Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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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.
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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

Important Notice

Case report
Year : 2011 | Month : November | Volume : 5 | Issue : 7 | Page : 1464 - 1466 Full Version

Primary B Cell Non-Hodgkin’s Lymphoma Presenting With Multiple Osteolytic Bony Lesions In Skull


Published: November 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1701
Maya Patil, Shilpa Aditya Pratinidhi, Ajay Malik, Rachana Gulati, Avinash R Joshi

1. MD, Assistant Professor, Dept of Paediatrics, Smt Kashibai Navale Medical College, Pune. 2. MD, Associate Professor, Dept of Biochemistry, Smt Kashibai Navale Medical College, Pune. 3. MD, Assoc Professor, Dept of Pathology, Armed Forces Medical College, Pune. 4. DCP, Assistant Lecturer, Dept of Pathology, Smt Kashibai Navale Medical College, Pune. 5. MD, Professor and Head, Dept of Pathology, Smt Kashibai Navale Medical College, Pune.

Correspondence Address :
Maya Patil, Assistant Professor,
Dept of Paediatrics, Smt Kashibai Navale Medical College,
Pune - 411041, Maharashtra, India.
Phone: 91-20-24106125,9890192458.
E-mail: mayashilpa5@gmail.com

Abstract

Background: Head and neck is a common site of extra-nodal NHL. However primary bony NHL is a rare presentation of an extranodal NHL. We are presenting a rare and a typical case of primary lymphoma of bone in a six year old male child presenting as low back ache, fever and difficulty in walking since two months. He had multiple osteolytic lesions in skull. Vertebral transpedicle biopsy revealed B cell lymphoma with morphologic and immunophenotypic features of immunoblastic type.

Discussion & Conclusion: We discussed NHL with an emphasis on extranodal bony manifestations. Primary bone NHL has a favorable outcome when treated with a combined modality therapy and regular follow up. To the best of our knowledge, this is one of the rare primary NHL of the bone being reported in the Indian literature.

Keywords

NHL, Osteolytic lesion, Transpedicular biopsy, Immunohistochemistry

Introduction
Lymphomas are the third most common group of cancers in children and adolescents (1). Non-Hodgkin’s lymphomas (NHL) represent approximately 60 percent of these and Hodgkin’s lymphoma account for the remainder. NHL are categorised as low, intermediate and high grade on the basis of aggressiveness. NHL only rarely present as a primary osseous lesions (2). Clinical presentation in children is varied and depends upon the histologic subtype, the extent of the disease and primary site of the tumour. Children typically have extranodal disease involving the mediastinum, abdomen, or the head and neck region. Up to 40 percent of these are extra nodal (2),(3),(5),(7). Most primary lymphomas of the bone, are classified as diffuse large B cell lymphomas (DLBCL) (5).

Histopathology diagnosis of NHL is not always easy as in childhood most malignant tumours other than lymphomas are composed of small cells that appear undifferentiated. There is a definitive role of immunohistochemistry in these tumours (7). High grade NHL comprise three histologic subtypes mainly, small non-cleaved, lymphoblastic and the large cell lymphoma (2),(3),(8),(9). DLBCL in children are relatively rare as they represent less than five percent of NHL. In our case, the child presented with bone involvement in the form of bone pains not relieved by rest, a palpable soft tissue mass, and systemic B symptoms but no lymphadenopathy. He was diagnosed as Primary lymphoma of bone (PLB). We are reporting a unique case for its rarity (Primary NHL of bone -diffuse large B cell lymphoma). In the paediatric population, it represents approximately three to nine percent of NHL cases (10).

Case Report

A six year old male child was admitted in our hospital with complaints of difficulty in walking since two months, low back pain for 15 days along with fever. At admission, patient was febrile with a temperature of 38°c, heart rate of 120 per minute, BP 90/66 mmHg and weighed 15 Kg. Scoliosis was noted at T12–L4 level and diffuse tenderness was present at thoraco-lumbar spine. There was no organomegaly or any significant lymphadenopathy. Bladder and bowel control was intact. Other systems were normal including fundus examination. X ray and MRI Spine was done on day 2 of admission which showed lesions suspicious of infective pathology in second lumbar vertebral region. Skull X ray revealed multiple osteolytic punched out lesions (Table/Fig 1). Over the course of next ten days, the patient gradually developed hyperreflexia.

In view of spinal tenderness and lytic lesions in the skull, a bone marrow aspiration and biopsy was done. Bone marrow aspirate and biopsy was reactive in nature. The CT scan report showed multiple lytic lesions in vertebral bodies, bilateral pelvic bones, and upper part of femur with an impression of a leukaemic or metastatic disease. CT guided vertebral transpedicle biopsy was done at L2-L3 region. The biopsy specimen was subjected to a panel of immunohistochemical markers – CD3, CD20, CD45, CD10 and BCL 6. The tumor cells were diffusely positive for CD45, CD20 and CD10 with scattered CD3 positive T cells. Bcl6 was negative (Table/Fig 2) (A to F)].

Based on the morphology and immunochemical features a diagnosis of DLBCL immunoblastic variant arising from follicularcentre cells was offered. Patient was sent to Tata memorial centre for further management.

