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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
Histopathological Spectrum of Spinal Tumours at a Tertiary Care Hospital, Gujarat, India: A Retrospective Study
Correspondence Address :
Dr. Khushbu Kantilal Tilva,
Block No. 1103, Gol Coin Apartment, Behind Speedwell Party Plot, Near Sanidhya 254, Rajkot-360004, Gujarat, India.
E-mail: tilvakhushbu@gmail.com
Introduction: The anatomic structures in the spinal area are diverse and unpredictable, often representing an excellent test for both the neuroclinicians and neuropathologists, thereby showing a broad heterogeneous spectrum of pathological lesions. Clinical history, radiological features, and pathological examination are required to diagnose spinal tumours.
Aim: To study the histopathological spectrum of spinal tumours in a tertiary care teaching hospital in Gujarat, India.
Materials and Methods: In this retrospective study, data was collected from the records of 100 patients who had spinal tumours and who attended the Department of Pathology. Histopathological diagnosis of the spinal biopsy specimen was the primary outcome variable. Age, gender, location of the tumour, and clinical features were other study relevant variables. The status of the spinal tumour (benign/malignant) was considered an explanatory variable. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. Categorical outcomes were compared using the Chi-square test.
Results: A total of 100 subjects were included, among which 42 participants were males, and 58 were females with the mean age 34.62±17.64 years. The maximum number of spinal tumours were noted in (21-30 year) 3rd decade (29%) of life. Benign spinal tumours (73%) were more common than malignant spinal tumours (27%). Schwannoma was the most common (37%) spinal tumour, followed by meningioma (20%), and ependymoma (14%). The distribution of spinal tumours based on anatomical location, 31% intradural intramedullary, 49% intradural extramedullary, and 20% extradural tumours. There was a significant difference between nerve sheath tumours and meningioma with gender (p-value <0.001).
Conclusion: The study identified schwannoma and meningiomas as the most common tumours. The thoracic region was the most frequently involved spinal level, followed by the cervical, and the most affected location was the intradural extramedullary.
Meningioma, Schwannoma, Spinal cord neoplasms
The anatomic structures in the spinal area are diverse and unpredictable, often representing an excellent test for both the neuroclinicians and neuropathologists, thereby showing a broad heterogeneous spectrum of pathological lesions. Spinal lesions are rare and usually relate to epidural space’s spinal tissues, which involve the spinal meninges, spinal nerve roots, and spinal cord. It commonly affects the thoracic region, although it can involve any spinal level (1),(2). Spinal cord tumours comprise 4-16% of all the Central Nervous System (CNS) tumours (2). Spinal lesions can be grouped into congenital malformations, degenerative diseases, inflammatory disorders, cystic lesions, vascular malformations, and neoplasms (1). Spinal tumour can be divided into two major groups: the first one is primary tumours which originate from the spinal cord, meningeal, or bone cells. The second group is metastatic lesions that invade the spinal cord and surrounding tissues and originate from other cells (3),(4). Based on anatomical location, the spinal Space Occupying Lesions (SOLs) are extradural and intradural lesions. Extradural lesions occur outside the spinal dura and emerge from the bony spine, intervertebral discs, and adjacent soft tissues. Intradural lesions arise within the dura. Intradural spinal tumours are further classified as extramedullary and intramedullary (5),(6).
Intradural extramedullary spinal cord tumours account for about 60% of the intraspinal tumours and include schwannomas (30%; incidence rate, 0.3-0.4 cases annually per 100,000 people), meningiomas (25%; incidence rate, 0.32 cases annually per 100,000 people), neurofibromas, teratomas, lipomas, and metastatic tumours (7),(8),(9),(10). Intramedullary lesions are situated in the substance of the spinal cord. Spinal cord gliomas represent roughly 80% of intradural intramedullary tumours, with astrocytic or ependymal tumours contributing the central part and the rest including hemangioblastoma (3-8%), ganglioglioma, lymphoma, and melanoma (rare) (11),(12).
