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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
Original article / research
Full Version
Histopathological Spectrum of Ovarian Tumours in a Tertiary Care Centre in South Kerala, India: A Cross-sectional Study
Correspondence Address :
Dr. PH Anitha Das,
Ambadi Sadan, Vellimon, P.O. Keralapuram, Kollam-691511, Kerala, India.
E-mail: anithadas49@gmail.com
Introduction: Ovarian tumours are among the most common tumours in females, exhibiting diverse histopathological patterns that remain crucial for early diagnosis. Proper classification of ovarian neoplasms, particularly malignant ones, is essential for accurate treatment. Accurately subclassifying ovarian tumours aids in treatments such as targeted therapy.
Aim: To examine the histopathological spectrum of ovarian tumours and to assess the role of histopathology in accurate diagnosis and treatment.
Materials and Methods: A cross-sectional study on the histopathological spectrum of ovarian tumours was conducted in Department of Pathology, Travancore Medical College, Kollam, Kerala, India, over a five-year period (January 2017 to December 2021). The study included 850 ovarian specimens, and the various histopathological patterns were studied according to the World Health Organisation (WHO) classification of ovarian tumours, 5th edition, 2020. These patterns and age distribution were expressed in frequency and percentage.
Results: Out of the 850 ovarian specimens, 140 were neoplastic and 710 were non neoplastic. Abdominal pain was the most common clinical presentation (30%). Among the 140 neoplastic cases, 115 were benign, 20 were malignant, and five were borderline. The majority of cases, including benign, borderline, and malignant tumours, were seen in the age group of 31-40 years (25.71%). Benign tumours were more common than malignant ones in all age groups. Categorising based on histopathological patterns, epithelial tumours were the most common (88 cases, 62.86%). Serous cystadenoma was the most common benign tumour, constituting 36 out of 115 benign cases (25.71%). Borderline serous tumour was the most common borderline epithelial tumour (3 out of total 5 borderline ovarian neoplasms, 2.14%). Serous cystadenocarcinoma was the most common malignant tumour (5 cases, 03.57%).
Conclusion: The wide spectrum of ovarian tumours presents diagnostic challenges. Effective therapeutic management of ovarian malignant tumours continues to be a challenge for clinicians. Histopathological examination remains crucial in diagnosis. Accurate histopathological diagnosis, combined with clinical staging, facilitates prompt and appropriate treatment and timely patient management.
Histopathology, Ovarian lesions, Serous cystadenoma
Ovarian lesions are currently among the most complex problems in gynaecology. The ovaries are complex intrapelvic organs of the female reproductive system and are a common site for both benign and malignant neoplasms in all age groups, from the intrauterine period to the postmenopausal age group (1). The ovary is the third most common site of primary malignancy in the female genital tract, after the cervix and endometrium, accounting for 30% of all cancers of the female genital tract (2). However, the mortality rate exceeds the combined mortality of both endometrium and cervical neoplasms. Many of the malignant ovarian tumours have had variable periods of time to grow and often involve the adjacent organs before any symptoms develop (3). Despite newer imaging techniques and genetic studies, histopathological examination still remains the mainstay in the early diagnosis of ovarian tumours. When combined with clinical staging, it helps in prompt and appropriate treatment and timely management of the patient (4). The main role of the pathologist lies in distinguishing ovarian neoplasms from the wide spectrum of non neoplastic lesions, such as endometriosis, corpus luteal cysts, and polycystic ovarian disease, which frequently form a pelvic mass and are often associated with abnormal hormonal manifestations. The identification of different histopathological types of ovarian tumours is also important, as their proper recognition in time is essential in guiding the therapy (5). Early diagnosis and appropriate treatment will improve the survival of ovarian cancer patients, especially those in the younger age groups (6). The present study was undertaken to study the diverse histomorphological patterns of ovarian tumours and to assess whether these patterns provide beneficial information for their correct diagnosis, thus helping in the timely management of the patients.
A cross-sectional study on the histopathological spectrum of ovarian tumours was conducted in the Department of Pathology, Travancore Medical College in Kollam, Kerala, India, for five-year study period from January 2017 to December 2021. Clearance from the Institutional Review Board and Ethics Committee (IEC No-111/22) was obtained.
Inclusion criteria: All ovarian neoplasms received as cystectomy, oophorectomy, and hysterectomy with unilateral or bilateral adnexa were included in the study.
Exclusion criteria: Non neoplastic ovarian lesions such as follicular cysts, endometriosis, and corpus luteal cysts were excluded from the study.
Relevant information such as age, clinical features, radiological findings, and tumour marker values like CA-125 (Range 0-35 U/mL) were entered into the proforma. Gross specimen findings and microscopic findings, including the histopathological patterns, were also reviewed and recorded in the proforma. Based on these histopathological patterns, neoplastic lesions were classified into benign, borderline, and malignant ovarian neoplasms according to the WHO classification of ovarian tumours, 2020 (7), and staging of the malignant tumours was performed based on AJCC staging (8).
Statistical Analysis
The collected data was entered into a Microsoft Excel worksheet, and frequencies and percentages were calculated.
