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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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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.
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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

Important Notice

Case report
Year : 2024 | Month : May | Volume : 18 | Issue : 5 | Page : ED11 - ED13 Full Version

A Rare Case of Granular Cell Tumour of Tongue in a 13-year-old Girl


Published: May 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/70014.19427
Archana Shivamurthy, Archana Muniswamyreddy, Vijaya Basavaraj

1. Assistant Professor, Department of Pathology, Sri Madhusudhan Sai Institue of Medical Sciences and Research, Chikkaballapur, Karnataka, India. 2. Assistant Professor, Department of Pathology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India. 3. Professor, Department of Pathology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India.

Correspondence Address :
Dr. Archana Muniswamyreddy,
No. 21, First Stage, Forth Cross, Brindavan Extension, Mysuru, Karnataka, India.
E-mail: achu05m2425@gmail.com

Abstract

Granular Cell Tumour (GCT) is a rare benign tumour that usually affects adults in the third to sixth decades, with females being more commonly affected. Here, a rare case of GCT occurring in a 13-year-old child is presented. A young girl presented with a painless swelling on the right-side of her tongue. Her past medical history was unremarkable. Upon examination, a firm, well-defined, non pulsatile, non tender lesion measuring 1×0.8 cm was noted, involving the right lateral border of the tongue. The lesion was excised and sent for histopathological examination. Gross examination revealed a 1×0.8×0.6 cm mass with a grey-white cut surface. Microscopy showed hyperplastic stratified squamous epithelium overlaying a submucosal tumour composed of polygonal cells arranged in sheets. The tumour cells had central small round nuclei with abundant granular eosinophilic cytoplasm and intervening skeletal muscle fibres. No necrosis, atypia, or increased mitosis were observed. Immunohistochemistry showed strong nuclear positivity and bright granular cytoplasmic positivity for S-100, confirming the diagnosis of GCT. The patient was followed-up for 14 months after surgery and reported no recurrences. GCTs typically manifest in older individuals, with the highest prevalence in the fifth and sixth decades of life. However, this case deviates from the norm, being noted in a 13-year-old child. This exceptionally unusual presentation should prompt the inclusion of GCT in the differential diagnosis of tongue neoplasms in paediatric patients as well. Periodic follow-up of these patients is recommended to detect malignant transformations and late recurrences at early stages.

Keywords

Abrikossof’s tumour, S-100, Tongue neoplasms

Case Report

A 13-year-old girl presented to the otorhinolaryngology clinic with a swelling on the right-side of her tongue that had been present for two months. It had an insidious onset, was slowly progressive in size, and was painless. Her past medical history was unremarkable. Local examination revealed a solitary swelling measuring 1×0.8 cm involving the right lateral border of the tongue (Table/Fig 1). The swelling was non pulsatile, non tender, firm, with fairly well-defined borders, and the overlying mucosa appeared normal. General physical examination was within normal limits, and there was no other significant personal or family history. A clinical differential diagnosis of neurofibroma, lipoma, schwannoma, and GCT was considered. Based on these findings, a decision was made to excise the lesion. The swelling was excised under general anaesthesia, appropriate sutures were placed, and haemostasis was achieved. The specimen was sent for histopathological examination. On gross examination, the lesion measured 1×0.8×0.6 cm with a grey-white cut section. Microscopy revealed hyperplastic stratified squamous epithelium overlying a submucosal tumour composed of polygonal cells arranged in sheets. Individual tumour cells had central small round nuclei with abundant granular eosinophilic cytoplasm and intervening skeletal muscle fibres (Table/Fig 2). There was no necrosis, atypia, or increased mitosis observed. These features were suggestive of GCT. Immunohistochemical staining with S-100 was performed to confirm the diagnosis. The tumour cells showed strong nuclear positivity and bright granular cytoplasmic positivity for S-100 (Table/Fig 3), thereby confirming the diagnosis of GCT. In the present case, complete healing occurred in one week, and no recurrence was observed after 14 months of follow-up.

Discussion

The GCT is a rare, benign tumour that commonly affects the tongue. With an incidence of approximately 1 in 1,000,000 population per year, it affects adults between the second and sixth decades of life (1),(2). It is often accidentally detected and has a female preponderance. It presents as a small lesion, with a size ranging from 1-3 cm. It is a painless, slow-growing tumour that is often asymptomatic at presentation. The reported prevalence ranges from 0.019-0.03% of all human neoplasms (2),(3),(4). The present case, reports a GCT of the tongue in a 13-year-old girl.

GCT is also known as Abrikossoff’s tumour, named after Russian pathologist Alexei Ivanovich Abrikossoff who described it in 1926 (1),(5). Historically, different terminologies were applied to this lesion, which include myoblastoma, granular cell nerve sheath tumour, and granular cell schwannoma owing to the uncertain histogenesis of this tumour, said to be derived from adult or embryonic muscle cells or Schwann cells (1),(2),(4),(6). In 1948, Fust and Custer were the first to point out its neurologic origin and stated that these tumours arise from Schwann cells. Later, using electron microscopy and histochemical techniques, Fischer and Wechsler provided convincing evidence that the cell of origin is the Schwann cell and suggested that these lesions be called granular cell schwannomas (6).

