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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
Sarcomatoid Carcinoma of Prostate with Alveolar Rhabdomyosarcomatous Pattern
Correspondence Address :
Dr. Misra V ProfessorDepartment of Pathology
M.L.N. Medical College,Allahabad - 211 001 (INDIA)
Ph. (0532) – 2256087,Fax : (0532) - 2256274
E-mail : vatsmi@hotmail.com
vatsala.m@rediffmail.com
Sarcomatoid carcinoma (carcinosarcoma) is a rare type of prostatic cancer, composed of an admixture of malignant glandular and spindle cell elements. We report here a case of a 56 year old male who underwent prostatectomy for the symptoms of bladder outlet obstruction.. Histopathology showed small areas of poorly formed glands admixed with large areas of purely alveolar pattern and rossettes. A provisional diagnosis of sarcomatoid carcinoma with alveolar rhabdomyosarcomatous pattern (Gleason’s score 5+4=9/10) was made. These two patterns led to a diagnostic dilemma between primary alveolar rhabdomyosarcoma of prostate, sarcomatoid carcinoma with rhabdomyosarcomatous pattern and mixed tumour of prostate. On immunohistochemistry, a positive staining for cytokeratin and negative staining for desmin, myogenin and myoD-1, led to a diagnosis of sarcomatoid carcinoma with rhabdomyosarcomatous pattern.The case was considered worth documentation, as it describes an alveolar rhabdomyosarcomatous pattern in a sarcomatoid carcinoma of the prostate. The correct diagnosis of such a case is important, as it may affect the treatment and prognosis of the patient.
Sarcomatoid Adenocarcinoma, Prostate, Alveolar Rhabdomyosarcoma
Sarcomatoid carcinoma (carcinosarcoma) is a rare type of prostatic cancer, with approximately only 100 cases reported in literature. Tumours are most commonly composed of an admixture of both malignant glandular and spindle cell elements. These tumours are always associated with high grade prostatic adenocarcinoma that occurred previous to, or simultaneously with the sarcomatoid component(1),(2). Sarcomatoid carcinoma is cytokeratin positive and negative for skeletal muscle markers(3).
Most of the primary rhabdomyosarcomas (RMS) of the prostate occur in the paediatric population(4) There are a very few prostatic rhabdomyosarcomas that have been reported in adults, ranging in age from 17 to 68 years old(5),(6) In younger patients, embryonal subtype is the predominant pattern, although; a single case of alveolar type rhabdomyosarcoma has been reported in an autopsy series from Japan(7). The RMS is positive for skeletal muscle specific markers such as myogenin and myo-D1, but is negative for cytokeratin.
A case showing an alveolar rhabdomyosarcomatous pattern in sarcomatoid carcinoma of prostate in a 56 year old male is documented here to highlight the importance of differentiating it from primary RMS as well as mixed tumour of prostate (carcinoma and sarcoma).
A 56 year old male patient presented with re-emergence of symptoms of bladder outlet obstruction (BOO), following a successful trans-uretheral prostatectomy (TURP), two years back. At that time, histological diagnosis of benign prostatic hyperplasia was made at another centre. The patient was symptom free for a period of two years. Initially, re-emergence of symptoms of BOO was attributed to the hyperplasia of the prostate from the residual nodes retained after TURP. However, digital rectal examination and elevated prostatic spesific antigen (PSA) levels of 23.8ng/ml, alerted the surgeon incharge to an aggressive pathology. Ultrasonography showed hypertrophied middle and lateral lobes projecting into the lumen of the urinary bladder. Per-operatively, the plane of surgical separation could not be identified. So, bits and pieces of prostatic tissue were resected, and the specimen was sent for histopathological examination.
Sections processed showed sheets of neoplastic cells, seperated by fibro - vascular septa. The cells were pleomorphic, hyperchromatic with vesicular nuclei, and prominant nucleoli. A good number of cells with clear cytoplasm (hypernephroid type) were also seen. Two pieces showed spindle cell differentiation, rosette formation and pleomorphic cells with pink cytoplasm that were arranged in an alveolar pattern (Table/Fig 1), (Table/Fig 2), (Table/Fig 3).
Sections processed from the bladder growth showed clear cells arranged in an alveolar pattern. A provisional diagnosis of sarcomatoid adenocarcinoma with rhabdomyosarcomatous pattern (Gleason’s score 5+4=9/10) was made. Immunohistochemistry showed strong cytokeratin positivity (Table/Fig 4)
whereas desmin, myogenin and myo-D1 were negative. This confirmed the provisional diagnosis of sarcomatoid carcinoma with an alveolar rhabdomyosarcomatous pattern, and ruled out the possibility of primary rhabdomyosarcoma and mixed tumour of prostate.
