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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
Struma Ovarii: A Rare Presentation in a Paediatric Patient
Correspondence Address :
Dr. Manjari Kishore,
A1, 1/10A, Sector-5, Rajender Nagar, Sahibabad, Ghaziabad-201005, Uttar Pradesh, India.
E-mail: drmanjarik@gmail.com
Struma Ovarii (SO) is a rare form of teratoma of ovary containing predominantly thyroid tissue, usually comprising more than 50% of the overall mass. It accounts for 1% of all ovarian tumours in adults. Due to its rare presentation in paediatric age group, the exact incidence is not known.The association of SO with hyperthyroidism has been noted in approximately 8% of cases. Radiological evaluation helps in preliminary diagnosis of a complex ovarian cyst, however, a definitive diagnosis of SO can only be made upon extensive histopathological evaluation. Present report is of SO in a 12-year-old female patient, who initially presented with pain abdomen, vomiting and hyperthyroidism with mildly elevated thyroid hormones Triiodothyronine (T3) and Tetraiodothyronine (T4). Magnetic Resonance Imaging (MRI) whole abdomen showed evidence of right-sided dermoid with mild ascites. An exploratory laparotomy was done followed by right ovarian cystectomy and histopathology revealed a mature teratoma predominantly comprising of thyroid tissue (>90% of total ovarian mass), thereby confirming the diagnosis of SO. After one month of surgical resection, the patient’s thyroid profile showed decrease in fT3 and fT4 levels. The index case highlights the unusual occurrence of SO in a paediatric patient along with the role of an extensive histopathological evaluation in diagnosis of the same.
Histopathology, Ovarian teratoma, Thyroid tissue
A 12-year-old female patient presented to hospital with complaints of pain abdomen and vomiting for last five days. There was no history of tuberculosis and any other chronic or major illness. The patient had attained menarche one year back. Her routine haematological parameters (Complete Blood Count) were within normal limits. However, thyroid function tests revealed slightly elevated T3 and T4 levels with normal Thyroid Stimulating Hormone (TSH) levels. Rest of the biochemical tests, i.e., liver and kidney function tests, lipid profile and blood sugar levels were within normal reference range.
Her ultrasound abdomen revealed a right, solid-cystic ovarian mass measuring 4.2×6 cm. Physical examination revealed mild abdominal distension with no palpable pelvic mass or any sign of ascites. Urine pregnancy test was negative. Her serum tumour markers, i.e., Cancer Antigen 125 (CA125) Carcinoembryonic Antigen (CEA), human Chorionic Gonadotropin (hCG) were within normal reference range. Clinically, a provisional diagnosis of twisted ovarian cyst was made, along with germ cell tumour of ovary (?teratoma). The patient was advised for surgical intervention. MRI whole abdomen was done and revealed a large heterogenous signal intensity lesion with fat signal and fluid signal intensity with free fluid level/haemorrhagic foci in pouch of douglas inseparable from right ovary-likely right dermoid ovarian cyst with mild ascites (Table/Fig 1)a-d.
Exploratory laparotomy by a Pfannenstiel incision found a multiloculated complex right-ovarian cystic mass. The left ovary, uterus and the rest of the abdomen appeared free from disease. A right ovarian cystectomy was performed. The postoperative course was uneventful, and the patient was discharged on Day 4. The surgical specimen was sent for detailed histopathological examination.
Grossly, a specimen labelled as right ovarian cyst, measuring 5.5×5.0×2.5 cms was received. The external surface appeared asymmetrical with grey-white glistening areas. Cut section showed multiloculated cyst filled with grey-brown material (colloid-like), haemorrhagic areas, grey-white areas, focal cartilaginous areas (Table/Fig 2)a,b. Few cystic spaces were noted filled with mucoid material and few filled with pultaceous material. On serial sectioning single tooth was found embedded in the wall of the cyst (Table/Fig 2)b.
Multiple sections were taken from the right ovarian cyst specimen. Sections showed partly encapsulated lesion showing extensive areas (>90%) comprising of benign thyroid follicles arranged in small groups, microfollicles and macrofollicles with luminal colloid. Intervening areas showed fibrocollagenous septa with delicate vessels (Table/Fig 3)a-d.
Sections from the compressed ovarian parenchyma showed histological evidence of ruptured epidermal cyst, sheets of sebaceous glands underneath squamous lined epithelium, focal cartilaginous areas and focal ovarian stroma lined by respiratory epithelium (Table/Fig 4)a-d. No neural tissue or any atypical cells were noted after extensive sectioning.
Based on clinical, radiological and a detailed histopathological evaluation, a diagnosis of SO (mature ovarian teratoma- Right ovary) was made. Post surgery, her thyroid profile was also found to be within normal reference range. Till the writing of this report and follow-up of one year with ultrasound, thyroid profile and CA-125 at regular intervals, no evidence of recurrence was found.