GCT usually involves adults between the second and sixth decades of life, and its incidence in children is rare. A thorough search of literature to identify published cases of GCT of the tongue in the paediatric age group (<15 years) was done, and the results are tabulated (Table/Fig 4) (5),(7),(8),(9),(10),(11),(12). Females are known to be affected 2-3 times more frequently when compared to men. GCT can affect any part of the body (1),(3),(13). About 45-65% of the GCTs involve the head and neck region, with 70% of these noted in the intraoral region. The tongue is the most common intraoral region affected, followed by the lips, retrocommissural area, buccal mucosa, and hard palate in order of frequency. The tongue, being rich in nerve fibres encased by Schwann cells, can be the cells from which GCTs arise. GCTs can be seen at various other locations like the skin, subcutaneous tissue, central nervous system, trachea, larynx, bladder, uterus, and vulva (2),(6),(14). In the present case, the lesion involved the right lateral border of the tongue.

On intraoral examination, GCTs of the tongue appear as solitary asymptomatic nodules, pink in colour, occasionally being yellowish. They are small lesions and are often less than three cm in size. They involve the subcutaneous or submucosal tissues. A few patients may present with a past history of inflammation or trauma at the involved site. Clinical differential diagnosis include fibroma, lipoma, neurofibroma, and schwannoma (2),(8),(15). On histopathological examination, GCTs are characterised by submucosal proliferation of polygonal cells, arranged in sheets. The abundant granular eosinophilic cytoplasm and small round to oval monotonous nuclei are characteristic features. These histologic features noted in present case helped us consider a diagnosis of GCT and rule out clinical differential diagnoses of lipoma, schwannoma, and neurofibroma.

Approximately 1-2% of benign GCTs can show metastasis. The characteristic features of malignant GCTs are described by Fanburg-Smith. These criteria include spindling of the tumour cells, high nuclear-cytoplasmic ratio, vesicular nuclei with large nucleoli, nuclear pleomorphism, increased mitotic rate (>2/10 hpf), and necrosis. Malignant GCTs show three or more of these features. The common sites for metastasis include the bone, lung, breast, lymph nodes, and peritoneum. The present case didn’t show any features of malignant transformation. Immunohistochemically, these tumours are positive for neuron-specific enolase and S-100. The neurogenic origin is supported by the immunohistochemical localisation of these markers in the tumour cells. Genetically, loss of heterozygosity involving chromosomes 9p and 17p has been described (2),(4),(5),(14).

The histopathological differential diagnoses include histiocytosis, amelanotic melanoma, oral granular cell leiomyoma, Pecoma (perivascular epithelioid cell tumour), xanthoma, alveolar soft part sarcoma, Rosai-Dorfman disease, and primitive non neural GCT (16),(17),(18),(19),(20). Correlation of clinicopathological parameters and immunohistochemical marker expression helps differentiate GCT from the other tumours. The differential diagnosis of oral lesions with cells having granular cytoplasm, their distinguishing features from GCT, and Immunohistochemistry (IHC) findings are tabulated (Table/Fig 5).

As GCTs are non encapsulated and a small risk of recurrence (7%) is associated with positive margins, a complete surgical excision with margin clearance is warranted. Long-term follow-up of these patients is advised as there is a risk of malignant transformation in about 10% and distant metastasis in about 2% of cases. Laser excision surgery has also been used as a treatment of choice in a few cases. The advantages include a reduction in bleeding and postoperative pain. It is also associated with more rapid healing.

Some authors have also stated that the vaporisation effect on remnant tissues could eliminate GCT cells on the surgical bed, thus hypothetically leading to a lower rate of recurrence (3),(5),(21). Lafuente Ibáñez de Mendoza I et al., conducted a multicentric study and a systematic review of oral GCTs in Spain and Brazil (22). A total of 272 cases of oral GCT were studied. Only 12 cases out of 272 were GCTs of the tongue in children <15 years of age. This study proves the rarity of GCTs of the tongue in the paediatric age group. A high index of suspicion, thorough clinical examination backed by histopathological and IHC studies help us arrive at a diagnosis. Excision is the treatment of choice, and periodic follow-up of these patients is recommended to detect malignant transformations and late recurrences at early stages.

Conclusion

GCT is a rare tumour that occurs on the tongue. The clinicopathological features of this lesion are derived from isolated case reports or case series. Categorising GCTs as benign and malignant is further challenging. GCTs typically manifest in older individuals with the highest prevalence in the fifth and sixth decades of life. However, the present case deviates from the norm and was noted in a 13-year-old child. This exceptionally unusual presentation should prompt the inclusion of GCT in the differential diagnosis of tongue neoplasms in paediatric patients as well.

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Viani MV, Corcione L, Di Blasio C, Bologna-Molina R, Vescovi P, Meleti M. A single case report of granular cell tumour of the tongue successfully treated through 445 nm diode laser. Healthcare (Basel). 2020;8(3):267. [crossref][PubMed]
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Lafuente Ibáñez de Mendoza I, López Ortega K, Trierveiler M, Oliveira Alves MG, Dias Almeida J, Gándara Vila P, et al. Oral granular cell tumour: A multicentric study of 56 cases and a systematic review. Oral Dis. 2020;26(3):573-89.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2024/70014.19427

Date of Submission: Feb 08, 2024
Date of Peer Review: Mar 04, 2024
Date of Acceptance: Mar 25, 2024
Date of Publishing: May 01, 2024

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: Feb 09, 2024
• Manual Googling: Mar 19, 2024
• iThenticate Software: Mar 22, 2024 (13%)

ETYMOLOGY: Author Origin

EMENDATIONS: 5

JCDR is now Monthly and more widely Indexed .
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