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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
Pilocytic Astrocytoma Arising in Ovarian Mature Cystic Teratoma: An Unusual Neuroectodermal Malignant Transformation Occurring in Pregnant Female
Correspondence Address :
Kalaivani Amitkumar,
S1, Thanyaregency, 11/61, Ganesh Nagar Main Road, Selaiyur, East Tambaram, Kancheepuram, Tamil Nadu, India.
E-mail: drkalaivani1980@gmail.com
Mature cystic teratomas are usually benign, however malignant transformation occurs rarely. It is identified in only 0.17-02% of cases. Malignant cells can arise from cell of any type, but most common malignant transformation found to be squamous cell carcinoma (80% cases) followed by adenocarcinoma. While neural tissue is identified in nearly 80% cases of mature cystic teratomas, neuroectodermal tissue with malignant transformation is the most exceptional event. There is minimal data available on primary neuroectodermal tumours of ovary, majority are astrocytoma of different grades, only few cases were reported in the literature so far. Authors report a extremely rare and unique case of pilocytic astrocytoma arising from a mature cystic teratoma in a pregnant female. A 33-year-old pregnant female in her first trimester came for regular antenatal visit, Ultrasound (USG) abdomen and pelvis single live intrauterine gestation corresponding to 10 weeks and incidental complex right ovarian cyst likely to be mature cystic teratoma. Patient underwent right ovarian cystectomy five months after normal vaginal delivery and provisional diagnosis was given as complex right ovarian dermoid cyst. Final detailed histopathological examination revealed a tumour with glial tissue within the cyst, reported as pilocytic astrocytoma {World Health Organisation (WHO) grade 1} arising in mature cystic teratoma. To the best of authors’ knowledge this is the third case showing pilocytic astrocytoma component in ovarian teratoma and the first case of this entity occurring in a pregnant female. Authors present an unusual case where radiology gave preliminary diagnosis however, extensive histopathological examination, histochemistry and immunohistochemistry helped in definite diagnosis.
Dermoid cyst, Glioma, Mature teratoma, Rosenthal fibres
A 33-year-old pregnant female in her first trimester of second pregnancy, came to Obstetric Outpatient Department for regular antenatal check-up without any significant complaints. Ultrasound (USG) abdomen and pelvis revealed single live intrauterine gestation corresponding to 10 weeks and complex right adnexal cyst of size 6.5×5.8×6.0 cm (Table/Fig 1)a,b. She was advised Nuchal Translucency (NT) scan and follow-up at 11 to 13 weeks, however she revisited the Institute OPD for cystectomy only five months after normal vaginal delivery which was conducted outside. She was P2L2 with regular previous menstrual cycles, married four years back and last child birth was five months. No other associated co-morbidities present. On abdominal palpation, separate, non tender, mobile right-sided cystic mass was found, compatible with ovarian cyst, was sent to radiology department for further evaluation. Baseline investigations such as complete blood count, routine urin e examination were done and found to be within normal limits. Serum tumour markers were analysed, Cancer Antigen (CA)125 was 12.6 U/mL, Alfa fetoprotein was 3.10 ng/mL, and beta human Chorionic Gonadotropin (HCG) was not detectable. USG abdomen and pelvis showed a complex right adnexal cyst of size 7.8×6.7×7.2 cm with fluid fat level and calcific focus. Magnetic Resonance Imaging (MRI) revealed large cyst with heterogenous fluid and fat signaling complex ovarian cyst of size 7.9×7.9×6.2 cm and the impression was given as likey to be mature cystic teratoma (Table/Fig 2).
Patient underwent exploratory laparotomy and right ovarian cystectomy demonstrating 8×8 cm large cyst replacing the right ovary along with bilateral tubectomy. Intraoperatively, right and left fallopian tubes, uterus and left ovary were unremarkable. Right ovarian cyst and bilateral tubectomy specimens were submitted for histopathology. Provisional diagnosis of dermoid cyst was made based on MRI impression and intraoperative findings. On gross examination, already cut opened cyst measured 9×6×2 cm completely replacing ovary, along with seperately lying bilateral tubes. On extending the cut, cyst drained clear fluid. Cut surface showed multiloculated cyst with visible hair follicles admixed with fat and pultaceous material, maximum cyst wall thickness was 1 cm with few solid areas (Table/Fig 1)c. Few cystic areas were filled with thick mucoid material. Specimen was sampled adequately.
Histologically cyst wall with mature derivatives of all three germ cell layers namely ectoderm, endoderm and mesoderm were identified. Stratified squamous epithelium with underlying good number of sebaceous glands, mature cartilage, foci of respiratory and transitional epithelium were identified. Areas of sharply demarcated glial tissue with biphasic morphology noted, predominantly composed of loose microcystic area with eosinophilic granular bodies and compact areas with plenty of bright-red sausage or corkscrew-shaped Rosenthal fibres and astrocytes with elongated nuclei were noted. Degenerative change in the form of psammomatous as well as patchy type calcification appreciated at places (Table/Fig 3)a-d. There was no evidence of necrosis, endothelial proliferation or increase in mitotic activity. Final impression was released as mature cystic teratoma with pilocytic astrocytoma component- World Health Organisation (WHO) grade 1 (1).
