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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
Bone Marrow Metastasis as an Initial Manifestation of Gastric Carcinoma: A Rare Case Report
Correspondence Address :
Dr. Prita Pradhan,
Professor, Department of Pathology, Kalinga Institute of Medical Sciences, KIIT,
University, Campus 5, Patia, Bhubaneswar-751024, Odisha, India.
E-mail: prita.pradhan@kims.ac.in
Gastric adenocarcinomas, despite being a leading contributor of cancer-related mortality, presentation directly with Bone Marrow (BM) infiltration sans prior Gastrointestinal (GI) symptoms holds sparse documentation in existing literature. Though a rare phenomenon, BM studies play a pivotal role in the presentation and management of such cases. This case report describes a 36-year-old female with worsening generalised body pain accompanied by fever. Radiologic evaluation revealed multiple lytic lucencies in the vertebral bodies and pelvic bones. A subsequent BM aspiration yielded suspicious looking cells in clusters and BM biopsy suggestive of metastatic deposits. These findings prompted a workup for unknown primary malignancy. Immunohistochemistry (IHC) on trephine BM biopsy suggested a tumour that is CK7+, CK20-, CDX2-, TTF1-, ER – and CA125-; suggesting upper GI primary. A Positron Emission Tomography-Computed Tomography (PET-CT) and upper GI endoscopy revealed a mass in the proximal part of body of stomach which showed a poorly differentiated adenocarcinoma. Thus, a final diagnosis of gastric carcinoma with bone marrow metastasis was confirmed and the patient was planned for palliative care.
Bone marrow neoplasm, Immunohistochemistry, Stomach neoplasm
A 36-year-old female presented with worsening back painand generalised weakness accompanied by fever, which wasunresponsive to over-the-counter drugs. The patient did not haveany symptoms of abdominal pain, nausea, vomiting, dyspepsia,malena or weight loss. There was no significant past history or familyhistory. On physical examination, pallor was present but there wasno icterus, clubbing, cyanosis, lymphadenopathy, organomegalyor oedema noted. Initial Complete Blood Counts (CBC) evaluationrevealed a Haemoglobin (Hb) of 8.1 gm/dL (Ref:12.0-15.0 gm/dL), a Total Leucocyte Count (TLC) of 19,420 cells/cu.mm (Ref:6-16×103/cu.mm) and a Differential Leucocyte Count (DLC) showingneutrophilic predominance, with an Mean Corpuscular Volume (MCV) of 85.1 fl (Ref:83-101 fl), and a platelet count of 1,32,000/ cu.mm (Ref:1,50,000-4,00,000/cu.mm) The peripheral smear revealed normocytic normochromic anaemia with neutrophilic leucocytosis. Her biochemical investigations revealed raised serum urea (66.2 mg/dL; Ref: 12-42 mg/dL) and serum calcium (12.5 mg/ dL; Ref: 8.6-10.3 mg/dL). The creatinine value was 1.25 mg/dL (Ref: 0.7-1.3 mg/dL) and the Liver Function Tests (LFT) were significant for Alkaline Phosphatase (ALP) of 349 U/L (Ref: 40-129 U/L) and serum albumin was decreased to 2.26 gm/dL (Ref: 3.5-5 gm/dL). The C-Reactive Protein (CRP) was found to be elevated to 283.9 mg/L (Ref: <5 mg/L). On radiology the patient was found to have lytic lucencies in the vertebral bodies and pelvic bones on NonContrast Computed Tomography (NCCT) and Contrast-Enhanced Computed Tomography (CECT) thorax and abdomen (Table/Fig 1). Based on these findings and clinical history possibility of a multiple myeloma was considered.
BM studies and M-band electrophoresis were done where the latter was found to be negative. BM aspiration procedure was difficult yielding scanty yet particulate material (Table/Fig 2). Smears showed clusters of large pleomorphic cells having high N:C ratio with coarse chromatin and moderate to abundant cytoplasm. A diagnosis of metastatic tumour deposit was made. These prompted a thorough search for a possible primary. Tumour markers Carcinoembryonic Antigen (CEA) and CA-125 were found to be 26.9 ng/mL (Ref: 0-5 ng/mL) and 211 U/mL (Ref: 0-35 U/mL), respectively. The BM biopsy confirmed an extensive infiltrate of tumour cells with markedly suppressed haematopoietic elements (Table/Fig 3). There was grade 3 secondary marrow fibrosis (Table/Fig 3). IHC staining panel was positive for Pan CK, CK-7 while negative for CK-20, CDX2, TTF1, ER, CA125 (Table/Fig 4) suggesting a primary in upper GI tract. On follow-up (Table/Fig 5), PET-CT was suggestive of metabolically active eccentric wall thickening in proximal body of stomach along lesser curvature. Upper GI endoscopy also revealed a circumferential mass involving the body of stomach. A biopsy of this mass which revealed a diffusely infiltrating tumour in sheets having large nuclei, coarse chromatin, moderate pleomorphism; few showing prominent nucleoli. The cytoplasm was moderate to abundant. A poorly differentiated adenocarcinoma was confirmed on histopathology. Hence a final diagnosis of diffuse-type gastric adenocarcinoma with bone and bone marrow involvement was rendered. The patient was transferred to oncology for further management. In view of adenocarcinoma with BM involvement, stage 4, she was started on oral capecitabine and admitted for supportive care and chemotherapy. She was started on oral morphine for pain management and was discharged for review after two weeks. She was, however, lost to further follow-up. Written consent was given by the patient for the publication of the case report and the images.