A majority of neoplasias of prostate are not difficult to diagnose, however, sometimes there is problem in differentiation of poorly differentiated adenocarcinoma having a sarcomatoid component, from other tumours having spindle cell morphology. They can be mixed tumour, primary mesenchymal tumour or benign stromal proliferation.
Spindle Cell Lesions of The Adult Prostate
Spindle lesions unique to the prostate
1. Stromal Nodules of Hyperplasia
2. STUMPs (Stromal tumors of uncertain malignant potential) and Stromal Sarcomas
3. Sarcomatoid Carcinoma of the Prostate
4. Sclerosing Adenosis
Spindle lesions not unique to the prostate
(1). Leiomyoma/Leiomyosarcoma
(2). Rhabdomyosarcoma
(3). InflammatoryMyofibroblastic Tumor
(4). Solitary Fibrous Tumor
(5). Gastrointestinal Stromal Tumor
(6). Miscellaneous Lesions-
A. Synovial Sarcoma
B. Osteogenic Sarcoma
C. Malignant Fibrous histiocytoma
D. Angiosarcoma
E. Neurofibroma
F. Malignant Peripheral Nerve Sheath tumor
In sarcomatoid carcinomas, the sarcomatoid component can vary from 5 to 99%; in which, cases having a predominant sarcomatoid component may be mistaken for a primary RMS prostate(1) Since sarcomatoid carcinoma and primary rhabdomyosarcoma have different aetiological profiles, histogenesis, prognosis and therapeutic interventions; it is of paramount importance to differentiate them.
In contrast to the relatively good prognosis for treated rhabdomyosarcoma in children, the prognosis in adults is poor, with most dying of the disease in < 2 years, despite multimodality therapy(4) Patients with sarcomatoid carcinoma also have poor outcomes, with an actual risk of death of 20% within 1 year of diagnosis, and frequent widespread metastases to sites including bone, liver, and lung.
The sarcomatous component in sarcomatoid carcinoma demonstrates malignant features including hypercellularity, enlarged hyperchromatic nuclei, frequent mitoses and occasional necrosis. Bizarre tumour giant cells may be present within the sarcomatoid component. In approximately 10% of sarcomatoid carcinomas, the sarcomatoid component has the maximum mild atypia. In approximately 30% of cases, heterologous patterns of osteosarcoma, chondrosarcoma, or rhabdomyosarcoma are also present(1) In the present case, a rhabdomyosarcomatous pattern was evidenced by the presence of rossettes and a purely alveolar pattern, both of which are not described in literature. These patterns led to a diagnostic dilemma of whether it was a primary alveolar rhabdomyosarcoma of prostate, or a sarcomatoid carcinoma with rhabdomyosarcomatous pattern. However, absence of the muscle specific markers led to a diagnosis of sarcomatoid carcinoma. Sarcomatoid carcinomas are usually positive for cytokeratin and epithelial membrane antigen(3) Expression of cytokeratin by the spindle cell component of sarcomatoid carcinoma suggests a common origin rather than a collision tumour composed of sarcoma and carcinoma(9) Thus, the neoplasm in question was diagnosed as sarcomatoid carcinoma having an alveolar rhabdomayosarcomatous pattern.
The diagnostic importance of recognizing them is important, as the treatment plans are different.Treatment for mesenchymal spindle cell lesions and especially rhabdomyosarcoma, is the intricate and organized blending of surgery, chemotherapy and radiotherapy. At present, patients are categorized according to their risk, which takes into account the location of the tumour and the histological and surgical results. For prostatic adenocarcinoma, there is a combination of treatments, such as surgery followed by radiation, or radiation paired with hormone therapy, which works best. So in adenocarcinomas, hormone therapy is used and conventional chemotherapy is reserved for the cases which are resistant to hormonal treatment. LHRH agonists such as bicalutamide and nilutamide are important hormonal agents used in prostatic carcinoma.
The present case is an adenocarcinoma, but two sections mainly showed spindle cell component (Table/Fig 2). In the rest of the sections, an alveolar pattern with broad septa and small cells attached to these septa with rosette like arrangements (Table/Fig 1) mainly central area and (Table/Fig 3) left upper area) was quite similar to the rhabomyosarcomatous pattern. These may be poorly formed glands, but their appearance was more like that of a rosette, than glands. That’s why a diagnosis of sarcomatoid adenocarcinoma with rhabdomyosarcomatous pattern (not differentiation) was made. The diagnosis was later confirmed by immunohistochemistry. The case was considered to highlight the varible presenting pattern of adenocarcinoma prostate that can be easily misdiagnosed (specially by postgraduates and young, less experienced pathologists), and to stress the role of IHC in resolving such diagnostic problems that could affect the treatment and prognosis of the patient.
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