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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 report
Full Version
Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF), causing Rupture Uterus, Haemoperitoneum and Mortality- A Case Report
Correspondence Address :
Dr. Gwendolyn Fernandes,
Additional Professor, Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
E-mail: drgwenfern@yahoo.co.in
Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF) is a very rare entity with a couple of cases in the literature. Amianthoid fibers are thick acellular mats composed of crystalline collagen fibers. This is an unusual case of a 53-year-old female with Chronic Kidney Disease (CKD), who presented with pain in the abdomen for three weeks. Computed Tomography (CT) showed a degenerated subserosal leiomyoma in the posterior wall of the uterus which had ruptured leading to haemoperitoneum. An emergency exploratory laparotomy with simple hysterectomy was done. Histopathology revealed a ruptured atypical leiomyoma with abundant amianthoid-like fibers. The patient expired seven days after surgery due to hypovolaemic shock. Rupture of the uterus in leiomyoma with amianthoid fibers has not been reported in the literature. Awareness of this entity is important in view of acute catastrophic consequences like haemoperitoneum, hypovolaemic shock, and death.
Crystalline collagen fibers, Degenerative changes of leiomyomas, Hypovolaemic shock
A 53-year-old female, a known case of Chronic Kidney Disease (CKD) with hypertension on dialysis, presented with acute pain in abdomen to the emergency services. She had a history of abdominal pain for three weeks and was referred to the tertiary care centre for increasing pain and worsening of general condition. Abdominal distension, tenderness, and guarding were present. Her blood pressure was 140/90 mmHg. She was evaluated in the General Surgery and Gynaecology Departments. On Contrast Enhanced Computed Tomography (CECT) of the abdomen and pelvis, a defect in the posterior wall of the uterus with lobulated periuterine haematoma with haemoperitoneum, probably secondary to degenerated subserosal fibroid was found. An emergency exploratory laparotomy with hysterectomy was done. A clinical diagnosis of endometrial adenocarcinoma leading to rupture uterus or ruptured ovarian tumour were made and at laparoscopy, the fundus of the uterus had a gun-shot appearance.
A simple hysterectomy specimen along with multiple brown bits of uterine tissue was received (Table/Fig 1)a. The uterine fundus showed a rupture of 3×2 cm with ragged haemorrhagic margins on its posterior aspect. On microscopy, a spindle cell tumour was identified within the myometrium, which showed a classic picture of an atypical leiomyoma with pleomorphic spindle cells arranged in fascicles. Large mats of acellular amianthoid-like fibers were seen amidst the atypical spindle cells (Table/Fig 1)b,c. On higher magnification the spindle cells showed plump pleomorphic nuclei with moderate cytological atypia (Table/Fig 1)d. No mitosis or necrosis were seen. On special stains, amianthoid-like fibers showed sea green colour on Masson Trichrome (Table/Fig 2)a and bright pink colour on Elastic Van Gieson stain (Table/Fig 2)b, while Congo red (Table/Fig 2)c was negative. Desmin (Table/Fig 3)a and Smooth Muscle Actin (SMA) (Table/Fig 3)b were positive, while DOG1, CD10, CD34, and Cyclin D1 were negative. MIB1 was 0. A diagnosis of Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF), leading to uterine rupture was rendered. The patient expired seven days after surgery due to hypovolaemic shock.
The ALWAF is an extremely rare entity with a couple of cases reported in the literature. Amianthoid-like fibers are thick, acellular mats of collagen, composed of crystalline fibers, surrounded by a spindle cell proliferation.
Uterine leiomyomas are benign mesenchymal tumours of smooth muscle origin. About 90% of leiomyomas are of the conventional type while 10% show a spectrum of morphological types. A variety of histological subtypes like cellular leiomyoma, atypical leiomyoma, mitotically-active leiomyoma, lipoleiomyoma, epithelioid leiomyoma, angioleiomyoma, and cotyledonoid type have been described (1),(2). Atypical leiomyomas are smooth muscle tumours with either focal or diffuse, moderate to severe cytological atypia, without coagulative necrosis and with a very low mitotic index (2).
Leiomyomas with amianthoid fibers or amianthoid-like fibers are very unusual leiomyomas, and their incidence is restricted to a couple of case reports in the literature. Spontaneous rupture of the uterus, however, has not been reported, and to the best of our knowledge, this is the first case in the literature describing spontaneous rupture leading to a haemoperitoneum, hypovolaemic shock, and death.
Collagen can be classified into four types I, II, III and IV based on fibrillar and non fibrillary organisation, molecular and immunohistochemical differences. Type I, II and III are crystalline and type IV is amorphous appearing (3). The term amianthoid was used for degenerating costal cartilage for macroscopically and microscopically observed fibers (4). Amianthoid fibers are acellular, eosinophilic, extracellular mats composed of crystalline collagen fibers. Immunohistochemistry shows positivity for collagen type I at the centre and collagen type III at the periphery (5). Amianthoid fibers vary from other collagen fibers in thickness, contour and the arrangement of collagen. They have a width of 1000 nm and a normal banding of 52-62 nm, and are 10 times the thickness of normal collagen (4). Normal or native collagen has a thickness of 35-120 nm (6). The term amianthoid-like fibers is used if the thickness of the fibers does not fall into the specified range of width 1000 nm and thickness more than 200 nm of amianthoid fibers (7). Ultrastructural studies are required to confirm the diameter of the fibrils and hence the fibrils were termed as “amianthoid-like”, as the authors were unable to perform ultrastructural studies.
The exact pathogenesis of amianthoid fibers is unclear. Various hypotheses have been put forth which include the falling together of pre-existing collagen fibrils or unmasking of collagen from the interfibrillar matrix (4). Anoxia has been implicated in the degeneration of perivascular collagen (8). Many also believe that the amianthoid fibers, in soft tissue tumours, results from active secretion and deposition by the tumour cells, and thus is degenerative in nature, leading to the rupture of the uterus and death of the index patient. In a case of chondrosarcoma described by Ghadially FN et al., amianthoid fibers found were 1000 nm thick and were located in the matrix of the chondrosarcoma. They favoured a degenerative origin for them (6). Amianthoid fibers are also seen as retrogressive changes that takes place in hyaline cartilage e.g., costal cartilage (4). Collagen becomes more crystalline with age, through cross-linking and the fibrils become thicker (4). Exaggeration of this process, with straightening and close-packing of the fibrils results in the formation of amianthoid fibers (4).
Amianthoid fibers are seen in a variety of neoplastic and non neoplastic conditions. They have been often described in intranodal palisaded myofibroblastoma (5). Case reports of leiomyomas, soft tissue tumours, myofibroblastoma, chondrosarcoma and even meningioma with amianthoid fibers are described in the literature (5),(9),[10,(11). Amianthoid fibers have been described in both conventional as well as atypical leiomyomas. However, no case of leiomyosarcoma with amianthoid fibers has been described till date.
Rupture of the uterus in leiomyoma with amianthoid fibers is extremely unusual and has not been reported in the literature. This case of rupture of uterus, leading to death as a consequence of the presence of amianthoid-like fibers in a leiomyoma, and awareness of this entity should be promoted because such catastrophic complications can result in death. This case report also expands the readers knowledge of the morphological spectrum of leiomyomas.
DOI: 10.7860/JCDR/2022/55476.16522
Date of Submission: Feb 05, 2022
Date of Peer Review: Mar 18, 2022
Date of Acceptance: Apr 19, 2022
Date of Publishing: Jun 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 09, 2022
• Manual Googling: Apr 18, 2022
• iThenticate Software: Apr 21, 2022 (2%)
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