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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
Acinic Cell Carcinoma of the Breast: A Rare and Diagnostically Challenging Entity
Correspondence Address :
Dr. KR Anila,
Nandanam ERA 112 A Erappukuzhy Kudappanakunnu, P.O. Thiruvananthapuram (Trivandrum)-695043, Kerala, India.
E-mail: anilavenu98@gmail.com
Acinic Cell Carcinoma (AcCC) of the breast is a rare subtype of invasive breast carcinoma that falls under the category of salivary gland-type tumours of the breast. Histologically, it closely resembles AcCC of the salivary gland. Here, the authors report a case of AcCC of the breast in a 51-year-old woman who presented with a palpable lump in her right breast. Radiological investigation revealed a Breast Imaging Reporting and Data System (BIRADS) score V lesion. A core biopsy was performed, and the histopathological examination revealed relatively bland cells arranged in an acinar pattern within a myxoid stroma, closely resembling adenosis rather than a neoplasm. The diagnosis posed a challenge in the core biopsy due to its close resemblance to adenosis. However, the clinical and radiological findings strongly suggested malignancy. Immunostaining with p63 was conducted, which helped demonstrate the absence of myoepithelial cells around the tumour cell nests and supported the neoplastic nature of the lesion. Despite the bland and low-grade morphology, the tumour was found to be triple negative for Oestrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER2), and it exhibited characteristic positivity for SRY-Box Transcription Factor 10 (SOX 10), S100, and CK7, which aided in making the diagnosis. The authors presented the case report to highlight the rarity of this subtype of breast carcinoma and to emphasise the importance of histomorphology and immunoprofile in reaching a diagnosis. To the best of the authors’ knowledge, the present case was the second reported case of AcCC of the breast from India, adding to the novelty of this case.
Breast, Salivary gland-type carcinoma, Triple negative
A 51-year-old woman who is a known case of invasive breast carcinoma of no special type in the left breast, diagnosed in 2018, completed treatment with neoadjuvant chemotherapy followed by left modified radical mastectomy, adjuvant radiation, and hormone treatment with tamoxifen. She completed treatment in December 2018. The patient was on regular follow-up, during which a lump was detected in her right breast on screening mammography in September 2022. Digital mammography revealed an irregular hypoechoic solid lesion with a BIRADS score of V (Table/Fig 1)a. Fine Needle Aspiration Cytology (FNAC) showed a cellular smear with atypical cells in sheets, papillaroid, and acinar patterns. The cells exhibited moderate to abundant pale cytoplasm, fine chromatin, small nucleoli, and nuclear inclusions. Occasional clusters showed cells with moderate cytoplasm and atypical nucleus, and it was reported as suggestive of carcinoma (Table/Fig 1)b.
A Core Needle Biopsy (CNB) of the mass revealed a lesion composed of relatively bland cells arranged in an acinar pattern. The cells were cuboidal to columnar, with moderate to abundant clear/granular eosinophilic cytoplasm and uniform round vesicular nucleus, resembling adenosis (Table/Fig 2)a,b. However, infiltrative nature could be appreciated in some areas.
To confirm the neoplastic nature, Immunohistochemistry (IHC) was performed. CK 5/6 and Tumour Protein 63 (p63) staining highlighted the lack of myoepithelial cells around tumour cell nests, while preserved myoepithelial cells were observed around the normal breast ducts [Table/Fig-3a]. ER, PR, and HER2 were negative, and the neoplastic cells exhibited positivity for S100 protein, CK7, and SOX10 [Table/Fig-3b-d]. DOG-1 staining was negative. Periodic Acid-Schiff with Diastase (PASD) staining showed diastase-resistant cytoplasmic granules. Based on the morphology and characteristic immunoprofile, a diagnosis of salivary gland-type carcinoma, AcCC, was made. The patient underwent surgery, specifically breast-conserving surgery guided by frozen section for margin and sentinel node status. The margins were negative, and the sentinel node showed reactive changes, so axillary clearance was not performed. Gross examination revealed a tumour measuring 4.8×4.3×2.5 cm, with a grey-white appearance, firm to hard consistency, well-defined borders, and lobulated cut surface. Microscopy confirmed the presence of salivary gland-type carcinoma, AcCC, with focal higher-grade areas showing high nucleocytoplasmic ratio and nuclear pleomorphism, unlike the relatively bland appearance observed in the core biopsy. The postoperative period was uneventful. Postoperative imaging, including Computed Tomography (CT) of the thorax, abdomen, pelvis, and bone scan, showed no evidence of metastasis.
The patient was planned for adjuvant chemotherapy with six cycles of paclitaxel and carboplatin, followed by adjuvant radiation. At the time of writing the case report, the patient was undergoing adjuvant chemotherapy and has received three cycles, tolerating it well.
