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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
Pure Embryonal Cell Carcinoma: A Rare Entity
Correspondence Address :
Neha Jaiswal,
Bharatnagar, Nagpur-440033 Maharashtra, India.
E-mail: nehangpjaiswal@gmail.com
Malignancy of the testes constitutes only one percent of all male cancers. Most testicular malignancies are Germ Cell Tumours (GCTs), which are broadly categorised into seminomatous and non-seminomatous types. Non-seminomatous GCTs are further classified into several subtypes based on their histopathological features. This case report presents a case of Pure Embryonal Cell Carcinoma (PECC) of the testes in a 32-year-old male. The diagnostic work-up involved a detailed medical history, physical examination, and imaging tests, including a scrotal ultrasound and Positron Emission Tomography-Computed Tomography (PET/CT) scan. These tests helped identify a testicular mass without metastasis. Additionally, serum tumour markers such as Alpha Fetoprotein (AFP), human chorionic gonadotropin, and lactate dehydrogenase were elevated, further confirming the presence of testicular malignancy. The management of the patient included surgery and chemotherapy. Histopathology and immunohistochemistry were performed, resulting in a diagnosis of pure embryonal carcinoma. This case highlights the significance of timely diagnosis and prompt management in improving the prognosis of patients with PECC.
Germ cell tumour, Metastasis, Testicular tumour
A 32-year-old male patient visited the clinic with a complaint of a painless mass in his right testicle for six months. The patient reported no other symptoms and had no noteworthy personal or family history. On physical examination, a firm, tender, non-transilluminating mass was felt in the right testis. The left testis appeared normal. The serum tumour markers were elevated as shown in (Table/Fig 1).
A scrotal ultrasound was performed, revealing a solid right testicular mass measuring 10 cm in diameter with areas of necrosis and calcification. The mass appeared highly suspicious for malignancy. Several enlarged lymph nodes were observed, but they were reactive in nature. A PET-CT scan was conducted, which indicated carcinoma of the testis without metastasis. The patient underwent a right inguinal high orchidectomy, and the specimen was sent for histopathology. Gross examination revealed a testicular tumour measuring 7.3x6.4x6 cm in the right testis. The external surface appeared enlarged and congested, as shown in (Table/Fig 2). The cut section displayed a soft grey, white to tan mass with haemorrhage and necrosis, as shown in (Table/Fig 3). Histopathological analysis confirmed a diagnosis of primitive embryonal carcinoma of the right testis. The tumour consisted of undifferentiated cells with large nuclei, prominent nucleoli, and scanty cytoplasm. The tumour cells were arranged in solid sheets, pseudo-glandular, alveolar, and tubular-papillary patterns. Numerous mitotic figures were present. These cells exhibited pleomorphism, hyperchromatic nuclei, large nucleoli, and ambiguous cell boundaries with nuclear overlapping. Areas of necrosis were also observed, as shown in (Table/Fig 4),(Table/Fig 5). No areas of yolk sac tumour, teratoma, or seminoma were identified. Immunohistochemical staining showed positivity for OCT-4 and CD30, supporting the diagnosis of primitive embryonal carcinoma. Staging was performed according to the American Joint Committee on Cancer (AJCC) staging system, classifying it as pT1N0M0 (1).
The patient underwent four cycles of chemotherapy with the Bleomycin, Etoposide, and Cisplatin (BEP) regimen. Follow-up scrotal ultrasound and CT scans of the pelvis, abdomen, and chest were conducted, revealing no residual disease or metastasis. The patient was regularly followed-up every three months with physical examination, tumour markers, and imaging studies. The treatment was well-tolerated, and there was no evidence of disease recurrence during the 12-month follow-up period.
Malignancy of the testes is a relatively infrequent cancer that affects males, with only 1% of all male cancers being testicular in nature. However, testicular cancer is commonly seen in males in their second and third decades (1),(2). Germ Cell Tumours (GCTs) are the most prevalent type of testicular cancer and can be classified into several subtypes based on their histopathological features. Testicular GCTs can be broadly categorised as seminomatous or non-seminomatous. Non-seminomatous tumours can be further classified into choriocarcinoma, yolk sac tumour, teratoma, and mixed GCTs. Combined GCTs are more common than pure GCTs. Mixed GCTs comprise two or more subtypes of GCT, while pure GCTs are exclusively composed of only one type of germ cell (3).
One such subtype is PECC, which accounts for only 1-3% of all GCTs. PECC is an aggressive tumour that arises from the undifferentiated embryonic cells of the testes. In this case report, we present a case of PECC of the testes in a 32-year-old male. This case highlights the significance of timely diagnosis and treatment in improving the outcome of patients with this rare and aggressive form of testicular cancer. Embryonal carcinoma is found as a part of 80% of mixed GCTs and is the second-most prevalent type of testicular cancer. Embryonal carcinoma is most frequently seen in men between the ages of 20 and 40. The factors that increase the risk of developing testicular malignancy are cryptorchidism and a previous history of similar illness or a family history of testicular tumours (3),(4),(5).
