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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
Non-Hodgkin’s Lymphoma Presenting as a Soft Tissue Mass on Right Thigh
Correspondence Address :
Dr. Savitri Mallikarjun Nerune,
Assosciate Professor, Department of Pathology, B.M. Patil Medical Sciences and Research Centre, Vijaypura-586013, Karnataka, India.
E-mail: saviraj31j@gmail.com
Non-Hodgkin’s Lymphomas (NHL) are a heterogeneous group of lymphoproliferative malignancies with a greater preference for disseminating to extranodal locations. Prevalence of extranodal involvement in NHL has increased in the past decade, and the sites involved are the stomach, spleen, waldeyer’s ring, Central Nervous System (CNS), lungs and skin. This is a rare case of NHL in a 48-year-old female who presented with solitary exophytic mass with ulceration over the right thigh and erythematous plaque over postaxillary region and enlarged right inguinal and left axillary lymph nodes. Magnetic Resonance Imaging (MRI) of the right thigh showed lobulated mass involving skin and subcutaneous soft tissues without any intramuscular extension suggestive of neoplastic mass. Fine needle aspiration cytology of the inguinal node and biopsy of the right thigh lesion showed features suggestive of NHL. She was treated with three cycles of Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisone (CHOP) regimen, but the patient succumbed to death after six months of chemotherapy.
Cutaneous lymphoma, Extranodal involvement, Lymph node
A 48-year-old female presented with an ulcerated lesion over the medial aspect of the right thigh and a lesion over the left posterior axillary fold. Right thigh soft tissue mass was initially noted as small localised swelling gradually progressed to an ulcerated lesion over one year, associated with loss of appetite for 15 days, not associated with pain or fever or discharge. There was no significant personal and family history.
On general physical examination, a solitary exophytic mass was noted, measuring 20x15 cm on the posterolateral aspect of the right thigh with crusting over the surface and erythema around. The lesion was seen extending superiorly about 10 cm from the anterior superior iliac spine and inferiorly 3-4 cm from the knee joint. The swelling was hard in consistency, tender, bleeds on touch, with the local rise of temperature, non mobile on quadriceps muscle contraction with a plane of swelling being intramuscular. Right inguinal node was palpable, measured 3x3 cm and was firm to hard in consistency. Peripheral pulsations over the right lower limb were felt (Table/Fig 1). Solitary erythematous indurated plaque over postaxillary fold with axillary lymphadenopathy was also noted.
On routine investigations, haemoglobin was normal, total leukocyte count was 14640 cells/cumm. Liver function test showed an increase in total bilirubin (5.10 mg/dL), alkaline phosphatase (475 U/L), whereas urine routine and renal function tests were within normal range with serology being negative.
Ultrasonography (USG) abdomen and pelvis showed no significant abnormality, Magnetic Resonance Imaging (MRI) of right thigh showed 16x10x8 cm sized lobulated mass involving skin and subcutaneous soft tissues in the medial aspect of the distal thigh, encasing subcutaneous vein, and compressing underlying muscles without any intramuscular extension suggestive of neoplastic mass (Table/Fig 2). A large 3x3 cm enlarged right inguinal node was noted. Fine needle aspiration cytology of the inguinal node showed features suggestive of NHL. A biopsy of the thigh mass was done and sent for histopathological examination.
On microscopic examination, partially encapsulated tumour tissue was noted to be comprised of a monomorphic population of tumour cells arranged in diffuse sheets. Individual tumour cells were small to medium sized with hyperchromatic nuclei and a scanty amount of cytoplasm. Hyalinised vessels surrounded by whorls of cells arranged in onion peel pattern noted. Abnormal mitotic figures 2-3/High Power Field (HPF) were also noted as focal areas of necrosis, nuclear debris, many apoptotic bodies, a few bizarre cells and neutrophils (Table/Fig 3),(Table/Fig 4). Based on these features, a diagnosis of Non-Hodgkin’s Lymphoma (NHL)/Castleman disease was suspected and immunohistochemistry was suggested.
On immunohistochemistry, neoplastic cells were positive for Cluster Differentiation 3 (CD3), CD5, D43, B-cell lymphoma 2 (Bcl2) focal positivity for CD4 and CD7 noted, cells were negative for CD10, CD56, cyclin D1, Bcl6, CD23, CD8, Terminal deoxynucleotidyl Transferase (TdT), granzyme and perforin. Immunomorphology favoured diagnostic of peripheral T cell lymphoma.
Fluorodeoxyglucose-positron emission tomography showed disease involvement in metabolically active supra and infra diaphragmatic lymph nodes, skin and subcutaneous lesions around the right thigh, knee and around the left upper arm (Table/Fig 5).
The therapy involving doxorubicin-based combination chemotherapy {Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisone (CHOP)} was initiated and three cycles were given. Unfortunately, the patient succumbed to death after six months of chemotherapy.
Non-hodgkin’s lymphoma is a heterogeneous group of lymphoproliferative disorders originating in B, T and natural killer lymphocytes (1). The extranodal disease is lymphomatous infiltration of anatomic sites other than lymph nodes. Prevalence of extranodal involvement in NHL has increased in the past decade, and the most common areas involved are the stomach, spleen, waldeyer’s ring, Central Nervous System (CNS), lungs and skin (2). Cutaneous lymphoma manifests either as a primary tumour or as a secondary manifestation as a disseminated disease. Primary cutaneous lymphoma has been the second most prominent group of NHL (3).
