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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
Short Communication
Full Version
Unusual Signet Ring Cell Change in Prostate Specimens obtained after Transurethral Resection: An Immunohistochemical Study
Correspondence Address :
Dr. Indira Gunasekaran,
Assistant Professor, Department of Pathology, PIMS Kalapet, Puducherry-605014, India.
E-mail: drindirag@gmail.com
The term ‘signet ring cell’ is used to describe the histological appearance of a tumour cell characterised by a compressed peripheral nucleus in the shape of a crescent and a large cytoplasmic vacuole (1). Traditionally, such cells have been considered a hallmark of high-grade signet ring cell adenocarcinoma (2). In prostatic tissue, these cells signify either primary or secondary adenocarcinoma. Similar-looking cells were observed in specimens exhibiting only nodular hyperplasia. While searching the literature, very few articles were found that report such non neoplastic signet ring cell changes in Transurethral Resection of the Prostate (TURP) specimens (3),(4),(5). These non malignant cells have been identified as either lymphocytes or stromal cells (4),(5). Alguacil-Garcia regarded this as an artefactual, degenerative change induced by the TURP procedure (4).
Hence, this study was undertaken to determine the frequency of signet ring cell changes in TURP specimens and to evaluate the nature of these cells using appropriate histochemical stains and immunostains.
Adenocarcinoma, Cytoplasmic vacuole, Nodular hyperplasia
A descriptive and retrospective cross-sectional study was conducted in the Department of Pathology at the Pondicherry Institute of Medical Sciences, Puducherry, India, from October 2014 to February 2015, after obtaining approval from the Institute Ethics Committee (IEC) (RC/14/72). All 34 consecutive cases of TURP, with a minimum of two paraffin blocks to a maximum of ten paraffin blocks, were retrieved from the period of January 2012 to September 2014. Each case had a minimum of 20 prostatic fragments and a maximum of 70 prostatic fragments. Histopathology slides of these cases were reviewed during the period from October 2014 to January 2015 by four pathologists. Immunohistochemistry was performed during the period of February 2015.
Inclusion criteria: TURP cases with a minimum of 20 prostatic fragments were included in the study.
Exclusion criteria: Any case with fewer than 20 prostatic fragments was excluded from the study.
Study Procedure
In all 34 cases, age, clinical details, and other relevant data were recorded from case files. Histopathology slides were blinded and reviewed by four pathologists to specifically detect signet ring cells. The findings of all four members were taken into account. There was no interobserver variation among them; therefore, the Kappa value was not calculated in this study. In the cases where such cells were observed, they were stained using two histochemical stains: Periodic Acid-Schiff with diastase predigestion (PAS-D) and Alcian Blue.
Immunohistochemical (IHC) studies were also performed on the above cases. IHC was conducted on formalin-fixed tissue using antibodies directed against Leukocyte Common Antigen, Dako, Santa Clara, USA (LCA; DAKO) and a cytokeratin cocktail (Pan CK; Clone AE1/AE3, DAKO). Sections were taken on positively charged slides and incubated for two hours at 58°C. Antigen retrieval was performed using Tris Ethylenediamine Tetraacetic Acid buffer (Tris EDTA) at pH 9.0 by the pressure cooker method. The secondary antibody, ‘Anti-mouse/rabbit polydetector horseradish peroxidase technique with 3,3´-Diaminobenzidine Tetrahydrochloride (DAB),’ was used as the chromogen. Histochemical stains and immunostains were performed manually using appropriate controls. Special stains for acid mucin, such as PAS-D and Alcian Blue, were carried out to rule out the possibility of secondary signet ring cell adenocarcinoma arising from other organs. When vacuolated signet ring cells showed intense membranous and cytoplasmic immunoreactivity for Pan CK (clone AE1/AE3), they were considered to be of epithelial origin. Intense membranous immunoreactivity for LCA was considered positive for lymphocytic origin.
Statistical Analysis
The demographic data, clinical details, and histopathological findings of the 34 cases were entered into Microsoft Excel (Microsoft Corp., USA), and percentages were calculated.
Out of the 34 TURP specimens studied, 32 (94.1%) were classified as nodular hyperplasia and two (5.9%) as prostatic adenocarcinoma. Vacuolated cells with clear or pale blue cytoplasm and a peripheral hyperchromatic nucleus, raising suspicion of signet ring cell carcinoma, were detected in three cases (8.8%). After an in-depth examination of each slide in every case, all four pathologists reached a consensus regarding the signet ring cell changes in these three cases. Two of the cases were found in nodular hyperplasia (two out of 32 nodular hyperplasia cases, 6.25%), while one was noted in a prostatic adenocarcinoma case. In both nodular hyperplasia cases, vacuolated cells were observed in aggregates within early stromal nodules (Table/Fig 1), mixed with other chronic inflammatory cells (Table/Fig 2). One case of prostatic adenocarcinoma with a Gleason score of 4+4=8 showed a few signet ring cells adjacent to the tumour (Table/Fig 3).
In all three cases, these cells were negative for PAS-D and Alcian Blue. In immunostains, these cells were positive for LCA in the two cases of nodular hyperplasia, suggesting their lymphoid nature (Table/Fig 4). However, in the case of prostatic adenocarcinoma, these cells were positive for Pan CK and negative for LCA, indicating a carcinomatous nature.
