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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
Granular Cell Ameloblastoma: A Rare Case Report and Literature Review
Correspondence Address :
Samiha Jameel Ahmed Khan,
Postgraduate Student, Department of Oral Pathology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
E-mail: samiha.khan26@gmail.com
Ameloblastomas are rare, benign, aggressive neoplasms of odontogenic epithelial origin. Among the various types of ameloblastomas, granular cell ameloblastoma is rare and accounts for less than 5% of the total. Granular cells are epithelial in origin. The distinct histopathological characteristics of granular cells are associated with high lysosomal content in tumour cells cytoplasm. A 43-year-old female patient presented with a painful swelling on the left-side of the jaw. The diagnosis was based on clinical, radiological and histopathological examination. A complete surgical resection was done. Histopathology showed features of granular cell ameloblastoma. The operative procedure was uneventful. Granular cell ameloblastoma has a high tendency for recurrence. Around 33.3% recurrence is reported, according to various studies. This rate is much higher than other subtypes of ameloblastoma, which are more common. Hence, it is essential to provide appropriate surgical treatment on time to prevent tumour recurrence and metastasis.This case report aims to highlight the unique features of granular cell ameloblastoma, distinguishing it from other subtypes and discussing the pathogenesis and treatment modalities.
Local, Lysosomes, Neoplasm recurrence
A 43-year-old female patient reported with a painful swelling over the left lower back region of the jaw of 3.5 years duration. The associated pain was gradual in onset, dull aching, continuous, and radiating to left-side of forehead region. Pain aggravated on mastication and relieved on its own over time. The swelling was initially small in size and increased to its present size of 10×9 cm. There was history of decreased salivation, change in consistency of saliva from thin to thick and ropy since three days. Patient gave history of difficulty in mastication since two months. There was no significant past medical or dental history.
On extraoral examination, the face appeared grossly asymmetrical due to swelling on the left-side extending anteroposteriorly from the left corner of the mouth to the left angle of the mandible and supero-inferiorly from 3 cm below the left lateral canthus of the eye to 2.5 cm below the inferior border of the mandible. On palpation, tenderness was present, and the swelling was firm and fixed to underlying structures (Table/Fig 1).
Intraoral examination revealed an ulcerative lesion of 5×4 cm present over the lower left-side of the alveolus extending from 37 anteriorly, and the posterior extent could not be assessed (Table/Fig 2). Superoinferiorly, the swelling extended from the level of occlusion of upper teeth to the depth of the lower left gingivobuccal sulcus involving the floor of the mouth.
A provisional diagnosis was made of odontogenic tumour of left body of mandible. A differential diagnosis of dentigerous cyst, odontogenic keratocyst, fibrous dysplasia, odontogenic myxoma, osteosarcoma and aneurysmal bone cyst was also considered. The tumour was not aspirated and the patient was advised radiological investigation for further evaluation.
On radiological examination, a multicystic radiolucent lesion was seen in the left mandibular premolar and molar region involving half of the ascending ramus (Table/Fig 3). Lobulation of the inferior cortex was seen at the angle of the mandible. Computed dental tomography (Table/Fig 4) showed a large multicystic non enhancing expansile lesion with few internal enhancing areas of the solid component in the left lower body and ramus of mandible causing the cortical break.
Enbloc resection of the lesion was done along with segmental mandibulectomy and disarticulation of the condyle of the left-side. Reconstruction was done with Recon plate (Table/Fig 5). The resected specimen was sent for histopathology (Table/Fig 6).
The Haematoxylin & Eosin (H&E) stained tissue section showed odontogenic epithelial islands in interspersed fibrocellular connective tissue stroma (Table/Fig 7),(Table/Fig 8). The odontogenic epithelial islands were arranged in follicles lined by tall columnar cells with hyperchromatic nuclei and a palisading pattern (Table/Fig 9). The suprabasal cells resembled the stellate reticulum. In some odontogenic follicles, spherical-shaped cells filled with eosinophilic granules were seen with eccentric nuclei suggestive of metaplasia (Table/Fig 10). Based on the histopathological report, it was diagnosed as Granular cell ameloblastoma.
The final diagnosis was made on the basis of routine histopathological examination done by H&E staining procedure. Based on histopathological examination, it was a clear case of granular cell ameloblastoma, so no immunohistochemistry studies were performed on the specimen.
The post-surgical course was uneventful and no recurrence was seen up to 6 months of follow-up period [Table/Figure 11],(Table/Fig 12),(Table/Fig 13).
Ameloblastoma is a benign neoplasm of the jaw of odontogenic epithelial origin. It is a slow-growing, locally invasive tumour that closely resembles enamel organ epithelium (1). Ameloblastoma occurs more commonly in 3rd to 5th decade of life with no gender predilection (2). The global prevalence of ameloblastoma is 0.5 cases per million persons per year according to a study done by Brown NA and Betz BL (3). In Maharashtra (India), ameloblastoma showed an incidence rate of 35.43% in a review of 127 cases of odontogenic tumours (4).
