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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
Case Series
Full Version
Utility of p63 in Giant Cell Lesions of Bone- A Case Series
Correspondence Address :
Shima Kannadas,
Assistant Professor, Department of Pathology, Malabar Medical College, Modakkalloor, Calicut-673315, Kerala, India.
E-mail: drkshima@gmail.com
Giant cell lesions of bone include a relatively large group of biologically and morphologically diverse bone lesions which shows presence of numerous multinucleate osteoclast like giant cells. Recently, p63 has been found to be a sensitive marker in the diagnosis of giant cell tumour. The aim of this case series is to assess the role of p63 in diagnostically difficult giant cell lesions of bone. The authors here present four cases with giant cell rich lesions of bone as seen in Hematoxylin and Eosin (H&E) staining, in which an accurate diagnosis was not possible with the available clinical and radiological data were included in this study. The tissue was stained with hematoxylin and eosin and Immunohistochemical staining (IHC) with p63 was done. Though the specificity of the marker was found to be less, it was concluded that, p63 can be used as an ancillary aid along with histomorphological and radiological data in arriving at a diagnosis.
Aneurysmal bone cysts, Immunohistochemistry, Non neoplastic lesions
Giant cell-rich lesions of bone show numerous multinucleated osteoclast-like giant cells and the presence of mononuclear stromal cells (1). The list includes giant cell tumour of bone, aneurysmal bone cysts, chondroblastomas, brown tumour, tenosynovial giant cell tumours, non ossifying fibromas, giant cell reparative granulomas, pigmented villonodular synovitis and osteosarcomas (2). The diagnosis of these giant cell-rich lesions is often challenging even for an experienced pathologist. As there are no well-established immunohistochemical and molecular markers in differentiating these giant cell lesions, the use of immunohistochemical marker p63 has been studied in some centres outside India and was found to express in the stromal cells of giant cell tumour and negative in non neoplastic lesions (3),(4),(5). As a first study of its kind from our country, easy availability and cost effectiveness p63 was chosen to be used as an aid in differentiating various giant cell-rich lesions (3). Four such cases are included in this case series which was conducted in a tertiary care centre in North Kerala, India.
Case 1
A 35-year-old male presented to the Department of Orthopaedics with pain and swelling of right index finger since two months. On examination, a well-defined mass of size 4×4 cm was palpable on the proximal phalanx of right index finger. Clinical diagnosis were osteosarcoma and aggressive giant cell tumour of small bone. X-Ray showed lytic lesion in the proximal phalanx of the right index finger with sclerotic margins. Magnetic Resonance Imaging (MRI) also showed the same features and suggested the possibilities of chondrosarcoma and enchondroma. Curettage of the mass showed (Table/Fig 1)a a neoplasm composed of uniformly arranged osteoclast like multinucleate giant cells surrounded by stromal cells. Stromal cells are oval cells with vesicular nucleus and prominent nucleoli. Provisional histological diagnosis of giant cell tumour of small bone was made. Immunohistochemistry with p63 showed diffuse strong nuclear positivity in the stromal cells (Table/Fig 1)b Osteoclastic giant cells were negative for p63. Final diagnosis was confirmed as giant cell tumour of small bone. After curettage, patient was asymptomatic without recurrence till the last visit.
Case 2
A 77-year-old male presented to the Outpatient Department with pain and swelling over upper third of left leg for the last one month. He was diabetic, hypertensive and on dialysis for chronic renal failure. On examination he had an ill-defined swelling over the left upper tibia. X-ray showed a lytic lesion over the anterior aspect of left upper tibia suggesting possibilities of chondrosarcoma, fibrosarcoma and multiple myeloma.
Tru-cut biopsy of the mass showed (Table/Fig 2)a a lesion composed of numerous osteoclast-like multinucleate giant cells which are randomly distributed in the stroma. As there were areas of hemorrhage and hemosiderin laden macrophages, serum parathormone, calcium and phosphorus levels were advised. His serum parathormone levels were found to be elevated (1809 pg/mL), calcium levels were low normal (8.5 mg/dL) and phosphate was high (7 mg/dL). Thus, a diagnosis of Brown tumour due to secondary hyperparathyroidism was made.
Immunohistochemistry with p63 showed absence of staining in stromal cells suggestive of non neoplastic etiology (Table/Fig 2)b. Final diagnosis was confirmed as Brown tumour. After surgical removal of parathyroid glands, his laboratory values became normal and was symptom-free.