Teratoma is a tumour of germ cell origin and usually consists of more than one germ cell layer structures (1),(2),(3). Based on cellular components, it is divided into mature, immature and monodermal variants. The two forms of monodermal ovarian teratomas are SO and carcinoid. SO is a rare ovarian tumour, categorised as a monodermal and highly specialised teratoma with presence of predominantly thyroid tissue (>50%) and accounting for approximately 5% of all ovarian teratomas. Usually SO does not secrete thyroid hormones, however, 8% of patients show clinical and biochemical features of hyperthyroidism (2),(3),(4). The definitive diagnosis of SO is only made based on histopathological findings.
This entity was described for the first time in the year 1889 by Boettlin who happened to see the presence of thyroid tissue in ovaries and subsequently few cases were reported by Von Kalden in 1895, Gottschalk in 1899 and Mayer in 1903 (2),(3),(4). However, as SO comprises of <1% of all ovarian tumours, there is limited data pertaining to SO in literature. It consists of 5% of all ovarian teratomas. This is supported by few series in literature, Ghartimagar D et al., (3), Yoo SC et al., (4), and Khediri Z et al., (5) reported SO cases to be 5%, 4.8%, 8.6% respectively.
SO is usually noted after the age of 40 years, the peak incidence being in the 5th decade (3),(4),(5). However, few cases have been reported in prepubertal and postmenopausal women. In series by Ghartimagar D et al., of total seven cases, three were seen in >40 years, three cases noted in 30-40 years and only one was seen in 26-year-old woman (3). Khediri Z et al., also reported three cases of SO in 17 years, 31 years and 40 years old female patients (5). Index case was much rarer in the fact that the patient was a 12-year-old female.
Majority of SO cases present with non specific symptoms. Yoo SC et al., noted 42% of patients of SO with non specific symptoms, just diagnosed during routine ultrasound evaluation. These non specific symptoms could be pain abdomen, palpable abdominal mass, vaginal bleeding, ascites, hydrothorax, elevated thyroid hormones, etc (4). It is noted in literature that approximately 8% of SO patients can have simultaneous presence of hyperthyroidism, which was noted in index patient also (5),(6),(7),(8). In a study by Kaur S et al., a case of SO was noted with preoperative high levels of T3 and T4 (6). The postoperative thyroid profile was normal as noted in index case.
Radiological evaluation serves as an important tool in the diagnosis and classification of ovarian mass, however for a definitive diagnosis of SO, a detailed histopathological evaluation is essential (7),(8). The differential diagnosis given on radiology could be dermoid cyst, benign cyst, endometrioma, malignancy. MRI shows multilocular cystic lesion with variable signal intensity within the loculi. However, no definitive opinion can be given just on the basis of MRI findings in suspected cases of SO.
Usually, the SO cases appear on unilateral side, and the right ovary being affected commonly (6),(7),(8). Bilateral SO is very rare, noted in just 6% of cases. Rana V et al., had reported a case of bilateral SO in an elderly patient with pseudo-Meig’s syndrome (8). Khediri Z et al., also found the occurrence of SO in the right ovary (5) as seen in our case. However, in study by Ghartimagar D et al., all 4 cases were noted in left ovary (3).
Majority of cases of SO measure 0.5 to 10 cm in their dimension and grossly appear as cystic mass containing brown gelatinous material (colloid like) with some solid areas (3),(4),(5),(6). Microscopically, it consists predominantly of normal looking or hyperplastic thyroid follicles along with other areas like sebaceous glands, squamous epithelium, etc. Malignant form of SO is very rarely noted with occurrence of 5-10%, with histological evidence of papillary, follicular or mixed form (7),(8),(9). The treatment of benign SO is usually the surgical resection of the involved ovary, especially in younger women. However, in case of malignancy or recurrence few factors like size of the tumour, presence of ascites, adhesions during surgery etc are taken into consideration (9),(10),(11),(12). Due to the rarity of this tumour, there is lack of literature pertaining to its diagnosis and treatment, especially in cases of malignant transformation (8),(9),(10),(11),(12).
In the present case, surgical resection of the involved right ovary was done considering the paediatric age group of the patient. Postsurgery, her thyroid levels were within normal range. No recurrence was noted in index patient till the last follow-up of one year.
SO is a rare ovarian tumour with majority behaving in a benign fashion. Though radiology can give a preoperative differential diagnosis of various cystic lesion involving the ovary, no definitive diagnosis can be given based on imaging. The case highlights the importance of detailed histopathological examination in giving an accurate diagnosis of benign teratoma with predominant thyroid tissue. The index is also rare in the fact that SO was noted in a paediatric female patient. Index case reiterates the importance of an integrative approach in the diagnosis and early management of a rare tumour.
DOI: 10.7860/JCDR/2022/57917.16941
Date of Submission: May 20, 2022
Date of Peer Review: Jun 28, 2022
Date of Acceptance: Aug 09, 2022
Date of Publishing: Sep 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: May 20, 2022
• Manual Googling: Jul 27, 2022
• iThenticate Software: Aug 16, 2022 (9%)
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