudocyst in tail of pancreas. Patient underwent triple phase Magnetic Resonance Imaging (MRI) with Magnetic Resonance Cholangiopancreatography (MRCP) which showed chronic pancreatitis with intraductal calculi in the head and distal body region with pseudocyst at tail region. Frey’s procedure was done and tissue sent in multiple pieces. Histopathology revealed features of infiltrating SCC in a background of atrophic pancreas. Immunohistochemistry for CK5/6, P63 and CEA was done for confirmation. It showed strong positivity for CK5/6 and P63, while CEA was negative. Final diagnosis of SCC of pancreas in a background of atrophic pancreas was rendered. Though pancreas is devoid of squamous cells, it is not uncommon to find squamous metaplasia of ductal epithelial cells secondary to chronic inflammation. In the present case, though clinical and radiological features points towards benign lesion, definite diagnosis as SCC is justified by histopathology and immunohistochemistry. Because of the rarity, diagnosis and treatment still remains a challenge.


Immunohistochemistry, Malignancy, Pancreas

Case Report

A 46-year-old female patient presented with abdominal pain radiating to the back and associated with on and off biliary vomiting for five months. There was no history of weight loss or loss of appetite. Patient was recently diagnosed to have type 2 diabetes mellitus. Laboratory investigations revealed that haemoglobin was 11.8 g/dL, Total Leucocyte Count (TLC) was 14,578 cells/mm3 with Differential Leucocyte Count (DLC)- neutrophil was 92%, lymphocyte was 05%, zero eosinophil and monocyte aws 3%. High Performance Liquid Chromatography (HPLC) was glycated haemoglobin (HbA1c) was 7.0%. Cancer Antigen 19-9 (CA 19-9) and carcinoembryonic antigen were within normal limits. Liver function tests showed normal values except for serum alkaline phosphatase which was raised (115 U/L).

Contrast Enhanced Computed Tomography (CECT) showed pancreatic atrophy with multiple calculi in head and body of pancreas and a pseudocyst in the tail of pancreas measuring 3.6×2.4 cm. An MRI with Magnetic Resonance Cholangiopancreatography (MRCP) was done subsequently which also showed pancreatic atrophy, main pancreatic duct was 9.2 mm, 3.6×2.4×2.3 cm pseydocyst in tail of pancreas along with intraductal calculi (Table/Fig 1).

Considering, it as chronic calcific pancreatitis, Frey’s procedure was done. Multiple bits of tissue from the head of the pancreas ranging in size from 0.8×0.5×0.3 cm to 2.2×1×0.4 cm were sent for histopathological study. Excisional biopsy was done and tissue was sent for histopathological examination. Microscopically, the tissue showed malignant squamous cells in nests over a background of atrophic pancreas (Table/Fig 2)a-c. The squamous origin of the tumour was confirmed by immunohistochemistry. Tumour cells showed strong diffuse cytoplasmic positivity of CK5/6 in >90% of tumour cells (Table/Fig 3)a and strong nuclear positivity of p63 (Table/Fig 3)b. The ductal origin of tumour cells was confirmed by negativity of Carcinoembryonic Antigen (CEA) in tumour cells (Table/Fig 3)c. In view of the histomorphological and Immunohistochemistry (IHC) finding a diagnosis of primary Squamous Cell Carcinoma (SCC) of pancreas was rendered. Chemotherapy was started on Outpatient Department (OPD) basis. However, since the patient moved to another state, she was lost for follow-up.


The SCC of pancreas is a rare non endocrine tumour having usually ductal origin. It accounts for approximately 0.5-2% (1) of all malignant pancreatic tumours and has a female predominance. Since, pancreas does not have native squamous tissue, the pathogenesis of SCC is uncertain. The diagnosis of primary SCC is made only after excluding metastatic disease and adenosquamous carcinoma of pancreas which is also another rare primary tumour (2). The first case of SCC pancreas was described by Lowry CC et al., in 1949 (3). Mussa AA et al., described the incidence of pure SCCP as 0.5% among all pancreatic carcinomas (4). Borwin HA et al., reported that three months after en bloc resection with negative margins and lymph nodes, he presented with widely metastatic disease (5). Squamous metaplasia in the pancreatic ducts is seen in 9-64% of all pancreatic specimen routinely examined at autopsy but transformation to SCC is an extremely rare incidence (6).

