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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
Immunohistochemical Analysis in Salivary Duct Carcinoma of the Upper Labial Mucosa: A Rare Case Report
Correspondence Address :
Dr. Jaya Dubey,
Postgraduate Student, Department of Oral Medicine and Radiology,
Government Dental College and Hospital, Ahmedabad, Gujarat, India.
E-mail: jayadubey.dubey8.jd@gmail.com
Salivary Duct Carcinoma (SDC) is a rare typically high grade, aggressive malignancy arising from the ductal epithelium of salivary glands characterised by ductal formations and central necrosis having pathomorphological resemblance to ductal breast carcinoma. Parotid and submandibular salivary glands are the most commonly affected while very few cases involving the minor salivary glands of the palate, labial mucosa, floor of mouth have been reported. This high grade malignancy must be treated aggressively by complete local excision with radical neck dissection and postoperative radiation therapy seems to offer maximum benefit for the patients. This article highlights a case of a 80-year-old male patient having an intraoral ulcer over a swelling which was since five years on the left side of upper lip with left submandibular lymph nodes enlargement is reported. An immunohistochemical analysis of the biopsy specimen was carried out which concluded a SDC. The swelling was surgically excised followed by postoperative radiotherapy and adjuvant chemotherapy. The patient was on a regular follow-up for two and a half years without any local recurrence or distant metastasis.
Adenocarcinoma, Comedonecrosis, Minor salivary gland
A 80-year-old male patient was relatively asymptomatic before five years when he noticed a small pea sized swelling in the upper lip region which was gradually increasing in size but patient did not consult any doctor for the same. However, patient got concern when he noticed an ulceration over the same swelling since last 20 days. There was no pain or paraesthesia without any history of bleeding or pus discharge from the same. Then he consulted private hospital where Computed Tomography (CT) scan of head and neck region was done and patient was referred to a tertiary health care centre. Patient had no past medical history and family history. Patient was having a habit of bidi smoking 5-7 per day and Khaini (form of tobacco) placement in lower labial vestibule for 2-3 minutes for 8-10 times a day since 10 years.
On inspection a single ill-defined swelling of size approximately 2×2 cm was present extraorally over the left side of upper lip. Intra orally a single well defined ulcerative lesion having greyish white floor with well-defined white margins was present over the swelling of left labial mucosa (Table/Fig 1). On palpation, swelling was well defined, smooth, lobular, and freely mobile with an overlying ulceration (Table/Fig 2). Ulcer was having a nodular base, firm consistency, non tender without any fixity to the underlying structure or any bleeding/discharge. Left submandibular lymph nodes were palpable, enlarged, firm in consistency and mobile. In addition to this, patient had smoker’s melanosis, nicotina stomatitis and homogenous leukoplakia. Clinically, there were diffuse melanin pigmentation in the oral cavity, blanching of the palate, inflamed minor salivary glands of palate and homogenous white patches in relation to bilateral buccal mucosa and alveolar ridges. Clinically, minor salivary gland neoplasm, squamous cell carcinoma and tuberculous ulcer were suspected.
Chest X-ray of the patient was normal. Contrast CT scan of the head and neck region revealed 29×25×19 mm sized heterogeneously enhancing solid nature lesion in upper lip on the left side with internal vessels (Table/Fig 3). Also, few enlarged lymph nodes were noted in left submandibular region largest measuring 25×18 mm in size. After performing incisional biopsy the sample was send to Oral Pathology Department. Histopathological examination revealed a poorly differentiated carcinoma favouring squamous cell carcinoma. Few areas of glandular structures and comedonecrosis were seen which was suggestive of adenocarcinoma (Table/Fig 4)a,b. Hence, Immunohistochemistry (IHC) was done which showed GCDFP-15, PR (focal weak positive 4-5%), Carcinoembryonic Antigen (CEA) and CK7 (creatine kinase) markers positive and P63 negative which concluded SDC.
In present case of SDC of upper labial mucosa staging of lesion was done T2 N1 M0 i.e., stage 3 was reported. The lesion was surgically excised with radical neck dissection followed by postoperative radiotherapy with adjuvant chemotherapy. Radiotherapy was given for four weeks and carboplatin 100 mg/m2 weekly. Patient was disease free and on regular follow-up since two and a half years (Table/Fig 5).
