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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
Ameloblastic Carcinoma: A Rare Case Report
Correspondence Address :
Dr. Sowmya Vimala Nandika,
Postgraduate, Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram-534202, Andhra Pradesh, India.
E-mail: sowmyavimala.nandika@vdc.edu.in
Ameloblastic carcinoma is a rare, aggressive, malignant form of ameloblastoma with a low incidence rate, accounting for 0.3-3.5% of all odontogenic tumours of the jaws and has a poor prognosis. It exhibits a 5:1 mandibular predilection, with the lungs being the most common metastatic site. Clinically, these lesions behave more aggressively than conventional ameloblastomas. The most common sign is an asymptomatic swelling, with less frequent findings of pain, rapid growth, trismus and dysphonia. About 38% of cases may present without typical clinical symptoms or unique clinical presentations. The present case is a rare case report of 40-year-old male patient of ameloblastic carcinoma presenting with a unique clinical manifestation as osteomyelitis. Initially, the patient reported the presence of an unhealed extraction site, followed by gradual swelling with discharge and pain over the past 20 days. After the necessary diagnostic procedures, the case was diagnosed as ameloblastic carcinoma and referred to higher centres for treatment. The lack of typical clinical presentation makes the diagnosis of these cases difficult. To prevent morbidity and mortality associated with these aggressive cases, they must be diagnosed and treated as early as possible.
Ameloblastoma, Odontogenic tumours, Osteomyelitis, Unhealed extraction site
A 40-year-old male patient presented with a chief complaint of pain in the lower left back tooth region for the past 20 days and swelling on the left lower side of the face for one year. Upon inquiry, he reported a history of pain that was insidious, intermittent, dull aching in nature, with moderate intensity and non radiating. The pain was aggravated by eating and relieved by medication. He also experienced yellowish discharge, altered taste sensation, food lodgment and bleeding while brushing. There was no relevant medical history reported. The patient mentioned that he had a lower left back tooth removed three years ago at a local dental clinic. He subsequently noticed a gradual, slow-growing swelling and an unhealed socket at that site. For this, he took analgesics and antibiotics but has not undergone any treatment in the last three years as he was out of the country. Initially, the swelling was mild and slow-growing, but it has now reached its current size, accompanied by numbness on the left-side of the face.
On general examination, all vital signs were normal and no palpable regional lymph nodes were detected. Upon extraoral examination, there was a diffuse swelling evident on the left lower third of the face, measuring approximately 5×4 cm, extending anteroposteriorly about 2 mm away from the corner of the mouth to the tragus of the ear and superoinferiorly from the canthomeatal line to the lower border of the mandible. This swelling caused elevation of the left earlobe and its colour was normal compared to the adjacent skin, with no evident secondary changes. On palpation, the swelling was smooth with a local rise in temperature, hard in consistency, neither tender nor compressible, nor reducible, nor fluctuating, nor pulsatile, nor pinchable, with evident signs of paraesthesia (Table/Fig 1)a,b.
On intraoral examination (Table/Fig 2), an unhealing socket was observed in the region of tooth 38, with granulation tissue present. Upon palpation, necrotic bone was evident, along with buccal wall expansion causing vestibular obliteration from the region of tooth 37 to the ascending ramus, accompanied by pus discharge. Based on these findings, a provisional diagnosis of osteomyelitis of the left posterior mandible was made.
Radiographic examination via Orthopantomogram (OPG) (Table/Fig 3) depicted a localised, unilateral radiolucency extending anteroposteriorly from the mesial root of tooth 37 to the posterior border of the ramus and superoinferiorly from 1 cm below the sigmoid notch to the lower border of the mandible. Inferior displacement of the mandibular nerve was evident.
For further confirmation, a Cone Beam Computed Tomography (CBCT) (Table/Fig 4)a-e was performed, which revealed a unilateral, round to ovoid, ill-defined hypodense area measuring approximately 41×42×28 mm. This area extended from the mesial surface of tooth 37 to the posterior border of the ramus anteroposteriorly and superoinferiorly from 3 mm below the sigmoid notch to 4 mm above the lower border of the mandible. There was thinning of the bone mediolaterally, buccal and lingual cortical bone expansion and evident erosion of the buccal cortical plate towards the ascending ramus. Thinning of the lingual cortical bone distal to tooth 37 was also observed, with involvement of the inferior alveolar nerve canal and mild root resorption of tooth 37. Thinning of the sigmoid notch was also evident. The radiographic diagnosis was unicystic ameloblastoma, with radiographic differential diagnosis of infected residual cyst and Odontogenic Keratocyst (OKC). The case was subjected to histopathological examination.