During the five years of the study, a total of 850 ovary specimens were received. Out of these 850 ovarian specimens, 140 were neoplastic, and 710 were non neoplastic. The majority of patients with neoplastic lesions (30.00%) presented with abdominal pain, while 20.00% presented with discomfort in the pelvic area. Other clinical symptoms included back pain, increased urinary frequency, constipation, and abdominal mass (Table/Fig 1).
Out of the 140 neoplastic cases, 115 (82.00%) were benign tumours, 20 were malignant (14.50%), and five were borderline tumours (3.50%). The majority of the cases, including benign, borderline, and malignant tumours, were seen in the age group of 31-40 (25.71%). The youngest patient was 13 years of age, a case of immature teratoma. The oldest patient was 70 years old, a case of serous cystadenocarcinoma. Benign tumours were more common than malignant ones in all age groups. Ten out of 20 malignant ovarian tumours were seen in the age group of over 50 (50.00%) (Table/Fig 2).
On radiological studies, benign tumours like serous cystadenoma and mucinous cystadenoma showed unilocular and multilocular cysts with no solid areas. Borderline tumours showed cysts with small solid and papillary areas. Malignant tumours such as serous carcinoma, mucinous carcinoma, endometrioid carcinoma, clear cell carcinomas, and dysgerminomas showed predominantly solid and focal cystic areas with variable attenuation and ascites. Germ cell tumours showed cysts with enhancement of solid components.
Upon categorisation based on histopathological patterns, epithelial tumours were the most common (62.86%), [Table/Fig-3,4]. Among the benign epithelial tumours, serous cystadenoma (Table/Fig 5) was the most common, constituting 36 out of 115 benign cases (25.71% of total tumours), followed by mucinous cystadenoma (30 cases, 21.42%) (Table/Fig 6) and Brenner tumour (03.57%). Borderline serous tumour was the most common borderline epithelial tumour (3 out of total 5 borderline ovarian neoplasms, 2.14% of total tumours). Serous cystadenocarcinoma was the most common malignant tumour (5 cases, 03.57% of the total neoplasms), followed closely by Endometrioid carcinoma (3 cases, 02.14%) (Table/Fig 7),(Table/Fig 8). CA-125 levels were elevated in the malignant neoplasms, especially serous carcinomas, with a mean level of 100 U/mL. Mature cystic teratoma (Table/Fig 9),(Table/Fig 10) was the most common germ cell tumour (35 cases, 25% of total tumours), and fibrothecoma was the most common sex cord stromal tumour (8 cases, 5.71%). One case of breast carcinoma metastasis to the ovary was also reported during this study period (Table/Fig 11).
Regarding AJCC staging (8) of the 20 malignant neoplasms in present study, eight were Stage-I tumours where the tumour is limited to one ovary with an intact capsule. Six were Stage-II with the tumour involving both ovaries with extension to fallopian tubes and uterus. Four were Stage-III with pelvic lymph node metastasis. Two cases were Stage-IV with distant metastasis.
The ovary is a female genital organ with complex anatomy and physiology influenced by various hormones. The different cell types in the ovary are capable of giving rise to different groups of tumours (9). Ovarian cancer is one of the leading causes of death in females. In the case of ovarian tumours, benign tumours outnumber malignant tumours. Almost 80% of ovarian neoplasms are benign, and it is also a common site for primary malignancy; metastasis to the ovaries can also occur. Nulliparity, a family history of cancer, and genetic mutations are some of the risk factors associated with the development of ovarian neoplasms (10). The high death rates are due to advanced malignancy at the time of diagnosis in the majority of the cases. Ovarian tumours are thus a group of neoplasms with a diverse spectrum of features. The WHO classified this wide spectrum of ovarian tumours into surface epithelial tumours, sex cord-stromal tumours, giant cell tumours, metastatic, and miscellaneous tumours (11). The present study was conducted to study the frequency of various histological types of ovarian tumours based on the WHO classification (7), the age distribution of these tumours, and the importance of these histological patterns in diagnosis and treatment.
A total of 850 ovarian cases were evaluated. Out of these 850 cases, 140 were neoplastic, and 710 were non neoplastic. Of the 140 neoplastic cases, 115 were benign (82.00%), 20 were malignant (14.50%), and five were borderline tumours (3.50%). The results were similar to the findings by Couto F et al., (80.76% benign tumours, 2.33% borderline tumours, and 16.91% malignant tumours) (12), Pilli GS et al., (76.00% benign tumours, 2.80% borderline tumours, and 21.20% malignant tumours), and Phukan A et al., (75.00% benign tumours, 3.60% borderline tumours, and 21.40% malignant tumours) (13),(14). Abdominal pain was the common clinical presentation 42 (30%) cases, followed by discomfort in the pelvic area 28 (20%) cases and back pain 28 (20%) cases (Table/Fig 1), which was similar to the study conducted by Phukan A et al., where abdominal pain was the common presentation (33 cases, 39.00%) (14). Panchonia A et al., in their study mentioned that many of the malignant ovarian tumours had variable periods of time to grow and often involve the adjacent organs before any symptoms develop (2). The maximum number of ovarian tumours was seen in the age group of 31-40 years, similar to the study conducted by Gupta N et al., where 51 out of a total of 212 cases studied were in the age range of 31-40 years (24.1%) (15). Benign tumours were found to be more common than malignant ones in all age groups (Table/Fig 3). Malignant ovarian tumours were most common in the age group of more than 50 in our study (50.00%, 10 out of 20 cases). This finding was similar to the study conducted by Panchonia A et al., where malignant tumours were more common in the menopausal age group of 46 to 60 years of age, while benign tumours were more common in the reproductive age group of 31 to 45 years of age (2).