The AcCC is a relatively common carcinoma of the salivary gland but rare in the breast (1). The breast and salivary gland are tubuloacinar exocrine glands that can develop tumours with similar morphological features, but their clinical behaviour depends on whether they are primary in the breast or salivary glands [2,3]. AcCC of the breast is a rare subtype of invasive breast carcinoma listed under rare and salivary gland-type tumours in the fifth edition of the World Health Organisation (WHO) classification of breast tumours. The first case was reported by Roncaroli F et al., in 1996 (4). Since then, less than 50 cases have been reported, including one case from India (5),(6). The breast and salivary gland share a common architecture in terms of tubulo-acinar glands with luminal epithelial and abluminal myoepithelial cells (7). Consequently, breast tissue can develop all types of tumours encountered in the salivary gland. However, the clinical outcomes of these tumours are not always similar and depend on the primary site. Although most salivary gland-type tumours of the breast share the same molecular alterations as their salivary gland counterparts, AcCC is an exception with a different molecular profile, suggesting that they are different entities (8).
The AcCC is a malignant epithelial neoplasm composed of clear and granular epithelial cells arranged in microglandular and solid patterns. The two patterns frequently merge together. Due to the high variability in architectural patterns, the diagnosis is based on recognition of the cytological features. The neoplastic cells have abundant, variably eosinophilic and basophilic granular cytoplasm, imparting a variegated appearance. PASD staining reveals intracellular, large, coarse eosinophilic granules. In the present case report, the authors could also demonstrate diastase-resistant PAS-positive cytoplasmic granules. Intracytoplasmic granules are also clearly evident on ultrastructural examination. The neoplastic cells may occasionally have a clear cytoplasm. Atypia is usually more prominent in solid areas, and mitotic figures may be seen but are usually not marked. AcCC may be accompanied by invasive ductal carcinoma NST (“mixed” cases), as documented in some studies (9),(10). The nucleus is centrally located and atypical, with a prominent nucleolus. The neoplastic cells show various degrees of atypia. Foschini MP et al., have highlighted that the difference between AcCC with a predominant microglandular growth pattern and microglandular adenosis can be challenging (6). The authors also experienced this 10difficulty in the core biopsy, where the differential diagnosis was between adenosis and carcinoma. In the present case, the initial core biopsy showed relatively bland cells, resembling adenosis, and the absence of myoepithelial cells had to be demonstrated before reaching a diagnosis of carcinoma. Cellular atypia and mitotic figures are usually more prominent in solid areas. Other differential diagnosis of AcCC include invasive carcinomas NST, apocrine carcinomas, oncocytic carcinomas, and secretory carcinoma. Secretory carcinoma lacks the intracytoplasmic granules seen in AcCC and has the characteristic ETV6-NTRK3 fusion. Apocrine carcinomas are positive for androgen receptor, while oncocytic carcinomas express ER in more than 50% of cases (2),(6). Salivary gland-type carcinomas of the breast are usually triple-negative, despite being associated with a good prognosis. Triple-Negative Breast Cancers (TNBC) as a group generally have a worse prognosis than stage-matched non-TNBC and lack the benefits of routinely available targeted therapy. However, TNBC is a heterogeneous group of neoplasms, with some special type carcinomas, including salivary gland-type carcinomas, having a relatively indolent course (9). Ajkunic A et al., in their review article on AcCC of the breast, noted that most of the cases in the literature were triple-negative, with only seven out of 66 cases positive for ER and seven out of 62 cases positive for PR. HER2/neu status was negative for all cases (11). The present case also showed negative ER, PR, and HER2 status. The neoplastic cells are positive for markers of serous differentiation, such as lysozyme and α1-antichymotrypsin. Additionally, they consistently exhibit positivity for S100, EMA, and low-molecular-weight cytokeratin. It also showed positivity for CK7, S100 protein, and SOX10, which is a marker for acinar cells. Most reported patients undergo chemotherapy and radiotherapy in addition to surgery (11),(12). Recurrent genomic rearrangement that upregulates the NR4A3 transcription factor has been described in salivary AcCC (13), but no study has reported on NR4A3 status for AcCC of the breast. The patient is currently undergoing adjuvant therapy following surgery.
The AcCC is a rare salivary gland-type carcinoma of the breast. Due to its rarity and typically low-grade histology, it can pose a diagnostic challenge, especially in limited biopsy samples. These carcinomas are triple-negative; however, unlike other TNBCs, AcCC usually has a better prognosis. More data on this entity are needed to better understand its clinical behaviour as a salivary gland-type tumour of the breast.
DOI: 10.7860/JCDR/2023/66550.18703
Date of Submission: Jul 26, 2023
Date of Peer Review: Sep 01, 2023
Date of Acceptance: Oct 04, 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: Jul 27, 2023
• Manual Googling: Sep 28, 2023
• iThenticate Software: Sep 30, 2023 (11%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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