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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
Should Mucin Histochemistry Be Routinely Done For Carcinoma Cervix
Correspondence Address :
PREETI( M.D. Pathology)
Department of Pathology
Adesh Institute of Medical Sciences and Research, Bathinda(INDIA).
E. mail: dr_priti77@yahoo.com
Aim: The primary objective of our study is to find out prevalence of mucin secretion in cervical carcinoma by mucin histochemistry with special reference to squamous cell carcinoma; diagnosed by Haematoxylin and eosin (H&E) stain and to find the relative incidence of invasive carcinoma on the basis of H&E stain versus mucin stains.
Materials & Methods:Biopsies from 223 cases of carcinoma cervix were subjected to H&E stain and mucin stains i.e. Periodic acid schiff with diastase (DPAS) and Alcian blue at pH 2.5. Interpretation of cases on the basis of H&E staining alone and on the basis of mucin stains was done and the results were compared with each other.
Results: Morphological assessment on the basis of H&E stain showed 201(90.1%) cases of squamous cell carcinoma, out of these 132(59.2%) cases were moderately differentiated and 62(27.8%) cases were poorly differentiated. On application of mucin stains 29(13.0%) cases and 2(0.9%) cases out of 201 cases of squamous cell carcinoma were re-classified as squamous carcinoma with mucin secretion and adenosquamous carcinoma respectively.
Conclusion: Mucin stains should be done routinely on moderately and poorly differentiated squamous cell carcinoma for evidence of mucin secretion which can be missed on H&E stain. Such carcinomas are known to have a more aggressive clinical course associated with a poorer survival when compared to non-mucin secreting squamous cell carcinoma.
Mucin, cervix and carcinoma
INTRODUCTION
Carcinoma of the uterine cervix is an important malignancy and accounts for 20 -25% of all the cancers in women. Approximately 80% of cervical cancer occurs in developing countries (1). Carcinoma cervix has been the important cancer in women in India over the past two decades. Based on data generated by Population Based Cancer Registries (PBCRs) under ICMR in year 2009, changing trends have been seen in the incidence of carcinoma cervix. Since over 70% of the population in India resides in the rural areas, cancer cervix still constitutes the number one cancer in the rural population (2). Squamous cell carcinoma constitutes the majority of all cervical cancers about 70% and primary adenocarcinoma make 10 -20 % (3).
Approximately 25-35% of carcinoma lacking definitive glandular structure have intracellular mucin demonstrable with the use of mucin stains (3),(8) .This lesion has been named as squamous cell carcinoma with mucin secretion or mixed carcinomas as classified by Fox system of classification (9).So, routine application of mucin stains have shown that 20 -30% of cervical carcinomas regarded as squamous cell carcinomas have to be re-classified into squamous cell carcinoma with mucin secretion or mixed adenosquamous carcinomas or adenocarcinoma (3). Such classification has prognostic significance as majority of squamous cell carcinoma cases with mucin secretion are seen in younger patients (3), (9) and it runs an aggressive clinical course and has poorer prognosis as compared to squamous cell carcinoma or adenocarcinoma (3),(4),(9),(10).
The primary objective of our study is to find out prevalence of mucin secretion in cervical carcinoma by mucin histochemistry with special reference to squamous cell carcinoma (diagnosed by H&E stain) and to find the relative incidence of invasive carcinoma on the basis of H&E stain versus mucin stains.
The present study was conducted from January 2006 to December 2009 in the Department of Pathology at Adesh Institute of Medical Sciences and Research, Bathinda. Two hundred and twenty three cases of carcinoma cervix were studied. The tissues were fixed by using 10% formalin and processed through alcohol and chloroform to form paraffin blocks. The tissues were sectioned at 4µm thickness and subsequently stained with H&E, DPAS and Alcian blue. Separate tissue controls were put for DPAS and Alcian blue.
The tumors were classified initially on H&E stained sections according to WHO classification (11). After mucin stain they were re-classified into Fox classification system (9). According to this, tumors with squamous growth pattern, keratin formation, intercellular bridges and no mucin positivity were classified into squamous cell carcinoma. The latter is subdivided into well, moderate and poorly differentiated. Tumors with acinar differentiation or widespread mucin secretion in atleast 75% of the tumor volume were labelled as adenocarcinoma. A Lesions exhibiting both squamous and acinar differentiation with the minor component constituting at least one third of the tumor were considered as adenosquamous carcinoma. Squamous carcinoma exhibiting smaller quantities of mucin (not more than 30% of the tumor volume) were diagnosed as squamous cell carcinoma with mucin secretion.