The SDC is a rare aggressive malignancy arising from the ductal epithelium of salivary glands characterised by ductal formations and central necrosis described by Kleinsasser O et al., in 1968 representing 1-3% of all malignant salivary gland tumour (1),(2). It was officially defined as a distinct clinicopathologic entity in the revised histologic classification of salivary gland neoplasms by the World Health Organisation (WHO) in 1990 (3),(4). It is also a type of rare adenocarcinoma showing cribriform pattern and comedonecrosis as seen in ductal carcinoma of breast (5).
Tumours of the minor oral salivary glands are generally stated to account for about 15% of all salivary gland neoplasms (6). SDC predominantly affects male >50 years of age. Similarly the present case was of a 80-year-old male patient. Usually, patients notice a slow growing painless mass initially and in advanced stages complain of pain, paraesthesia, pressure etc., due to facial nerve involvement in cases of parotid gland involvement. In the present case, patient had a complaint of a slow growing painless mass since 5 years. Also, there was an ulceration over the swelling located in the upper lip on the left side. There was no pain or paraesthesia without any history of bleeding or pus discharge from the same. The appearance of the ulcer was completely different from a usual squamous cell carcinomatous ulcer in which there are multiple red papillary projections, indurated base and borders with bleeding on slightest provocation and rapidly spreading in nature (5),(7).
The asymptomatic slow growing swelling and the long duration (5 years) was most likely to be suggestive of a benign tumour. However, submandibular lymph node enlargement led us to the suspicion of conversion of a benign tumour into a malignancy (7). Histologically, the poor differentiation of the lesion was suggestive of a poorly differentiated malignancy. Few areas of glandular structures and comedonecrosis led us for an immunohistochemical analysis (8).
The SDCs are immunoreactive for low and high molecular cytokeratin and markers such as CEA, LeuM1, and Epithelial Membraneantigen (EMA). Strong nuclear reactivity for Androgen Receptors (AR) is reported in all SDC. SDC cells are focally positive for apocrine marker GCDFP-15 and Mitochondrialantigen (MIA), and typically negative for S-100 protein, myoepithelial markers, and oestrogen and Progesterone Receptors (PR). P63 marker shows positivity for squamous cell carcinoma and is generally used in poorly differentiated carcinomas. P63 negative values helped to rule out squamous cell carcinoma. PR was weakly positive which ruled out breast carcinoma. Gross Cystic Disease Fluid Protein 15 (GCDFP-15), Carcinoma embryonic antigen and CK7 were positive which confirmed SDC (9),(10).
The differential diagnosis of SDC spans a range of low-grade and high-grade salivary gland malignant neoplasms, the most common ones of which include papillary cystadenocarcinoma, papillary cystic acinic cell carcinoma, high grade mucoepidermoid carcinoma and metastatic carcinoma of breast. Breast adenocarcinoma is among the most common adenocarcinomas to metastasise to the parotid gland. It has been suggested that negative oestrogen receptor together with diffuse intense staining for CEA favour a diagnosis of SDC over breast carcinoma. SDC should also be differentiated from high grade mucoepidermoid carcinoma. The presence of squamoid or intermediate basaloid cells and intracellular mucin characterises the latter (5),(11).
It is more aggressive than the more common salivary malignancies with five year overall survival ranging from 42% (stage 1) to 23% (stage 4). The lesion was surgically excised with radical neck dissection followed by radiotherapy and carboplatin weekly due to the aggressive nature of the lesion. SDC in the present case might have arisen from a carcinoma expleomorphic adenoma taking into consideration the long duration and clinical appearance of the lesion (12),(13).
In the present case, according to TNM staging T2N1M0, it was a stage 3 cancer. A complete surgical excision of the swelling with radical neck dissection on the left side followed by postoperative radiotherapy with adjuvant chemotherapy gave us a disease free survival of two and a half years. Hence, although SDCs are aggressive in nature associated with metastasis and low survival rate, an early diagnosis and appropriate management improves the survival rates.
DOI: 10.7860/JCDR/2022/52301.16093
Date of Submission: Sep 09, 2021
Date of Peer Review: Nov 24, 2021
Date of Acceptance: Jan 03, 2022
Date of Publishing: Mar 01, 2022
AUTHOR DECLARATATION:
• 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 CHECKING METHODS:
• Plagiarism X-checker: Sep 11, 2021
• Manual Googling: Dec 14, 2021
• iThenticate Software: Dec 30, 2021 (17%)
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