Discussion

NHL only rarely present as a primary osseous lesions. PLB is defined as a lymphoma that is confined to the bone or bone marrow. It comprises approximately three to seven percent of all extra-nodal NHL and seven percent of Primary bone tumour (1),(2),(3),(4),(5),(6),(7),(8),(9),(10). As primary lymphoma of bone is a highly curable disease, differentiation from other causes of lytic bone lesions such as secondaries from carcinomas and other tumours is important. The child was admitted in the ward with the complaints pertaining to bone involvement. He had difficulty in walking since last two months, low back pain along with fever and diffuse tenderness over the back. All these changes indicate the presence of the disease which was indolent (11). PLB can present in both adult as well as paediatric population but, with different prognosis, thus both are a separate entities. The majority of cases of DLBCL are primary but, it can also arise by transformation of B-CLL /SLL, lymphoplasmacytic lymphoma, follicular lymphoma, MALT lymphoma and lymphamatoid granulamatosus (14). The diagnosis can be made by Fine needleaspiration cytology (FNAC) or biopsy or by examination of bone marrow. Immunohistochemistry helps to make accurate diagnosis. Macroscopically, DLBCL usually forms a distinct tumour mass at extra nodal site. Microscopically, the commonest subtypes of PLB are B cell lymphomas with diffuse mixed cell or diffuse large cell histology. Sheets of large monomorphic lymphoid cells with one or more prominent nucleoli and a distinct rim of cytoplasm are usually noticed in DLBCL. CD 19, CD20, CD22 and surface immunoglobulins as seen in immunophenotyping are present in DLBCL (7). The International prognostic index (IPI) has been shown to be useful a prognostic tool for predicting the behavior of the disease in NHL (13). Elevated serum LDH or higher modified stages are associated with a trend toward poorer overall survival among children with CNS disease as seen by Sandlund et al (14). Molecular profiling of DLBCL by various methods and to varying degrees may help separate DLBCL cases into different prognostic relevant groups and allow them to be treated accordingly (15).

Conclusion

A greater tumour burden at diagnosis adversely influences the treatment outcome of children with NHL and CNS disease at diagnosis, suggesting a need for ongoing improvement in both systemic and CNS-directed therapy. DLBCL should be differentiated from other lymphomas and other malignancies morphologically in most cases. Immunohistochemical stains are of great help with the subtyping of NHL after morphological diagnosis. We also conclude that Transpedicular biopsy is an excellent tool to diagnose Primary lymphoma of bone in difficult cases.

Key Message

Physician dealing with bone, back pain in children should also consider and exclude the possibility of haematological malignancy in those children who are not responding to conventional treatment.

References

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Sandlund JT, Downing JR, Crist WM. Non-Hodgkin’s lymphoma in childhood. New Eng J of Med 1996; 331:1238-43.
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Tong M, Yau TK, Wu WC, Lam JJ, Lee AWM. Primary Non-Hodgkin’s lymphoma of bone: a rare cause of lytic bone lesion. JHK coll Radiol 2004; 7: 24-30.
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Thakur JS, Minhas RS, Mohindroo NK, Sharma DR, Mohindroo S, Thakur A, et al. Primary non-Hodgkin’s lymphoma of the infratemporal fossa: a rare case report. Head & Neck Oncol 2009; I:20.
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De Camargo OP, dos Santos Machado TM, Croci AT, et al. Primary bone lymphoma in 24 patients treated between 1955 and 1999. Clin Orthop 2002; 397:271-80.
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Kitsoulis P, Vlychou M, Papoudou-Bai A. Primary lymphoma of the bone. Anticancer Res 2006; 26(1A):325-37.
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Stokes SH, Walz BJ. Pathological fracture after radiation therapy for primary non-Hodgkin’s malignant lymphoma of bone. Int J Radiation Oncol Biol Phys 1983; 9:1153-59.
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Döll C, Wulff B, Rössler J, Schaper J, Havers W. Primary B cell lymphoma of bone in children. Eur J Paediatr 2001; 160(4):239-42.
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Murphy SB, Fairdough DL, Hutchison RE, Berard CW. Non-Hodgkin’s lymphomas of childhood: An analysis of histology, staging and response to treatment of 338 cases at a single institution. J Clin Oncol 1989; 7:186-93.
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Zhao XF, Young KH, Dale F. Paediatric primary bone lymphoma–Diffuse large B-cell lymphoma. Morphologic and immunohistochemical characteristics of 10 Cases. Am J Clin Pathol 2007; 127:47-54.
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Baar J, Burkes RL, Gospodarowicz M. Primary Non-Hodgkin’s lymphoma of bone. Semin Oncol 1999; 26:270-5.
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Wong KF, Chan JK, Ng CS. Large cell lymphoma with initial presentation in the bone marrow. Hematol Oncol 1992; 10:261-71.
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Pileri SA, Dirnhofer S, Went P, Ascani S, Sabattini E, Marafioti T, et al. Diffuse large B-cell lymphoma: one or more entities? Present controversies and possible tools for its subclassification. Histopathology 2002; 41:482-509.
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Dubey P, Ha CS, Besa PC. Localized primary malignant lymphoma of bone. Int J Radiation Oncol Biol Phys 1997; 37: 1087-93.
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Sandlund JT, Murphy SB, Santana VM, Behm F, Jones D, Berard CW, et al .CNS Involvement in Children with newly diagnosed non- Hodgkin’s lymphoma. J Clin Oncol 2000;18(16): 3018-24.
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Youjun Hu, Yang K, Krause JR. Review Diffuse Large B-cell Lymphoma, Differential Diagnosis and Molecular Stratification. N A J Med Sci 2011; 4 (2):67-76.

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