Taylor EC et al., in their study discussed that the imaging appearance of ovarian tumours is often non specific; it closely parallels the gross pathologic appearance, and radiologic-pathologic correlation is helpful to aid in a deeper understanding of the subtypes (16). A pelvic ultrasound is the most common radiologic tool used, but Computed Tomography (CT)/ Magnetic Resonance Imaging (MRI) scans are also very useful. Findings that raise concern for malignancy are larger size, growth within the mass, enlarged lymph nodes, and growth into nearby organs. The radiological findings of present study were similar to the study conducted by Taylor EC et al., (16). On analysing the histopathological patterns, epithelial tumours were the most common neoplasms (88 cases, 62.86%), which was similar to the study conducted by Phukan A et al., (56 cases, 66.70%) (14). Serous cystadenoma was the most common benign tumour, constituting 36 out of 115 benign cases (31.30%). Serous cystadenocarcinoma was the commonest malignant tumour (25.00% of the malignant neoplasms). Mature cystic teratoma was the most common germ cell tumour (35 cases, 25% of total tumours). These results were similar to the studies conducted by Gupta N and Bisht D and Bukhari U et al., (17),(18).
In present study, CA-125 levels were found to be elevated in malignant neoplasms, particularly in serous carcinomas, with a mean level of 100 U/mL. However, increased CA-125 levels are not specific to ovarian malignancy; they are also observed in physiological and benign conditions such as endometriosis, pregnancy, ovarian cysts, and inflammatory diseases of the peritoneum. Therefore, a combination of biomarkers such as CA-125 and human epididymis protein 4 (HE4) levels, which are more specific, was thought to be more predictive of malignant ovarian tumours (19). Ovarian carcinomas are one of the leading causes of death in gynecological malignancies, even after surgery and chemotherapy treatments. This therapeutic challenge arises due to the advanced disease stage at the time of presentation, highlighting the need for targeted therapy in ovarian malignancy to improve the clinical outcome in ovarian carcinoma patients (20). In their study, Chakrabarti PR et al., concluded that the proper interpretation of cellular morphology is important for categorisation and correct treatment planning of ovarian cancers (21). Among the 20 malignant neoplasms in present study, eight were AJCC Stage-I tumours, where the tumour is limited to one ovary with an intact capsule. Six were Stage-II tumours with the tumour involving both ovaries with extension to fallopian tubes and uterus. Four were Stage-III tumours with pelvic lymph node metastasis. Two cases were Stage-IV with distant metastasis (8). The prognosis of ovarian cancer depends on the stage of the disease at the time of diagnosis. The median survival of ovarian cancer is approximately 40-50% at 10 years, with stage-related survival for Stage-I between 70-92% compared to less than 6% for Stage-IV (22). The recurrence risk of ovarian malignancies also strongly correlates with the stage at diagnosis. Fewer than 10% of women with Stage-I disease will have a recurrence, whereas 90% of women with Stage-IV disease will have recurrent malignancies (23). Malignant ovarian tumours are known for high mortality, and the prognosis depends on categorisation and staging, which will help the clinician to plan timely management, especially with targeted therapy.
Limitation(s)
The limitation of present study was that it was a cross-sectional, record-based study using data from a prescreened population in a single tertiary care centre. Therefore, the data may not be generalisable to a community setting.
The wide spectrum of ovarian tumours poses diagnostic challenges. Benign tumours were found to be more common than malignant ones in all age groups. Malignant ovarian tumours were most common in the age group of over 50. Surface epithelial tumours were the commonest ovarian tumours, followed by germ cell tumours, as observed in other studies. Effective therapeutic management of ovarian malignant tumours continues to be a challenge for the clinician. Histopathological examination still remains the mainstay in the diagnosis. An accurate histopathological diagnosis, combined with clinical staging, helps in prompt and appropriate treatment and timely management of the patient.
The authors would like to acknowledge faculty members and non teaching staff of the Department of Pathology and faculty members of Department of Gynaecology who helped us by providing the valuable insights. Authors also thank our statistician Mr. Sony Simon who facilitated this study.
DOI: 10.7860/JCDR/2024/67965.19047
Date of Submission: Oct 09, 2023
Date of Peer Review: Nov 07, 2023
Date of Acceptance: Jan 17, 2024
Date of Publishing: Feb 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? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 10, 2023
• Manual Googling: Jan 13, 2024
• iThenticate Software: Jan 15, 2024 (14%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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