Periodic acid schiff histochemical stain highlighted eosinophilic granular bodies and Masson trichrome stain demonstrated bright Rosenthal fibers (Table/Fig 4)a,b. Immunohistochemical stain Glial Fibrillary Acidic Protein (GFAP) also performed to confirm glial origin and to highlight the Rosenthal fibres, came out to be strong and diffuse positivity. Ki-67 stain showed low proliferation index of 1 to 2% compatible with low grade (grade 1) tumour (Table/Fig 4)c,d.
The postoperative period was uneventful. On follow-up visits till 11 months of postoperative period, patient was asymptomatic without any complaints. Written consent for publication was obtained from the patient.
Benign (mature) cystic teratomas are one of the most common ovarian neoplasms occurring in women of reproductive age group, accounts for 20% of all ovarian neoplasm and 95% of all ovarian germ cell tumours (2). Peak incidence is 20-29 years. Mature teratomas/dermoid cyst, a germ cell tumour contains well differentiated tissue of all three layers of germ cells, including ectoderm, endoderm, and mesoderm (3),(4). Mature cystic teratomas are usually benign, but malignant transformation identified in 0.17-2% of cases (5). Malignant cells can arise from cell of any type, but most common malignant transformation is squamous cell carcinoma (80% cases) followed by adenocarcinoma (6).
While neural tissue is identified in nearly 80% cases of mature cystic teratomas (7), neuroectodermal tissue with malignant transformation is very rare, however neuroectodermal tumours including glioblastomas, oligodendrogliomas, ependymomas, and astrocytomas were reported previously (8). In the detailed literature search, only 44 cases of gliomas including the present case have been described, out of these cases 37 cases were found within a mature cystic teratoma and seven developed from immature type. Four cases diagnosed as fibrillary astrocytomas WHO grade ranging from I–II, 16 cases were ependymomas and 13 cases found to be grade IV glioma (9). Oigodendroglial, ependymal tissues, ganglia of sympathetic type, and Schwann cells may be identified in mature cystic teratomas. Pilocytic astrocytoma of central nervous system is the most common childhood tumour occurring in cerebellum, classified as grade-I tumour by World Health Organisation. This should be differentiated from other types such as infiltrating or diffuse type of astrocytoma since these types tend to infiltrate adjacent tissues. To the best of our knowledge this is the third case showing Pilocytic astrocytoma component, first case reported as pure pilocytic astrocytoma (10) and the second case reported as collision glial neoplasms composed of pilocytic and ependymal components (9).
Due to routine antenatal USG examination, incidental diagnosis of adnexal masses are on rise. Though there is spontaneous resolution of few masses, some cases end up in complications like torsion, interference in normal labour or rupture resulting in surgical emergency, which adversely affects maternofetal outcome (11).
Late detection may increase the risk of malignant transformation, however the risk of occurrence of malignancy in pregnancy ranges from 1 in 10000 to 1 in 50000 (12). The most common ovarian tumour occurring in pregnancy was mature teratoma followed by serous cyst, bilateral borderline serous carcinoma was identified in one patient (13). The present case is the first unique case of pilocytic astrocytoma originating from a mature cystic teratoma occurring in a pregnant female. The treatment modes and prognosis are notwell prevalent for these tumours due to rarity.
While the literature knowledge is limited about the behaviour of low-grade astrocytoma arising in a mature cystic teratoma, the patients described in the previous studies were cured with surgical resection itself (8). As far as gynaecological tract’s astrocytomas are considered, authors believe that patients with low grade glial tumours undergoing complete surgical resection will have good prognosis. Szczepa Ska M et al., studied about ovarian lesions occurring in pregnant females 35% of cases were surgicly intervened to excise the tumour and 65% of the cases were managed by non surgical conservative modality (13). Gliomas of all types arising within mature or immature teratomas of the ovary tend to present as ectopic site lesions such as in peritoneal cavity and sometimes in the lymph nodes (14). This theory appears not suitable for this case.
The identified risk factors involving malignant transformation of mature cystic teratoma are larger size tumour, older age, postmenopausal status and elevated CA-125 levels (15). The exact mechanism is not understood, however it was suggested that presence of mature cystic teratomas without excision for longer period may be related to malignant transformation. Teratomas presenting in postmenopausal and older women may present for several years before excision. This long-term presence can be related with overexposure to carcinogens or causing increased mutations over a period of years (16). Interestingly, in the present case report the patient presented with larger size tumour which is the only known risk factor of malignant transformation.
This case report presented extremely rare entity of pilocytic astrocytoma originating from ovarian mature cystic teratoma occurring in a pregnant female. Where radiology gave preliminary diagnosis however, extensive histopathological examination and immunohistochemistry helped in definite diagnosis, emphasising the need of appropriate sampling to identify rare components with proper grading and subtyping. This case report will be contributing to the minimal information obtainable for primary pilocytic astrocytoma of female genial tract showing malignant ectodermal transformation in the background of mature cystic teratoma. Many more case studies and follow-up details are surely needed for helping physicians to plan for better treatment and to understand the prognosis of these rare entities.
DOI: 10.7860/JCDR/2023/60785.17312
Date of Submission: Oct 14, 2022
Date of Peer Review: Nov 17, 2022
Date of Acceptance: Dec 01, 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: Oct 14, 2022
• Manual Googling: Nov 23, 2022
• iThenticate Software: Nov 28, 2022 (2%)
ETYMOLOGY: Author Origin
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