Tumours of the spinal cord are more common in the pediatric population than in adults (13). The symptoms usually seen in patients with primary spinal tumours are pain along the spinal axis, neck or back pain, radiating pain, sensory disturbance, gait disturbance, sexual dysfunction, paraesthesia, and paraplegia (14). Albeit their rarity, spinal tumours are a significant reason for morbidity and mortality (15). Clinical history, radiological features, and pathological examination are required to diagnose spinal tumours (3). Medications, surgery, radiation, or a combination of these treatments are employed to manage these tumours (16). The study aimed to evaluate the spectrum of spinal tumours that presented to tertiary care teaching hospital in Gujarat, India.
In this retrospective study, data was collected from the record available in the Department of Pathology at a tertiary care teaching hospital, Gujarat, India. The study specimen of spinal tumours were collected from the patients who attended the Pathology Department from June 2016 to September 2018 and the analysis of the collected data was carried out in October 2018. The study was approved by the Institutional Review Board and the Ethics Committee of B. J. Medical College and Civil Hospital with reference number 439/2016. Data confidentiality was maintained, and informed consent was taken from the patient while collecting the sample that the specimens might be used for study purposes in the future.
Sample size calculation: The sample size calculated assuming the proportion of any CNS tumours was 6.49% (17). The other parameters considered for sample size calculation were 5% absolute precision and 95% confidence level. Based on the previous hospital records, the approximate number of cases attending the study setting during the one year was 100,000. Hence a finite population correction was applied for 100,000. As per the formula for sample size calculation (18), the required number of subjects was 94. To account for a non participation rate of about 6% (6 subjects), it was decided to sample about 100 subjects in the study. All the eligible specimens of the patients were included by convenient sampling till the sample size was obtained.
Inclusion criteria: All the study specimen, belonging to patients of any age and both gender, diagnosed with spinal tumours at the Department of Pathology, during study period were included in the study.
Exclusion criteria: Primary vertebral tumours and paraspinal soft tissue lesions were excluded. Non neoplastic conditions of the CNS were excluded.
Procedure
Relevant clinical data, including age, gender, and clinical symptoms, were noted. The protocol followed for a histopathological examination in our Department of Pathology for specimens was as follows- After receiving, all surgically resected specimens were fixed in the 10% neutral buffered formalin for 24 hrs. Bony parts were decalcified in Nitric acid (HNO3). After detailed gross examination, various tissue representative areas were taken from the received surgical specimen and submitted to routine tissue processing and paraffin embedding. Sections of 5 μ thickness were cut, and stained with Haemotoxylin and Eosin (H&E), slides were examined under a light microscope, and the diagnosis was made. Recent World Health Organisation (WHO) classification of central nervous system tumours was used for the variety and grading of the tumours (19).
Statistical Analysis
Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. A p-value <0.05 was considered statistically significant. R studio and coGuide version V.1.0.3 was used for statistical analysis (20).
A total of 100 subjects were included in the final analysis. The mean age was 34.62±17.64 years, 42 participants were male, and the remaining 58 were female. The maximum number of spinal tumours were noted in the 3rd decade (21-30 year, 29%) of life (Table/Fig 1). Benign spinal tumours (73%) were more common than malignant spinal tumours (27%). Muscle weakness (39%) was the most common clinical feature, followed by pain (18%), and swelling (13%). Spinal tumour was more common in the thoracic region (49%), followed by cervical region (23%) (Table/Fig 2).
Schwannoma was the most common (37%) spinal tumour, followed by meningioma (20%). Out of 10 people with glioma, all of them had a malignant tumour. Out of 20 people with meningioma, all of them had a benign tumour. Out of 14 people with ependymoma, 2 (20%) had a benign tumour, and 12 (80%) had malignant tumour (Table/Fig 3).
Among the people with a benign tumour, most participants (64.38%) had intradural extramedullary location affected. In people with a malignant tumour, the majority (66.67%) of participants had intradural intramedullary tumour (Table/Fig 4).