Signet ring cells, characterised by hyperchromatic, peripherally pushed nuclei and vacuolated cytoplasm, have traditionally been considered a hallmark of signet ring cell adenocarcinoma. The vacuole may have a pale basophilic appearance, as it represents cytoplasmic mucin (1),(2). Prostatic tissue exhibiting signet ring cells raises two possibilities: primary prostatic adenocarcinoma and, rarely, metastatic spread from signet ring cell carcinoma of the colon, rectum, stomach, etc. (6),(7). In primary prostatic adenocarcinoma, the occurrence of signet ring cell changes is estimated to be around 2.5% in adenocarcinoma of the prostate (8). Additionally, there is a rare variant known as signet ring type prostatic adenocarcinoma (6),(8). The cells may or may not exhibit cytoplasmic mucin, as indicated by staining with PAS and Alcian Blue (6). These cells are cytokeratin positive and LCA negative. One case from the present study involved prostatic adenocarcinoma with a Gleason score of 4+4=8, which had a few signet ring cells present within the tumour proper. The PSA levels were elevated, and perineural invasion was evident. The cells demonstrated positive cytokeratin staining, while the other stains and the LCA IHC marker were negative, indicating a carcinomatous nature. Metastatic spread from signet ring cell carcinoma originating from other primary sites is another rare possibility. In such cases, appropriate clinical and surgical findings would be expected. The signet ring cells are anticipated to show cytoplasmic PAS/Alcian Blue positive mucin (7).
The present study was initiated after observing an unusual presence of signet ring cells in a case of nodular hyperplasia with normal PSA levels. Consequently, 34 consecutive archived specimens of TURP were reviewed by four pathologists, leading to the identification of three cases that exhibited signet ring cells. One was adenocarcinoma, as mentioned earlier. However, two cases with signet ring cells against a background of nodular hyperplasia was observed. These unusual cells were observed in early stromal nodules, intermingled with chronic inflammatory cells, primarily lymphocytes. The cells showed negative staining with PAS-D and Alcian Blue. Based on a literature search, LCA and cytokeratin immunostaining was performed, which revealed positive staining with LCA, suggesting their lymphoid nature. This finding was also noted by Alguacil-Garcia A (4). Similarly, Coyne JD and Ahmed K observed exaggerated and florid signet ring cell changes in bladder biopsy cases, noted in both stromal and lymphoid cells (9).
In fact, lymphoid cells are known to exhibit such rare morphological changes. A rare variant of non Hodgkin’s lymphoma, referred to as signet ring lymphoma, is recognised, which can be of B-cell or T-cell origin (10). The nature of the cytoplasmic vacuole or inclusion-like material in lymphoma cells is still under debate, as it may represent IgG or IgM forming Russell-body-like globules.
Thus, in the present study, the frequency of artefactual signet ring cell changes found in TURP specimens of nodular hyperplasia was 6.25% (two out of 32 nodular hyperplasia cases).
What could explain such morphological changes in prostatic lymphoid cells? A literature search revealed very few articles mentioning such changes. The authors considered various possibilities, such as procedure-related trauma, cautery thermal artefact, fixation artefact, etc. (3),(4),(11). Alguacil-Garcia A mentions that such changes were not noted in any of the seven open prostatectomy specimens author studied. Therefore, author favoured the degenerative nature of the changes related to the TURP procedure. Tprkov K, on “Benign Mimics of Prostatic Adenocarcinoma,” refers to this change in lymphocytes as a result of thermal artefact (12). Present study also favoured the possibility of thermal effects; however, further studies should be conducted to confirm this.
Another query raised was regarding the location of the cells-why are they seen in early stromal nodules? Wang HL and Humphrey PA also found them only in early stromal nodules. They hypothesised that the cells might be myofibroblasts, as they showed vimentin positivity and weak desmin positivity. However, LCA staining was not performed in their study (3). These LCA-positive signet ring cells can be mistaken for signet ring carcinoma during routine reporting, as they possess hyperchromatic nuclei, possibly due to their lymphoid nature. However, primary signet ring cell prostatic adenocarcinoma is extremely rare, with only 20 cases reported from the year 2000 to 2020 after an extensive literature search (13).
Limitation(s)
In present study, only 34 consecutive cases received over a period of 32 months were analysed. A more extensive study with a larger sample size and a broader panel of IHC stains would help in estimating the prevalence and nature of the signet ring cells.
In TURP specimens, signet ring cell changes should be approached with caution. Therefore, histochemical and IHC markers must be employed to determine whether they represent carcinomatous cells or lymphoid cells. Awareness of this distinction may help in avoiding erroneous labelling of signet ring cells as carcinoma. A greater number of studies with larger sample sizes are needed to ascertain the prevalence of this change.
DOI: 10.7860/JCDR/2024/73534.20334
Date of Submission: Jun 13, 2024
Date of Peer Review: Aug 10, 2024
Date of Acceptance: Oct 08, 2024
Date of Publishing: Nov 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• 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: Jun 14, 2024
• Manual Googling: Aug 12, 2024
• iThenticate Software: Oct 07, 2024 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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- Academic Search Complete Database
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- Indian Science Abstracts (ISA)
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