Patients with SCC of pancreas present with abdominal pain, back pain, loss of appetite, weight loss, nausea, vomiting and obstructive jaundice. Uncommon presentations with upper gastrointestinal bleeding and sometimes malena have also been reported (7). SCC has an equal distribution in all parts of the pancreas, with tumours often overlapping multiple regions. A study report showed 73% of SCCs in head of the pancreas followed by 45% in the body (6).

In cases of pancreatic SCC local lymph node metastasis and distant metastases to liver are common. Tumour blush sign in angiography and endoscopic retrograde cholangiopancreatography or tumour enhancement on Contrast-Enhanced Computed Tomography (CECT) can be used to diagnose SCC (4). Also, endoscopic ultrasoundguided Fine Needle Aspiration Cytology (FNAC) is being accepted recently for the identification of pancreatic malignancies with a high sensitivity and specificity (8),(9).

Many hypothesis has been proposed in regard to the origin of pancreatic SCC, some of which are as follows (9):

1) Malignant change in a primitive cell which is capable of differentiating into either squamous or glandular carcinoma;
2) Squamous change in a pre-existing adenocarcinoma;
3) Malignant transformation in a squamous metaplasia of the ductal epithelium;
4) Malignant change in aberrant squamous cells.

Pure squamous histology has poor prognosis and poor survival rate as compared to adenocarcinoma and adenosquamous carcinoma (3). Therefore, other rare primary tumours of pancreas and metastasis of other SCC to pancreas should be ruled out. Primary SCC is highly aggressive, most often locally advanced, or metastatic at the time of diagnosis. Treatment options are limited (9). A surgical resection should be considered in addition to treatment with platinum based chemotherapy (4). Prognosis is extremely poor and median survival was noted to be seven months, with a range of 6-16 months, in a study of seven patients who underwent curative resection (9).


Pure SCC of pancreas is a rare tumour. Though pancreas is devoid of squamous cells, it is not uncommon to find SCC due to metaplasia of ductal epithelial cells secondary to chronic inflammation. Metastasis from other sites should be ruled out before establishing a diagnosis of primary pancreatic SCC. Based on the rare incidence of the histologic subtype of tumour, diagnosis and treatment remains an enormous challenge to clinicians and pathologists.


Abedi SH, Ahmadzadeh A, Mohammad Alizadeh AH. Pancreatic squamous cell carcinoma. Case Rep Gastroenterol. 2017;11(1):219-24. [crossref] [PubMed]
Kumar Das, Majumdar S, Kumar Muduly D, Mishra S, Mohapatra CRR, Bunger D, et al. Management of primary squamous cell carcinoma of the pancreas with a nanosomal paclitaxel lipid suspension-based regimen: A case report. Mol Clin Oncol. 2019,10:430-34. [crossref] [PubMed]
Lowry CC, Whitaker HW Jr, Greiner DJ. Squamous cell carcinoma of the pancreas. South Med J. 1949;42:753-57. [crossref] [PubMed]
Mussa AA, Healy CF, McCarthy J. Primary squamous cell carcinoma of the pancreas: case report and literature review. Ann Pancreat Cancer. 2020;3:14. [crossref]
Brown HA, Dotto J, Robert M, Salem RR. Squamous cell carcinoma of the pancreas. J Clin Gastroenterol. 2005;39:915-19. [crossref] [PubMed]
Itani KM, Karni A, Green L. Squamous cell carcinoma of the pancreas. J Gastrointest Surg. 1999;3:512-15. [crossref] [PubMed]
Sears HF, Kim Y, Strawitz J. Squamous cell carcinoma of the pancreas. J Surg Oncol. 1980;14:261-65. [crossref] [PubMed]
Minami T, Fukui K, Morita Y, Kondo S, Ohmori Y, Kanayama S, et al. A case of squamous cell carcinoma of the pancreas with an initial symptom of tarry stool. J Gastroenterol Hepatol. 2001;16:1077-79. [crossref] [PubMed]
Beyer KL, Marshall JB, Metzler MH, Poulter JS, Seger RM, Díaz-Arias AA. Squamous cell carcinoma of the pancreas. Report of an unusual case and review of the literature. Dig Dis Sci. 1992;37:312-18. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/58876.17332

Date of Submission: Jul 21, 2022
Date of Peer Review: Sep 02, 2022
Date of Acceptance: Oct 10, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• 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

• Plagiarism X-checker: Jul 29, 2022
• Manual Googling: Oct 06, 2022
• iThenticate Software: Oct 08, 2022 (6%)

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