It is most commonly seen near the angle of the mandible (5). Ameloblastoma is clinically identified as a painless, slow-growing swelling in the jaw. Facial deformity, malocclusion, tooth loss, pain and paresthesia may be seen on the affected side (6). Ameloblastoma presents as a significant hard tissue swelling in the jaw bone. Sometimes, it may even be present as soft tissue swelling in the maxilla or mandible with no involvement of the underlying bone (7). This type is known as peripheral ameloblastoma, and it can often be confused with intraosseous ameloblastoma. However, intraosseous ameloblastoma spreads from inside the jaw bone into the gingiva. Past studies have also described these lesions as odontogenic gingival epithelial hamartoma (8). Solid or multicystic ameloblastoma typically shows a multilocular radiolucency with well-defined borders on radiographs. Conventional ameloblastoma may also indicate a unilocular radiolucency commonly seen in unicystic ameloblastoma. Cortical bone’s perforation, expansion, and root resorption/divergence in adjacent teeth are widely seen (5).
Among the many known histopathologic subtypes of ameloblastomas, the most common patterns are follicular and plexiform (9). The less common subtypes include the granular cell ameloblastoma, acanthomatous, basal cell, and desmoplastic ameloblastoma.
Granular cell ameloblastoma is a distinct subtype. Granular cell ameloblastoma represents 1-5% of all ameloblastomas (10). It is identified by groups of granular cells with profuse cytoplasm. These granular cells resemble lysosomes and create a solid mass in the centre comprising of epithelial cords and islands (11). Granular cell ameloblastoma is aggressive in nature, with an increased rate of recurrence and can even progress into metastasis (12). Granular cell ameloblastoma does not differ from other subtypes when it comes to radiological or biological behaviour. Histopathology is the only way of differentiating granular cell ameloblastoma from other common subtypes.
Granular cell ameloblastoma is a rare form of ameloblastoma. The treatment and prognosis of granular cell ameloblastoma does not vary when compared to the common subtypes. Although the rate of recurrence of granular cell ameloblastoma is quite high as compared to the other subtypes (5). Kameyama Y et al., in their research, classified 1 out of a total of 77 cases as granular cell ameloblastoma (13). Reichart PA et al., reported and discussed the literature on ameloblastoma (jaws) from the year 1960 to 1993 (10). The author stated that only 56 (3.5%) cases out of 1593 cases were of granular subtype and also suggested that the age group for the granular cell subtype is most common to the other subtypes, for which an average age of 35-year-old is reported, ranging from 4 to 92 years (10). In another study, Hartman KS did a review of twenty cases of granular cell ameloblastoma from the files of Armed Forces Institute of Pathology (AFIP) (14). The author noted a mean age of 40.7 years (ranging from twenty-one to sixty-five years). Forty percent of the cases were seen in non Caucasians with no specific gender preference (14). Most tumours (19 out of 20) affected the posterior region of the mandible (14). A strong preference for mandible was confirmed by subsequent reviews (15). The most common symptoms reported were jaw swelling and pain. No distinct radiographic findings have been reported in comparison to other subtypes.
Immunohistochemistry studies were done by Kumamoto H and Ooya K on six cases of granular cell ameloblastoma. They revealed that increased apoptotic cell death and associated phagocytosis might cause granularity in ameloblastoma (16). Granular cell ameloblastoma showed a similar biological behaviour as other histological subtypes. It is aggressive locally and shows a high recurrence rate (17). A 33.3% recurrence rate for granular cell ameloblastoma was reported by Reichart PA et al., which was higher as compared to other common subtypes (10). In the study conducted by Hartman KS, 73% (11 of 15 patients) of recurrent lesions were reported (14). The prognosis of the disease depends on the type of treatment/surgery. In granular cell ameloblastomas, enucleation or curettage is the choice of treatment which generally results in recurrence. The main reason behind this is the presence of the tumour border within bone (cancellous), which is present beyond the evident macroscopic surface and the radiographic borders of the lesion. Therefore radical surgery is often suggested for treatment (17).
Interestingly, granular cell ameloblastomas seldom show a malignant pattern leading to metastasis (15). The main histological features of granular cell ameloblastoma are granular cells, typically present in the centre of the tumour, which gradually replaces the stellate reticulum cells. Initially, they were believed to portray ageing or degeneration [18,19]. Still, recent Immunohistochemical (IHC) studies have suggested that it is related to increased apoptotic cell death of the lesional cells and phagocytosis of neighbouring neoplastic cells (16). The differential diagnosis of granular cell ameloblastomas includes granular cell odontogenic tumours, granular cell tumours and congenital epulis. These lesions show biologically distinct behaviours and should be distinguished from granular cell ameloblastomas (20).
Granular cell ameloblastoma is an infrequent variant of ameloblastoma showing distinct histologic and immunohistochemical features. The prognosis and treatment are similar to other common subtypes of solid or multicystic ameloblastoma. Granular cell ameloblastoma should be distinguished from other lesions with granular cells mainly due to its high risk of recurrence. A better knowledge of the molecular pathogenesis of ameloblastoma and its various subtypes may provide diagnostic and therapeutic benefits.
DOI: 10.7860/JCDR/2023/61118.17500
Date of Submission: Oct 29, 2022
Date of Peer Review: Dec 01, 2022
Date of Acceptance: Jan 03, 2023
Date of Publishing: Feb 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: Oct 30, 2022
• Manual Googling: Dec 23, 2022
• iThenticate Software: Jan 02, 2023 (4%)
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