Like any other oncological disease, testicular tumours are formed due to complex interactions among genetic, environmental, and hormonal risk factors. The multiple-hit hypothesis plays a crucial role in the malignant transformation and development of testicular cancer. The hallmark of most invasive GCTs is the alteration in the short arm of chromosome 12 (6),(7). Embryonal carcinoma is relatively rare (10.8%) among pure Testicular Germ Cell Tumours (TGCTs). However, in mixed TGCTs, embryonal carcinoma is the most common histological element (80.4%). Pure embryonal 5carcinoma more frequently affects younger males in their twenties and thirties, with a median age at diagnosis of 15 years. Embryonal carcinoma is quite uncommon in the ovary (7),(8),(9).
Embryonal carcinoma is an aggressive tumour and is associated with early metastatic spread (10). Besides metastasis, the prognosis of a patient with embryonal carcinoma also depends on factors such as location, post-orchiectomy levels of tumour markers (AFP >10,000 ng/mL, beta-hCG >50,000 IU/L, LDH >10 times the upper limit of normal). While apoptotic particles, extensive necrosis, and single-cell necrosis draw attention, the prognosis is not dependent on the histological pattern (11).
The management of PECC (Pure Embryonal Carcinoma of the Testes) poses a challenge for healthcare providers due to its rarity. The widespread use of testicular ultrasonography has led to an increased detection of tiny, non-palpable tumours compared to earlier times (12). Histopathological analysis reveals tumour cells exhibiting various patterns, often involving multiple patterns simultaneously. The most frequently observed patterns are solid, syncytial, tubular, and tubular-papillary (13). Tumour cells have an epithelial appearance and may exhibit significant anaplasia. They appear polygonal with thickened nuclear membranes, vesicular nucleus, dense granular cytoplasm, and clear boundaries (13),(14).
The range of possible differential diagnosis for testicular tumours is extensive and includes large cell lymphoma, yolk sac tumour, and seminoma. The therapy varies greatly depending on the subtype of testicular tumour, underscoring the importance of accurately diagnosing a particular type (14). Therefore, extensive sampling of specimens is crucial to provide a diagnosis of “pure embryonal carcinoma” and exclude the possibility of mixed germ cell neoplasia (15).
The patient complained of progressive scrotal swelling with pain. A CT scan was performed, which revealed a testicular tumour with metastasis. The patient underwent surgery, and the tumour was sent for histopathology. On histopathological examination, the tumour cells were arranged in solid, pseudo-glandular, alveolar, and tubular-papillary patterns. These cells displayed pleomorphism, hyperchromatic nuclei, large nucleoli, ambiguous cell borders with nuclear overlapping, and mitotic figures. The stromal component showed squamous metaplasia. Areas of necrosis and haemorrhage were observed, while the surrounding areas exhibited fibrosis and adipose tissue. Multiple tissue samplings were performed to rule out the presence of other GCT components since mixed GCT is more frequent than pure GCT. However, no other GCT component was identified.
The diagnosis of PECC is based on the morphological features observed during histopathological examination of the testicular tissue obtained from orchiectomy. PECC is characterised by undifferentiated malignant cells that resemble the embryonic cells of the testis. The tumour cells showed positive staining for Placental Alkaline Phosphatase (PLAP) and CD117, which are specific markers for GCTs. The presence of these markers, along with characteristic histopathological features, helps differentiate PECC from other subtypes of GCTs (16),(17).
The treatment for PECC involves a multimodal approach, including surgery, chemotherapy, and radiation therapy. Radical orchiectomy is the primary treatment for localised PECC. The purpose of the surgery is to remove the entire tumour and any potential metastatic lesions. Adjuvant chemotherapy is administered after surgery to minimise the risk of recurrence and metastasis. The most commonly used chemotherapy regimen for PECC is the BEP regimen. Radiation therapy is reserved for cases with residual disease after surgical intervention and chemotherapy or in cases with metastatic lymph nodes (18),(19).
Patients with pure embryonal carcinoma have a better prognosis than those with mixed GCTs. The prognosis for PECC depends on the stage of the disease at diagnosis, with patients diagnosed at an early stage having a better prognosis than those with advancedstage disease. PECC is associated with a high-risk of recurrence, and patients require close follow-up after treatment to monitor for any signs of recurrence (19),(20).
PECC is a rare and highly malignant subtype of GCT that affects young males. The diagnosis of PECC is based on histopathological examination, which shows undifferentiated malignant cells that stain positive for PLAP and CD117. Treatment for PECC typically involves radical orchiectomy followed by adjuvant chemotherapy. Since a localised malignant tumour has a higher probability of being cured than a metastatic malignancy, detecting it at an earlier stage is the most significant factor that determines the survival and outcome of cancer patients.
DOI: 10.7860/JCDR/2023/65227.18695
Date of Submission: May 04, 2023
Date of Peer Review: Jun 30, 2023
Date of Acceptance: Jul 20, 2023
Date of Publishing: Nov 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 10, 2023
• Manual Googling: Jul 04, 2023
• iThenticate Software: Jul 17, 2023 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
- 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
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com