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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)
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.
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Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

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
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:
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.


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.


NHL, Osteolytic lesion, Transpedicular biopsy, Immunohistochemistry

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.


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).


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.


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