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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
Cytodiagnosis of Spindle Cell Squamous Cell Carcinoma presenting as a Metastatic Lesion to Chest Wall: A Case Report
Correspondence Address :
Dr. Garima Akhilesh Chandrakar,
Junior Resident, Department of Pathology, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha-442005, Maharashtra, India.
E-mail: garimachandrakar27@gmail.com
Spindle cell carcinoma is a rare biphasic tumour composed of squamous cell epithelial and spindle cell mesenchymal components. This variant of squamous cell carcinoma masquerades as sarcoma with a high-risk of recurrence and metastasis. Metastatic lesions to the chest wall of squamous cell carcinoma from a distant primary are rare. The most common sites for metastasis from head and neck cancers are usually seen in the lungs, liver, bone, and brain. In this present case, the patient presented with complaints of an ulcerated mass on the left buccal mucosa with limited mouth opening. Despite wide excision of the mass and postoperative radiation, it resulted in distant metastases to the chest wall after a disease-free survival of four months. The metastasis of the chest wall appearing as red, inflamed, small, multiple, subcutaneous nodules is even rarer. The diagnosis of subcutaneous metastatic nodules of squamous cell carcinoma on Fine Needle Aspiration Cytology (FNAC) appearing in the literature is infrequent. The primary in this case was oral squamous cell carcinoma, which in follow-up after wide local excision of the mass with marginal mandibulectomy, presented as multiple inflamed appearing nodules on the chest wall. The primary site of the tumour showing classical squamous cell carcinoma and its metastatic lesion appearing on morphology as the spindle cell variant of squamous cell carcinoma are also infrequently reported in the literature. Herein, one such unusual case of subcutaneous metastasis on the chest wall cytodiagnosed on FNAC is reported.
Epithelial-mesenchymal transition, Neoplasms, Sarcomatoid
In September 2022, a 45-year-old man attended the Outpatient Department (OPD) of Ear, Nose and Throat (ENT) with complaints of an ulcerated mass on the left buccal mucosa with limited mouth opening for the past three months (Table/Fig 1). The examination revealed a tumour mass of ulceroproliferative type located on the left lower gingivobuccal sulcus measuring 2.1×2×1 cm. Biopsy from the mass lesion showed histomorphology of well-differentiated squamous cell carcinoma. The patient underwent excision of the mass with marginal mandibulectomy.
The final histopathological diagnosis confirmed invasive well-differentiated squamous cell carcinoma showing dermal nests of cells with prominent keratinisation, potentially forming pearl-like structures with mild nuclear pleomorphism and occasional mitotic figures. The pathological staging of the disease at the excision of the mass was pT2N2bM0. The patient underwent an adjuvant CTRT regimen, i.e., radiotherapy with concurrent chemotherapy (cisplatin weekly at 40 mg/m2) as recommended. During the 4th follow-up visit after four months, the patient complained of three red-coloured swellings over the left chest wall and diffuse swelling in the axilla. Clinically, these swellings appeared inflamed and red in colour and were firm to palpate (Table/Fig 2).
The swellings measured 3×2 cm, 3×2 cm, and 2×1 cm, respectively. They were partly fixed to the chest wall and appeared to be located in the subcutaneous plane. The swellings were progressive in character and lacked fluctuation, remaining firm. The patient was advised to undergo FNAC under Ultrasound Sonography (USG) guidance to confirm their nature.
The FNAC was performed following standard steps on the three chest wall nodular swellings. The aspirated material was blood-mixed and smeared. The dry smears were stained with May Grunwald Giemsa (MGG) stain, and wet fixed smears were stained with Papanicolaou and Haematoxylin and Eosin (H&E) stains.
Microscopically, common cytomorphologic features were observed from the three swellings on the left-sided chest wall. The smear showed cell sheets displaying nuclear streaming and spindling, with nuclei exhibiting hyperchromasia and uneven chromatin. Bird’s eye-appearing cell groups made of two to three cells, along with isolated spindle tadpole cells, fibre cells, and fusiform-shaped squamous epithelial cells, were also observed. Rare small cell whorls were noticed, and the background showed cell debris, cells with ink dot nuclei, cytoplasmic plaques, macrophages, a few polymorphs, and crenated red blood cells (Table/Fig 3),(Table/Fig 4).
The cytodiagnosis of chest wall metastasis of spindle cell squamous cell carcinoma with cystic necrosis was performed. One of the three swellings underwent a trucut needle biopsy, revealing the underlying pathology of spindle cell squamous cell carcinoma. FNAC from the diffuse axillary swelling was also conducted; however, the cytological examination of the aspirate revealed adipose tissue. The patient later attended the institutional tumour board for the management of the newly detected chest wall lesions. After a month of follow-up following the chest wall lesion diagnosis, the patient complained of progressive dyspnoea even without physical activity. A chest X-ray was performed, revealing the presence of pleural fluid on the left-side. The cytological examination of the pleural fluid showed an infiltrate of spindle squamous carcinoma cells. Subsequently, the patient underwent two pleurodeses. Postprocedure intercostal chest drain was monitored serially. The chest drain was then removed after seven days, and the patient was discharged to palliative care with no recurrent effusion.