Gastric cancer continues to remain the fourth most common cause of cancer associated mortality worldwide. If metastasis occurs, it is usually to liver, lymph nodes and peritoneum (1). Bone and BM metastasis are exceedingly rare as inaugural presentation (2),(3). Here, authors present a unique case of a young female with gastric malignancy that initially presented with non-GI complaints like severe bone pain and fever which was found to have bone secondaries on BM aspiration and biopsy which eventually revealed to have a primary in the stomach.
What makes this case unique is that, these patients usually have at least one prior GI symptom along with bone pain. Here the patient was young and presented directly without GI symptoms with bone pain and weakness as inaugural symptoms. Such unusual manifestation of a stomach carcinoma is very rarely documented in literature and pose diagnostic dilemmas (4),(5). Here, the evaluation of back pain in a young female resulted in diagnosis of metastatic gastric adenocarcinoma. Most common haematological presentations of such cases are thrombocytopenia, Disseminated Intravascular Coagulation (DIC), Microangiopathic Haemolytic Anaemia (MAHA) and leucoerythroblastic reaction which were indicative of BM involvement in few studies (5),(6),(7). Kusumoto H et al., reported an elevated serum ALP and/or serum Lactate Dehydrogenase (LDH) levels in stomach cancer patients with bone involvement, similar to the present case (8).
As the BM metastasis in GC cases is uncommon, the clinical presentation and ideal management is not understood or established yet and despite chemotherapy, as highlighted by Kusumoto H et al., the survival has been found to be 2-3 months (8). Bone metastasis are more often seen in younger individuals who present with signet ring cells, diffuse-type or poor differentiation. Rapid proliferation with invasion into capillary mucosa in stomach bed is likely speculated as reason for early dissemination. Poorly differentiated histology leads to more aggressive disease compounded by non-portal spread; possibly through vertebral venous plexus. Rapid aggressive proliferation leads to bone destruction along with haematological problems. RANKL, a key player in the osteoclastic cells based resorption of bone, has been found in the gastric cancer cells and is speculated as a likely cause for the same by Tantia P et al., (5). This can lead to confusion with other lesions including fractures, infectious pathologies, degenerative changes and other benign conditions. PET-CT, Magnetic Resonance Imaging (MRI) along with BM studies is essential (5). Also, the chemotherapy administration is often precluded by the suppressed marrow due to infiltration leading to cytopenias (9). Bone involvement entails complex crosstalk with the components of the microenvironment formed by osteoclasts, stromal cells and immune cells along with osteoblasts. The conventional remodelling which occurs with a balance of bone formation and resorption is disrupted. Early onset disease with bone metastasis likely reflect activation of inflammation, suppressed immunity and disrupted coagulation profile necessitating a more customised approach (10).
Unlike the present case Sun W et al., found BM metastasis in gastric carcinoma was not found to be associated with thrombotic microangiopathy (11). Proskuriakova E et al., documented a case of disseminated intravascular coagulation (DIC) in a patient with metastatic gastric adenocarcinoma (12). In this case, the patient was not manifesting any coagulation abnormalities. Similar to the present case they also show signet ring cells, highlighting the poor prognosis. Similar to the present case Gosavi A et al., used PETCT as an important investigation for the diagnostic process (13). Similar findings were documented by Yang Z et al., in an elderly lady who presented with generalised pain and have histologically confirmed gastric adenocarcinoma along with widespread bone metastasis (14). Palo A et al., presented a similar case of gastric adenocarcinoma with cytopenias showing BM infiltration wherein multidisciplinary approach helped in clinching the diagnosis (15).
This case throws light upon a rare presentation without GI symptoms, presenting solely with bone pain in a young individual. This emphasises the broad differentials in young patients with lytic bone lesions. Gastric adenocarcinoma may present with BM involvement, which is more common with poorly differentiated and diffuse type. The diagnosis requires multimodality diagnostic methods with integration of imaging findings, BM studies, IHC along with tumour marker correlation. Holding an overall integrated multidisciplinary approach is a crucial step during the management of patients as GI carcinoma may have varied presentation.
DOI: 10.7860/JCDR/2026/81021.24239
Date of Submission: May 30, 2025
Date of Peer Review: Jul 17, 2025
Date of Acceptance: Jun 25, 2026
Online Ahead of Print: Aug 01, 2026
Date of Publishing: Sep 01, 2026
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: Jun 16, 2025
• Manual Googling: Jun 19, 2026
• iThenticate Software: Jun 22, 2026 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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