Surprisingly, the histopathological report of Haematoxylin and Eosin (H&E)-stained soft tissue sections (Table/Fig 5)a-f revealed islands, sheets, nests and cords of highly cellular odontogenic epithelium densely packed in an infiltrative pattern within a fibrous stroma. The peripheral cells of the epithelium exhibited hyperchromatic nuclei with reversal of polarity, along with cytoplasmic vacuolations. The epithelial cells displayed varied morphology, including round, oval, angular and spindle shapes, with features such as nuclear enlargement, cellular and nuclear pleomorphism, nuclear hyperchromatism, an altered nuclear-cytoplasmic ratio and a few mitotic figures. The connective tissue was dense and fibrous, with collagen fibres interspersed with flat to plump fibroblasts. Chronic inflammatory infiltrate was predominantly composed of macrophages, neutrophils and plasma cells. Areas of haemorrhage were evident. A focal area showed non keratinised hyperplastic stratified squamous epithelium with areas of acanthosis, cellular and nuclear pleomorphism. Based on these findings, a definitive diagnosis of ameloblastic carcinoma of the mandible was made and the case was referred to a higher centre.
Various synonyms have been provided for carcinomas derived from ameloblastomas, such as malignant ameloblastoma, metastatic carcinoma and primary intra-alveolar epidermoid carcinoma. There is controversy surrounding the classification and definition of ameloblastic carcinoma since this term was introduced by Elzay RP in 1982 (1). In 1984, Slootweg PJ and Muller H proposed a definition and nomenclature to distinguish ameloblastic carcinoma from malignant ameloblastoma (2).
Ameloblastic carcinoma belongs to the family of malignant epithelial odontogenic tumours, accounting for about 11 cases out of 5,231 total odontogenic tumours of the jaw. In other countries, it is reported to account for approximately 1.6-2.2% of all odontogenic tumours (3),(4). It is classified into primary and secondary types. The primary type arises de novo, whereas the secondary type arises from pre-existing ameloblastoma, which is extremely rare. The exact mechanism for malignant transformation remains unknown due to the limited number of cases. The present case is classified as the primary type, as there is no evidence of a pre-existing ameloblastoma.
In contrast to ameloblastoma, ameloblastic carcinoma exhibits more aggressive clinical behaviour, such as rapid growth, perforation of the cortex and painful swelling. According to past cases reported in the literature (Table/Fig 6) (2),(3),(5),(6),(7),(8),(9),(10),(11),(12),(13),(14),(15),(16),(17), about 17% of cases reported painful swelling involving the mandible (8),(11),(16). Additionally, 17% of cases reported paresthesia (3),(9),(10), while 76% of cases reported aggressive behaviour with indistinct borders and bone destruction (2),(3),(6),(7),(8),(9),(11),(13),(14),(15),(16),(17). Furthermore, 17% of cases reported an abnormal extracted socket (2),(14),(16), which was consistent with the present case. In the present case, an unhealed extracted socket was evident, with the presence of necrotic bone along with pus discharge.
According to Ogane S et al., the diagnosis rate was difficult, accounting for about 39% (3). In the past 10 years, 13 (61.9%) out of 21 cases were diagnosed as benign tumours. On the other hand, 7 cases (33.3%) were diagnosed as malignant tumours.
Histopathologic features of ameloblastic carcinoma include pleomorphism, fission, focal necrosis, perineural invasion and hyperchromasia of the nuclei. In addition to these, Hall et al., reported the absence of a central stellate reticular region and the presence of epithelial cell aggregates, cytosolic plexiform or insular patterns, hyperchromatin, dense cellular arrangement, atypical nucleoli, focal necrosis and neural and vascular invasion, which can make it difficult to distinguish from ameloblastoma (18).
Surgical resection is the first choice for treatment, followed by reconstruction. Postoperative radiation therapy is beneficial in some cases with invasive behaviour and positive margins. In the present case, based on clinical, radiographic and histopathological changes, resection of the mandible, preserving the condyles, followed by reconstruction and later postoperative radiotherapy, can be advised, as the lesion was aggressive. Furthermore, various radiotherapy devices, such as the gamma knife, helical tomotherapy and carbon ion therapy, have been developed. Recent advancements in molecular biological techniques have improved tumour therapy (6).
The survival rate is about five years in 69.1-83.2% of cases, which is relatively high, but it decreases to 0-21.4% in metastatic cases. The recurrence rate is about 20.9-38.4%. As for distant metastases, the lungs are the predominant site, with an incidence of 15.4-22.0% (3). Ameloblastic carcinoma has a higher chance of recurrence or distant metastasis; thus, long-term follow-up is mandatory. Therefore, early-stage diagnosis, close periodic screening for metastasis and adequate treatment are necessary to improve patient prognosis.
Ameloblastic carcinoma is a rare entity with no classic symptoms. It exhibits a range of clinical and radiographic manifestations, varying from benign to malignant. Ameloblastic carcinoma can present with rapid growth, pain, paresthesia, trismus, mobility, ulceration, or severe cortical bone resorption and it can potentially be lethal. In the present case, an abnormal extracted socket was observed along with necrotic bone and evident pus discharge. Therefore, alongside clinical and radiographic investigations, a prompt histopathological investigation is necessary. Early diagnosis and close periodic screening for recurrence and metastasis are essential for a better prognosis.
DOI: 10.7860/JCDR/2024/74279.20323
Date of Submission: Jul 15, 2024
Date of Peer Review: Sep 17, 2024
Date of Acceptance: Oct 08, 2024
Date of Publishing: Nov 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: Jul 16, 2024
• Manual Googling: Sep 19, 2024
• iThenticate Software: Oct 07, 2024 (14%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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