Among the male participants, 25 (60.98%) participants had nerve sheath tumours, 2 (10%) participants had meningioma, 8 (57.14%) participants had ependymoma, and 5 (62.5%) participants had astrocytoma. The difference in the proportion of gender between the nerve sheath tumours was statistically significant (p-value=0.001). The difference in gender between the meningioma is found to be significant with a p-value of 0.001, with the majority of 18 (90%) female participants (Table/Fig 5).
Histopathological findings: When Haematoxylin and Eosin (H&E) slides of the patients were observed in case of schwanomma, it was found highly cellular, spindle cell arrange in palisading manner and tumors cells separated by abundant edematous fluid. (Table/Fig 6). In case of ancient schwannoma, scattered atypical to bizzare appearing nuclei was observed (Table/Fig 7). In cases of neurofibroma, characterstically markedly elongated nuclei with wavy, serpentine confuration and pointed end (Table/Fig 8). Astrocytoma cases depict mild nuclear atypia of tumor cells and dense fibrillary background (Table/Fig 9). Oligodendroglioma cases showed “egg fried appearance” (Table/Fig 10). The glioblastoma cases under microscope depicted dense cellularity, marked pleomorphism and tumor cells palisading around necrosis (Table/Fig 11).
The cases of meningioma showed whorls pattern and psammoma body (Table/Fig 12). Myxopapillary ependymoma cases showed epithelial tumor cells arranged around fibrovascular cores (Table/Fig 13). In case of cavernous angioma, large vessels with cystically dilated lumina and thin walls were observed (Table/Fig 14). For the diagnosis of lipoma cases, the H&E slides gave the appearance of mature adipose tissue as in (Table/Fig 15).
Diversity of anatomic structures in the spinal region make the histopathology report more clinically valuable (21). In this study, various spinal tumours were evaluated for age, gender, incidence, anatomical location, clinical feature and its pathological profile.
The maximum number of spinal tumours (both benign and malignant) were noted in 3rd decade (29%) of life in this study while according to Hirako K et al., benign spinal tumour more common in 50-59 years and malignant spinal tumour more common in 40-49 years (3).
Most of previous studies showed male predominance (3),(16),(22),(23),(24),(25),(26) while the present study showed female predominance (58%) which was comparable with Drashti P et al. and Santos Júnior EC et el., (27),(28).
The most common presenting symptom was muscle weakness in the present study which was comparable with Drashti P et al., (27),(28) and Murad et al., (29) while in some studies, the pain was the most frequent symptom (16),(22),(25),(28). At vertebral level, the thoracic region was the most frequently involved followed by cervical and lumbar in this study which was comparable with other studies (16),(22),(27),(28). Intradural extramedullary location (49%) was affected more and a similar pattern is seen in other studies (3),(16),(22),(27),(29) while in Santos J. et al., (28) intradural intramedullary location was most common site. Benign tumours (73%) were more common than malignant (27%) tumours which was comparable with other studies (Table/Fig 16) (3),(16),(22),(27),(28),(29).
Schwannoma was the most common (37%) spinal tumour in the present study which was comparable with other studies (3),(16),(22),(28) where (27),(29) meningioma was more common.
Limitation(s)
Small sample size was the limitation of the study which hampers the generalisability of the results.
Tissue diagnosis is imperative due to the broad spectrum of pathological lesions in this area with differing prognosis and therapeutic protocols. The tumour’s location was essential to understanding the nature and course of the disease in these tumours. Schwannoma and meningiomas were the most common tumours identified in the present study. The thoracic region was the most frequently involved at spinal level, followed by the cervical, and the most affected location was the intradural extramedullary.
DOI: 10.7860/JCDR/2023/59217.17277
Date of Submission: Jul 23, 2022
Date of Peer Review: Aug 29, 2022
Date of Acceptance: Oct 07, 2022
Date of Publishing: Jan 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• 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
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