Spindle cell squamous cell carcinoma is an unusual histological variant of squamous cell carcinoma, constituting <1% of cancers occurring in the head and neck region (1). It is considered a cancer of poorly differentiated grade, with a high potential for local recurrence and metastasis (2). The unique histomorphology of spindle cell squamous cell carcinoma involves sarcomatous morphological features where squamous cells take on spindle shapes resembling sarcoma (2). Reports of spindle cell squamous cell carcinoma in the buccal mucosa are infrequent, with metastasis to level IV cervical lymph nodes at the time of diagnosis has also been reported in the literature (3),(4).
However, instances of spindle cell squamous cell carcinoma metastasising to the infraclavicular region affecting the chest wall and axilla are rarely reported in the literature (5). Metastatic chest wall masses from spindle cell squamous cell carcinoma often mimic primary chest wall tumours, making differentiation challenging (5). FNAC is invaluable in distinguishing primary chest wall malignant lesions from metastatic lesions of spindle cell squamous cell carcinoma (4). Common primary tumours of the chest wall are typically malignant round cell tumours or spindle mesenchymal cell tumours, occasionally including osteochondral tumours. The metastasis of primary gingivobuccal squamous cell carcinoma to the chest wall is a rare occurrence, as indicated by published data (5),(6),(7). Reports of cytodiagnosis through FNAC of metastatic spindle cell variants of squamous cell carcinoma in cases with a history of primary oral (buccal) squamous cell carcinoma are rarely found in the literature.
Oral squamous cell carcinoma is one of the common malignancies in the head and neck region, with common metastasis to level IV cervical lymph nodes. However, the presence of a well-differentiated squamous cell carcinoma displaying the morphology of spindle cell squamous cell carcinoma at a metastatic site is unusual. Reports by Dennis J et al., Iqbal MS et al., Lee E-T, Palla B et al., and Bavle RM et al., describe spindle cell squamous cell carcinoma occurrences in the oral cavity and head and neck regions (2),(3),(8),(9),(10). The histomorphology described at the metastatic site by the aforementioned authors was that of spindle cell squamous cell carcinoma. None of these authors reported a change in morphology from the primary site to the metastatic site in well-differentiated oral squamous cell carcinoma to exhibit a spindle cell variant of squamous cell carcinoma.
The presently reported case was unique. The metastasis was of a different histological type than the primary tumour. The primary tumour in this case was a well-differentiated squamous cell carcinoma of the buccal mucosa, while the metastasis was a spindle cell variant of squamous cell carcinoma in the chest wall nodules. Such a morphological change to a spindle cell (sarcomatoid) squamous cell carcinoma suggests aggressive biological behaviour of the tumour. The aggressiveness of the spindle cell variant of squamous cell carcinoma has been described in a few studies (9),(10),(11). There are rare reports in the literature describing squamous cell carcinoma of the buccal mucosa metastasising to the chest wall. One such report was published by Singh JS and Sharma AD (5). Studies by Sharma P et al., and Mohapatra M et al., reported a few cases of cutaneous metastatic lesions diagnosed via FNAC from both known and unknown primaries (6),(7). In most cases diagnosed via FNAC from chest wall cutaneous metastasis, the carcinoma was other than metastasis of oral squamous cell carcinoma. Singh J and Sharma AD reported four cases of metastatic cutaneous lesions on the chest wall of squamous cell carcinoma diagnosed via FNAC (5). The primary of one was in the lung and the primaries in other two cases were unknown. This report describes buccal squamous cell carcinoma showing distant single metastasis presenting as multiple subcutaneous chest wall nodules. The FNAC of chest wall nodules suggested metastatic spindle cell squamous cell carcinoma. The role of FNAC in the diagnosis of metastatic oral squamous cell carcinoma in lymph nodes and other sites is well established (5). Therefore, postoperative cases of oral squamous cell carcinoma suspected of recurrence or metastasis undergo FNAC to confirm or exclude malignant squamous cell pathology.
The clinical presentation of this case, as described in the report, was highly unique. The FNAC in the present case provided the diagnosis of multiple subcutaneous metastatic nodules of the spindle cell variant of squamous cell carcinoma. Reports of the occurrence of multiple metastatic nodules in the chest wall in operated cases of oral squamous cell carcinoma have not been reported in the literature, especially their diagnosis via FNAC. This study depicts the clinicocytopathological features of metastatic lesions as well as highlights the utility of FNAC in diagnosing these lesions. Since spindle squamous cell carcinoma is an extremely aggressive and poorly differentiated variant with a poor prognosis, prompt diagnosis and early treatment are necessary.
DOI: 10.7860/JCDR/2024/71421.19703
Date of Submission: Apr 23, 2024
Date of Peer Review: May 11, 2024
Date of Acceptance: May 21, 2024
Date of Publishing: Aug 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: Apr 24, 2024
• Manual Googling: May 13, 2024
• iThenticate Software: May 20, 2024 (19%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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