Case 3
A 47-year-old male presented to the Emergency Department with displaced bone fracture proximal third of right leg. On examination there was swelling and deformity in the infrapatellar region of right leg. X-ray showed displaced both bone fracture proximal third of right leg and a lytic lesion involving upper tibia (Table/Fig 3)a suggestive of simple bone cyst, aneurysmal bone cyst and giant cell tumour.
Bone curettings showed (Table/Fig 3)b a lesion composed of blood-filled cystic spaces lined by fibroblasts, reactive osteiod and scattered multinucleate giant cells. Provisional diagnosis was aneurysmal bone cyst. The p63 staining showed nuclear positivity in the stromal cells (Table/Fig 3)c. Final diagnosis was confirmed as giant cell tumour with secondary aneurysmal bone cyst. After complete curettage no recurrence was reported in this case.
Case 4
A 14-year-old boy presented to the Orthopaedic Outpatient Department with swelling and deformity of right leg for six months duration. On examination there was a hard swelling with fixity to the underlying left tibia. The MRI showed a well defined cortical based lesion with sclerotic margins in the lower metadiaphyseal region of tibia suggestive of a benign bone tumour.
Therapeutic excision of the tumour showed (Table/Fig 4)a spindle cells arranged in storiform pattern with scattered osteoclast like giant cells and foam cells suggestive of non ossifying fibroma.
The p63 staining showed absent staining in the stromal cells and osteoclastic giant cells (Table/Fig 4)b. Final diagnosis was confirmed as non ossifying fibroma. Patient was asymptomatic till the last follow-up.
The p63 belongs to the family of transcription factors and plays a role in skeletal development as mutations in p63 in humans lead to limb abnormalities and null p63 mice exhibit skeletal defects (4). Based on its function in the cell, p63 could contribute to tumorigenesis by inactivating p53 (tumour suppressor gene) (6) and regulate apoptosis (7) and cell-cycle (8). The expression of p63 in various bone lesions is shown in (Table/Fig 5) (9).
Among the giant cell lesions, Giant cell tumour of bone is the most frequently reported, locally aggressive, and has a propensity to recur locally which mandate the use of markers in its prompt diagnosis (10),(11),(12).
In the first case of the present series, even though the clinical presentation was favoring an aggressive giant cell tumour, radiological features were suggestive of a chondroid neoplasm. Histological findings and immunohistochemistry confirm the diagnosis as giant cell tumour. In a study reported by Lee CH et al., (5), p63 overexpression was seen in significant number of giant cell tumours with a strong staining confined to the stromal component (3),(4),(5). As mutations in the H3F3A gene (encodes Histone H3.3) is involved in the pathogenesis of Giant cell tumour of bone, immunohistochemical staining using a monoclonal antibody directed against H3F3A is positive in 95-100% of giant cell tumour (13). But the specificity and availability of this marker is very less (14).
In the case of brown tumour, the initial clinicoradiological features were suggestive of a neoplastic etiology. Absence of p63 supported by lab values, suggested a nonneoplastic etiology (5). The rate of p63 expression in aneurysmal bone cyst in Dickson BC et al., and Lee’s CH et al., (4),(5) studies is lower when compared to giant cell tumour of bone. De la Roza et al., (3) and Linden MD (14) found higher results. If some cases of aneurysmal bone cyst are p63 positive, there would be a component of a giant cell tumour of bone. Hence in third case of present case series possibility of giant cell tumour with secondary aneurysmal bone cyst was considered.
Studies on p63 expression in non ossifying fibroma are rare as it is a less common benign fibrohistiocytic tumour of bone. In a study conducted by Hammas N et al., (Table/Fig 5), it was found that only 25% of cases were p63 positive (9). The absence of p63 staining in fourth case of present case series suggests that staining of p63 is variable in non ossifying fibromas and hence thorough morphological correlation should be done for the confirmation of diagnosis. Similar studies in larger number of cases are required to know utility of p63 in giant cell lesions of bone as an effective diagnostic marker.
This case series shows that p63 may serve as an effective surrogate biomarker for differentiating giant cell tumour from other giant cell lesions of bone.
DOI: 10.7860/JCDR/2022/55478.16181
Date of Submission: Feb 08, 2022
Date of Peer Review: Mar 04, 2022
Date of Acceptance: Mar 16, 2022
Date of Publishing: Apr 01, 2022
AUTHOR DECLARATION:
• 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: Feb 10, 2022
• Manual Googling: Feb 21, 2022
• iThenticate Software: Mar 29, 2022 (16%)
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