Non-hodgkin’s lymphoma is a lymphoid tissue neoplasm originating from B cell precursors, mature B cells and mature T cells. NHL is divided into indolent and aggressive courses based on disease prognosis (4). Indolent lymphomas are follicular lymphoma, chronic lymphocytic leukaemia/small lymphocytic lymphoma, and splenic marginal zone lymphoma with waxing and waning lymphadenopathy (4). Aggressive lymphomas present with weight loss, fever, night sweats called as B symptoms. These include large B cell lymphoma, Burkitt lymphoma, precursor B and T cell lymphoblastic leukaemia/lymphoma, adult T cell leukaemia/lymphoma, and certain other peripheral T cell lymphomas (4).
Immunosuppression, ultraviolet radiation, viruses and other infections such as Epstein-Barr virus, Human T-lymphotropic Virus (HTLV), Human Herpes Virus-8 (HHV8), Hepatitis C, Simian Virus 40 (SV40), Helicobacter pylori would be potential risk factors to develop NHL. Occupational exposure to pesticides including phenoxy acids, organophosphates, and organochlorines, as well as chronic inflammatory and autoimmune disorders such as rheumatoid arthritis, sjogren’s syndrome, and Systemic Lupus Erythematosus (SLE) add to risk factors for NHL (5). A potential risk factor, in this case, would be immunosuppression or viral aetiology.
Chromosomal translocation, mutation, or deletion is another factor that leads to NHL. Chromosomal translocation activates proto-oncogenes, whereas chromosomal deletion or mutation inactivates tumour suppressor genes. The most prevalent chromosomal aberration in NHL is the t (14;18) translocation (6).
The most typical sites for extranodal lymphomas are lower limb, especially in the thigh (25%), followed by the retro-peritoneum (16%), then the upper limb (11%), unusual sites of extranodal lymphoma are gastrointestinal tract, thyroid, bone, brain, testis, soft tissue, kidney, liver, breast and skin (7),(8). The differential diagnosis include benign masses and malignant tumours such as soft tissue sarcomas, metastatic melanoma, metastatic carcinoma (small cell carcinoma of the lung), malignant bone tumours involving soft tissue (Ewing sarcoma) and lymphomas (7).
Nodular or diffuse are the histologic pattern described. In the nodular pattern the neoplastic cells aggregate in cluster form. In diffuse pattern, there is monotonous distribution of cells, within the lymph node, without any indication of nodularity or the establishment of germinal centers (9). In the indexed case diffuse pattern was noted.
Cytology helps in differentiating lymphomas from other soft tissue related cancers. A further biopsy is required for doing immunohistochemistry, subtyping and a definitive diagnosis of lymphoma. Avoiding ineffective radical surgery prevents morbidity and also provides a reliable clinical parameter to assess therapy success and response (7).
Non-hodgkin’s lymphoma is commonly treated by chemotherapy, radiotherapy, immunotherapy, stem cell transplant, and in rare cases surgery. Radiation is the primary treatment for early stage of tumour (10). Common adverse effects of chemotherapy are myelosuppression immunosuppression, and neutropenic fever. Myelosuppression can be treated by transfusions (red cells and platelets) or by administration of colony-stimulating factors (e.g., granulocyte colony-stimulating factor) (4).
Peripheral T cell lymphoma being the most probable diagnosis in this indexed case by immunohistochemistry represents a heterogeneous group of rare haematologic malignancies accounting for less than 10% of NHL (11). These lymphomas are clinically distinguished by superficial, hyperkeratotic patches and plaques or localised or disseminated eruptive papules, nodules, and tumours revealing core ulceration and necrosis. BetaF1+, CD3+, CD8+, granzyme B+, perforin+, TIA-1+, CD45RA+, CD45RO-, CD2-, CD4-, CD5-, and CD7-/+ phenotypes are present in the tumour cells (12). CHOP or CHOP-like regimen is considered the standard treatment with newly diagnosed Peripheral T cell lymphoma. Autologous stem cell transplantation’s role has been investigated to prevent the high relapse rate in chemosensitive patients (13).
Extranodal NHL is uncommon, accounting for 0.1% of soft tissues lymphoma cases (14). When they initially manifest, soft tissue lymphomas are termed primary, if other disease sites in staging process are not involved. An early excision biopsy is required to confirm the diagnosis of malignant neoplasms and ascertain the histological subtype. The best treatment option for NHL of the soft tissues is chemotherapy or radiotherapy (15).
To be distinguished between soft tissue sarcoma and lymphoma; clinical history, physical examination, and MRI would be non concluding, therefore pathological diagnosis should be made prior to surgery (16).
Soft tissue lymphomas represent an infrequent entity. It is essential to differentiate soft tissue lymphomas from soft tissue sarcomas. Prior histopathological diagnosis from biopsy tissue plays an important diagnostic role in avoiding amputation of a limb. A soft tissue lymphoma should always be considered in the differential diagnosis of a suspected soft tissue sarcoma.
DOI: 10.7860/JCDR/2023/58832.17562
Date of Submission: Jul 02, 2022
Date of Peer Review: Aug 12, 2022
Date of Acceptance: Nov 22, 2022
Date of Publishing: Mar 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. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 04, 2022
• Manual Googling: Nov 09, 2022
• iThenticate Software: Nov 19, 2022 (9%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
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- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
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- www.omnimedicalsearch.com