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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
Sarcomatoid (Spindle Cell) Carcinoma Arising in Mature Cystic Teratoma as a Mural Nodule: A Case Report
Correspondence Address :
Renu Sukumaran,
Associate Professor, Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.
E-mail: renu.sukumaran@gmail.com
Mature cystic teratomas are the most common ovarian germ cell tumours.Malignant transformation is rare in mature cystic teratoma. Spindle cell/sarcomatoid carcinoma is an uncommon type of squamous cell carcinoma. A 45-year-old female presented with abdominal distention and discomfort. Magnetic Resonance Imaging (MRI) showed multiloculated cystic mass measuring 21×20×14 cm with heterogeneously enhancing solid component measuring 5×3.5 cm in right adnexal region. Excision of the mass done. Macroscopic examination showed irregular cystic mass containing pultaceous material and hair, and a mural nodule measuring 5×5 cm. On histopathological examination, the cyst wall showed mature teratomatous elements. Sections from mural nodule showed sheets of atypical spindle cells with increased mitosis and foci of necrosis. On immunohistochemical examination, the spindle cells showed patchy weak to moderate positivity for cytokeratin, 34 beta E12, CK5/6 and P40. Diagnosis of spindle cell/sarcomatoid carcinoma arising in mature cystic teratoma was given. Malignant transformation in mature cystic teratoma is rare and should be suspected in large sized tumours in older patients. Sarcomatoid carcinoma is an extremely rare form of secondary malignant neoplasm arising from mature cystic teratoma.
Adnexal mass, Multiloculated cystic mass, Secondary malignant neoplasm, Squamous cell carcinoma
A 45-year-old female presented with complaints of abdominal distention and discomfort of three months duration. There was no significant illness in the past. Examination showed 20×20 cm firm abdominopelvic mass lesion. Routine blood investigations were within normal limits. The Cancer Antigen 125 (CA 125) level was 73 U/mL and CEA was 6.39 ng/mL. Ultrasound (USG) abdomen showed large complex cyst measuring 20×19×16 cm with solid component measuring 6×6 cm. Magnetic Resonance Imaging (MRI) showed multiloculated cystic mass 21×20×14 cm with heterogeneously enhancing solid component 5×3.5 cm in the right adnexal region. Excision of adnexal mass was planned. Peroperatively, there was a complex cystic mass measuring 30×25 cm with impending rupture in right adnexal region with minimal ascites. Excision specimen was sent for frozen section diagnosis. Macroscopic examination showed irregular cystic mass containing pultaceous material and hair. There was a mural nodule measuring 5×5 cm, cut section of which was solid grey white with glistening areas (Table/Fig 1).
Frozen section examination of the mural nodule showed sheets of atypical spindle cells with nuclear pleomorphism and increased mitosis. Cyst wall showed lining by mature squamous epithelium and hair follicles. A diagnosis of mature cystic teratoma with mural nodule showing poorly differentiated malignant spindle cell neoplasm was given. The patient underwent type A hysterectomy, left salpingo-oophorectomy, omentectomy with bilateral pelvic and paraaortic lymph node sampling. On further histopathological examination, the cyst wall showed lining by squamous epithelium, hair follicles, sebaceous glands, adipocytes and foci of ulceration. Cyst wall adjacent to mural nodule showed foci of moderate to severe dysplasia of squamous epithelium (Table/Fig 2).
Sections from mural nodule showed sheets of atypical spindly cells with moderate amount of pale eosinophilic cytoplasm, plump ovoid/spindly nuclei, variably prominent nucleoli. Mitosis including atypical forms and foci of necrosis noted (Table/Fig 3). On immunohistochemical examination, the spindle cells showed patchy weak to moderate positivity for cytokeratin, Epithelial membrane antigen (EMA), CK5/6 and P40 (Table/Fig 4). The cells were negative for SMA and desmin. Ascitic fluid cytology also showed malignant cells. Correlating the morphology and immunoprofile diagnosis of sarcomatoid (spindle cell) carcinoma (stage 1C) arising in mature cystic teratoma was given. Based on the stage of the disease, chemotherapy was started.
Mature Cystic Teratoma (MCT) constitute almost 20% of all ovarian neoplasms [1-3]. Mature teratoma is a tumour composed exclusively of mature tissues derived from two or three germ layers. Ectodermal derivatives include squamous epithelium and cutaneous adnexal structures (sebaceous and sweat glands, hair follicles) as well as neural ectoderm. Mesodermal derivatives are represented by fat, muscle, bone, cartilageand teeth. Endodermal derivatives consist of the respiratory/gastrointestinal epithelium, thyroid and salivary gland (1),(2),(3).