Data was analyzed by using descriptive statistical analysis like percentages; while univariate statistical method of Fisher’s exact test was used to compare the two methods. p value <0.05 was considered significant at a confidence interval of 95%
The prevalence of the different histopathological types of cervical carcinomas was studied. The tumors were initially classified based upon H&E stain. Squamous cell carcinoma accounted for 201(90.1%) cases. Of these 132(59.2%) cases were moderately differentiated and 62(27.8%) were poorly differentiated (Table/Fig 1)(Fig.1). Adenocarcinoma comprised of 12(5.4%) cases. Seven (3.1%) and 3(1.4%) cases were that of undifferentiated and adenosquamous carcinoma respectively as shown in (Table/Fig 2) .Out of 201 cases diagnosed initially as squamous cell carcinoma with H&E stain, 31(15.4%) cases showed mucin positivity. 16 (12.1%) out of 132 cases of moderately differentiated squamous cell carcinoma and 15 (24.1%) cases of poorly differentiated carcinoma showed mucin positivity (Table/Fig 3),(Table/Fig 4). No case of well differentiated squamous cell carcinoma showed evidence of mucin. All cases of adenocarcinoma and adenosquamous carcinoma were mucin positive as shown in (Table/Fig 5) .The relative incidence of the different histopathological types of cervical carcinoma with H&E stain versus mucin stains (Fox classification). This shows that the number of squamous cell carcinoma decreased from 201 (90.1%) to 170 (76.2%). Out of 31 cases 29 (13.0%) cases were re-classified as squamous cell carcinoma with mucin secretion and two cases were reclassified as adenosquamous carcinoma as shown in (Table/Fig 6).
Worldwide, cervical cancer is the fifth most deadly cancer in women (12).It affects about 16 per 100,000 women per year (13). In developed countries like United States endometrial carcinoma has taken over due to extensive and successful screening by Pap smear (14). Classification of invasive carcinoma given by Buckely and Fox is most widely accepted (15). Benda et al. (4) were the first to demonstrate the importance of mucin secretion in cervical cancer which was confirmed later on (1), (9), (10). Broadly cervical cancer is categorized into squamous cell carcinoma, adenocarcinoma and mixed carcinoma ,however lesion diagnosed as moderately or poorly differentiated squamous cell carcinomas on H&E stain may turn out to be squamous cell carcinoma with mucin secretion, adenosquamous carcinoma or adenocarcinoma after staining with mucin stains depending upon the amount of mucin present. This emphasizes the importance of mucin stain as a routine for diagnosis of cervical carcinoma. A similar variation in tumor is seen in other anatomical sites with epithelial junction, such as anal canal and gastroesophageal junction. Poorly differentiated neoplasms render more complexity by the fact that a single tumor can exhibit features suggesting an origin from multiple cell types. Mucin stain is integral for correct classification of the tumors (17).
In our study assessment of cervical cancer was done on H&E stain alone and then on both H&E and mucin stains. The results showed that majority of cases were that of squamous cell carcinoma i.e. 201(90.1%) out of 223 cases on H&E stain. After application of mucin stains the number of cases of squamous cell carcinoma was reduced to 170(76.2%). Buckley et al. (9) observed that number of squamous cell carcinoma changed from 187(76.0%) to 152(61.7%) and Misra et al. (7) found that the number of squamous cell carcinoma decreased to75 (76.5%) from 90(91.8%) after applying mucin stains. Squamous cell carcinomas with mucin secretion was the second in list, cases accounting to 29(13%). Misra et al. (7) reported 12 (12.3%) cases of squamous cell carcinoma with mucin secretion out of 98 cases originally reported as squamous cell carcinoma. Other authors have reported cases of squamous cell carcinoma with mucin secretion to be 20%, 7.8% and 8.5% respectively (5), (9), (18). In the present study mucin secretion was mostly seen in poorly and moderately differentiated squamous cell carcinoma, which is in accordance with other studies (7), (8). None of the well differentiated squamous cell carcinomas showed mucin positivity. Other studies have also reported a similar observation (4), (9), (18), (20).
In the present study we have been able to identify squamous cell carcinoma with mucin secretion from the subgroup of moderately and poorly differentiated squamous cell carcinomas. Identification of squamous cell carcinoma with mucin secretion should be considered separately from pure squamous cell carcinoma and pure adenocarcinoma because such neoplasms runs an aggressive clinical course and is associated with worse prognosis as compared to their squamous and adeno counterparts (4), (9), (10). Furthermore these tumors occur with increased frequency in women aged less than 40 years and account for poor prognosis in young patients who present with rapidly metastasizing tumors (4),(9).
The survival in mixed tumors was significantly worse than with squamous cell cancers (P= 0.006), 5-year survival rates being 52% and 75% respectively (10). Poorer prognosis of mixed carcinomas is because of high incidence of myometrial invasion, pelvic node metastasis and vascular invasion by tumor (9), (10].
The application of mucin stains should be done routinely on moderately and poorly differentiated squamous cell carcinomas to detect cases of carcinoma with evidence of mucin secretion which can be missed on routine haematoxylin and eosin stain.
Tumors so identified are likely to have a more aggressive clinical course associated with poorer survival when compared to non-mucin-producing squamous carcinomas. This is a cost effective investigation with a great bearing on the ultimate treatment and prognosis of the patient.
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