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

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



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




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



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.


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 journalsNo manuscriptsNo 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

Important Notice

Case report
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 643 - 644

Mycosis Fungoides: Tumor D´ emblee – A Rare Presentation: A Case Report

CLEMENT R S D’SOUZA, HILDA FERNANDES, SAFEENA AMBER, KIRANA PAILOOR, PREETHI RAI Correspondence Address :
Hilda Fernandes
Dept of Pathology,FMMC,
Mangalore-575002
Email=hilda67@rediffmail.com

Abstract

Mycosis Fungoides (MF) is a condition characterized by infiltration of skin by neoplastic T lymphocytes. The disease has various stages viz. premycotic, patch, plaques, nodules, tumors and erythroderma. ‘Tumor d’emblee’ is a variant of tumor stage that develops from an apparently normal skin without prior patch or plaque stage. We present Case of a 70 year old lady with a reddish nodule over her right leg without prior plaques or itching. Fine Needle Aspiration Cytology, Histopathology and Immunohistochemistry studies were done to diagnose it as mycosis fungoides. Mycosis fungoides is the most common subtype of cutaneous T cell lymphoma. Tumors are the initial manifestation in 10% of patients.

Keywords

Mycosis Fungoides, Tumor d’Emblee

Mycosis Fungoides (MF) is a condition which is characterized by the infiltration of the skin with plaques and nodules which are composed of T- lymphocytes. The disease is extremely variable in its clinical course and presentation. The disease has various stages, viz premycotic, patch, plaques, nodules, tumours and erythroderma. “Tumour d’emblee” is a variant of the tumour stage that develops from apparently normal skin without the prior patch or the plaque stage (1)(2)(3). Tumours are the initial manifestation in approximately 10% of the patients (4).

Case Report

A 70 year old lady presented with a nodule over the extensor aspect of the right leg, which was gradually increasing in size since last three months. There was no history which was suggestive of any preceding skin changes or dermatitis. Her past medical history was unremarkable. There was no history of anorexia, weight loss, fever or night sweats. On examination, the nodule measured 3 centimetres in diameter and it was erythematous with ulceration (Table/Fig 1). There was neither induration nor discolouration in the surrounding skin (Table/Fig 2) . There was no significant lymphadenopathy. Her systemic examination was unremarkable and no organomegaly was noted. Fine needle aspiration which was done from the nodule, revealed singly dispersed, round cells with scanty cytoplasm and an irregular nucleus, which suggested a diagnosis of cutaneous lymphoma. Her chest X-ray, ultrasound of the abdomen, peripheral smears and bone marrow studies were within normal limits. Her histological examination showed a dense infiltrate throughout the dermis and in the subcutis forming nodules (Table/Fig 3). The epidermis showed focal epidermotrophism. The infiltrate showed small to medium sized cells with cerebriform nuclei. Based on the clinical and histological findings, a diagnosis of Cutaneus T Cell Lymphoma (mycosis fungoides – d’emblee type) was made. Immunohistochemistry revealed tumour cells which were positive for the leucocyte common antigen and CD3 (Table/Fig 3) and negative for CD20 and CD30, thus confirming the diagnosis of Cutaneus T Cell Lymphoma. As Merkel cell carcinoma was a histological differentialdiagnosis, the markers for synaptophysin and chromogranin were also done and both were negative. The patient refused chemotherapy and was lost to follow up. However, an enquiry revealed that the patient did not have any systemic symptoms and she died after 4 months due to an unrelated illness. During these four months, the patient was neither hospitalized nor investigated.

Discussion

MF is relatively rare, accounting for 1% of all the Non-Hodgkin’s lymphomas (4). However, it represents the most common type of cutaneous lymphoma. The natural history of MF is one of slow progression, with patches and plaques giving rise over time to nodules that may eventually ulcerate. Histology reveals the predominance of small pleomorphic (cerebriform) cells. MF is often indistinguishable from pseudolymphoma, in that, cerebriform nuclei in the dermal infiltrate and pautrier microabscesses in the epidermis are frequently seen. However, a history of drug intake and the disappearance of the infiltrate on the withdrawal of the drug will help to differentiate from MF. Malignant T cells of the Sezary syndrome have phenotypic and antigenic overlaps with those of MF. If the peripheral blood does not reveal abnormal cells, buffy coat preparation and flow cytometry are helpful to establish the diagnosis of Sezary syndrome. In 1885, Vidal and Brocq described the “tumor d’emblee” variant in which nodules are seen from the outset4 .This presentation is not well characterized and some of these patients may have other forms of T cell malignancies. (1)(5) Nodular MF that has undergone large celltransformation, has to be differentiated from unclassified peripheral T cell lymphoma. . These tumours also present as nodules without the pre -existing plaques or patches of MF. On histology, prominent, nodular or diffuse infiltrates of medium to large pleomorphic T cells and immunoblasts are seen. But epidermotropism is usually absent. Primary cutaneous anaplastic CD 30+ large cell lymphomas clinically present with ulcerated nodules, mostly on the trunk and can resemble nodular MF, but on histology, these does not show epidermotropism and there is a dense infiltrate of large anaplastic T cells with the CD30+ antigen and frequent mitosis. These patients generally have systemic involvement at the time of the diagnosis. As this patient did not have systemic or extracutaneous spread and the absence of large cell transformation at the time of the initial presentation, unspecified, primary, cutaneous T cell lymphomas and primary, cutaneous anaplastic CD30+ large cell lymphomas were not considered as the diagnosis.

The standard treatment for the early lesions includes psoralensin association with UV-A (PUVA), irradiation and interferons or a combination of these three modalities. In the late stages, in addition to PUVA, retinoids, interferons, conventional chemotherapy, extracorporeal photopheresis and radiotherapy have been used (2)(4).

Classical cutaneous phases of mycosis fungoides may frequently overlap or occur simultaneously. The prognosis is directly related to the extent of the disease progression with more advanced lesions like cutaneous nodules and extracutaneous dissemination, thus showing an aggressive course. Since there was no hospitalization at the time of death, the course of the disease in this patient was not documented. If only tumours are present without prior or co-existing patches or plaques, the diagnosis of MF should be questioned. A detailed systemic examination and immunohistochemistry work up to rule out high grade cutaneous pleomorphic lymphoma or other variants of T cell lymphoma has to be carried out.

References

1.
Femiani F, Buaonainto C, Heulfe I. What news are on mycosis fungoides. J Stomatol Invest 2008;2:57-58.
2.
Aghoram R, Thappa DM, Kumari R, Negi V. S, Swaminathan RP, Jayanthi S. Tumor d’emblee responding to methotrexate and prednisolone. Indian J Dermatol Venerol Leprol 2009; 75:199-200.
3.
Sahoo A, Biswas MK. Mycosis fungoides: Tumour D’emblee. Indian J. Dermatol Venerol Leprol. 1995; 61 :369-370.
4.
Hsu MY, Murphy GF. Cutaneous Lymphomas and leukemias. In Elder DE (eds). Lever’s Histopathology of the skin. Lippincott Williams and Wilkins; 2009,936-944
5.
Keehn CA, Belongie IP, Shastik G, Fenske NA, Glass LF. The diagnosis, staging and treatment options for mycosis fungoides. Cancer control 2007;14:102-110.

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