Although mature cystic teratoma is benign, malignant transformation can occur in 1% to 2% of cases (1),(2). A malignant tumour can arise from any of three germ cell layers in a teratoma and is identified adjacent to both normal and metaplastic cells. Squamous Cell Carcinoma (SCC) is the most common somatic malignancy arising in a teratoma, followed by adenocarcinoma, melanoma and sarcoma (1),(2),(3). Squamous cell carcinoma variants including verrucous, papillary, spindle cell/sarcomatoid, basaloid and adenosquamous carcinomas are also been rarely described in malignant transformation of mature teratoma (1),(4).
Spindle cell/sarcomatoid carcinoma is an uncommon type of squamous cell carcinoma, comprising up to 3% of all cases of SCC (4),(5). Spindle cell/sarcomatoid carcinoma show divergent differentiation by epithelial-mesenchymal transition. The usual presentation of spindle-cell /sarcomatoid squamous cell carcinoma is as an exophytic mass with a predominantly ulcerated surface. The diagnosis of spindle cell carcinoma is based on demonstrating epithelial differentiation, either on routine morphology (squamous dysplasia of residual surface epithelium or foci of conventional squamous cell carcinoma mixed with sarcomatoid tumour) or by positive immunostaining {cytokeratins, Epithelial membrane antigen (EMA), p63, or p40}. However, around one third of spindle cell carcinomas are purely spindled and will not demonstrate any epithelial component. Heterologous mesenchymal differentiation in the form of malignant bone, cartilage, or skeletal muscle can also occur (6),(7),(8). The expression of epithelial markers by the spindle cells is variable. Only 70% of cases will show positive immunostaining for epithelial markers (1),(2). In addition, focal expression of mesenchymal markers including smooth muscle actin, muscle-specific actin and S100 protein can be present adding to diagnostic dilemma.
When this malignant spindle cell neoplasm is not demonstrating epithelial component on routine histopathological examination and not expressing epithelial markers by immunohistochemistry, the diagnosis become most challenging. The differential diagnoses include leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, fibrosarcoma and malignant fibrous histiocytoma (2),(3),(7). Thorough sampling to identify epithelial component and immunohistochemical study using multiple epithelial markers will help in rendering an accurate diagnosis.
Two hypotheses have been proposed for the histogenesis of SCC in mature teratoma of the ovary. According to the first, it arises from the squamous epithelium of the teratoma. According to the second hypothesis, SCC arises from columnar epithelium which has undergone squamous metaplasia (3),(9),(10).
In their study, Amérigo J et al., demonstrated carcinoma in situ of a bowenoid type in two out of five SCCs arising from mature cystic teratoma cases and they suggested that the SCC was of epidermal origin (9). Iwasa A et al., studied the expression of CK10 and CK18 in 24 cases of SCCs arising from teratomas. They found the majority of the cases (14/21 cases) expressed CK18 which is normally expressed in the columnar epithelium. Only a minority of cases (7/21 cases) showed CK10 positivity which is normally expressed in the squamous epithelium. These findings are very similar to the SCCs of cervix and lung, derived from squamous metaplasia derived from columnar epithelium (10).
Because of rarity of this condition, the optimal management remains unclear. Surgery is the mainstay treatment. Surgical management include total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and surgical debulking of all grossly visible disease. The role of adjuvant therapy is unclear. Adjuvant chemothearapy is offered in high-stage disease.
The most common malignant transformation in teratoma is squamous cell carcinoma. In most cases, SCC is moderately differentiated and is exclusively associated with mature teratomas/dermoid cysts. Large teratomas in older patients should be carefully sampled for malignant component. Sarcomatoid carcinoma is an extremely rare form of secondary malignant neoplasm arising from mature teratoma and present as mural nodule.
DOI: 10.7860/JCDR/2023/59776.17296
Date of Submission: Aug 21, 2022
Date of Peer Review: Sep 11, 2022
Date of Acceptance: Oct 19, 2022
Date of Publishing: Jan 01, 2023
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. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 26, 2022
• Manual Googling: Oct 08, 2022
• iThenticate Software: Oct 17, 2022 (6%)
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