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

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

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"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."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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On Sep 2018

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On Aug 2018

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
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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.
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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 one’s 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
(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.
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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)
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.
On April 2011

Important Notice

Case report
Year : 2011 | Month : October | Volume : 5 | Issue : 5 | Page : 1092 - 1094

Neurilemmoma Masquerading as Tonsillitis: A Case Report


MD Pathology, Assistant Professor, Department of Pathology, SGRDIMS & Research, Amritsar-143001, Punjab, India. MD Pathology, Professor, Department of Pathology, SGRDIMS & Research, Amritsar-143001, Punjab, India. MS (E.N.T), Assistant Professor, Department of Otolaryngology, SGRDIMS & Research, Amritsar-143001, Punjab, India. MS (Anatomy), Assistant Professor, Department of Anatomy, Chintpurni Medical College, Pathankot, Punjab, India.

Correspondence Address :
Monika Lalit
24, Lane 5, Gopal Nagar,
Majitha Road, Amritsar-143001, Punjab, India.


Neurilemmoma, also known as schwannoma, is a benign neoplasm which originates from the Schwann cells which cover the myelinated nerve fibres. The most common site is the tongue while palatal schwannomas are even rarer. A case of schwannoma which was clinically diagnosed as a tonsillar mass (tonsillar hyperplasia) which caused obstructive symptoms in a young male child has been reported here. The patient presented with repeated episodes of sore throat, fever and difficulty in and pain on swallowing, of 6 months duration, along with a recent episode of high grade fever, which subsided with antibiotics.

On local examination, it was observed that there was bilateral hypertrophy of the tonsils with congested pillars and that the right tonsil appeared to be more enlarged in size than theleft one. The right side anterior pillar could not be separately differentiated from the tonsil. The tonsilolingual sulcus on the right side was obliterated and it was assumed that the palatine tonsil was enlarged and intermingled with the lingual tonsil. Bilateral tonsillectomy was perfomed and the tissue was sent for histopathological examination. The right sided mass turned out to be Neurilemmoma.

This case was worth reporting as it highlighted the importance of including schwanomma as an important differential diagnosis whenever a treating physician encountered a tonsillar mass or a mass of unexplained aetiology in the oral cavity, which caused a diagnostic dilemma. A detailed clinical history, physical examination, cytology and radiological assessment helps in differentiating schwanomma in such settings.


Neurilemmoma, Schwannoma, Tonsillar mass

Neurilemmoma, also called as schwannoma or neurilimoma, is a benign neoplasm which originates from the peripheral neural sheath of any myelinated nerve (1). Schwannoma arises from the Schwann cells which cover the myelinated nerve fibres (2). Only 1% of the schwannomas are intraoral in location (3), (4), with the tongue being the commonest site, while palatal schwannomas are even rarer (5). By physical examination, sometimes it is very difficult to differentiate a schwanomma from other reactive and neoplastic swellings; which can sometimes be misleading for a treating physician. Ancient Schwannomas with the longest duration of 18 years in the floor of the mouth and of 20 years in the vestibule of the left maxilla have also been seen (6), (7). A case of schwannoma which was clinically diagnosed as tonsillar hyperplasia, which caused obstructive symptoms in a young male child, has been reported here.

Case Report

A 14 year old male presented to the outpatients department of the Otolaryngology unit of a tertiary care centre with the chief complaint of repeated sore throat for the past 5 years, along with fever once every two months. He also reported difficulty in and pain on swallowing for the past 6 months, with a recent episode of high grade fever, with a swelling on the neck on the right side, which subsided with antibiotics(Table/Fig 1).

On local examination, it was found that there was bilateral hypertrophy of the tonsils, with congested pillars. The right tonsil appeared to be more enlarged in size than the left one and the right sided anterior as well as the posterior pillar could not be appreciated throughout its extent. The vascular markings on it were quiteprominent. On palpation, the right tonsillar mass was found to be firm to soft in consistency, while the left tonsil was found to be soft. The tonsilolingual sulcus on the right side was obliterated and it was assumed that the palatine tonsil was enlarged and intermingled with the lingual tonsil(Table/Fig 2).

On the basis of the history, a number of episodes of sore throat and fever and the positive right jugulodigastric lymph node, a diagnosis of tonsillitis was made and bilateral tonsillectomy was done. Preoperatively, a separate mass in the right tonsillar fossa was noted, which was thought to be the rudimentary right tonsil and it was removed by using a classical dissection method and was sent for histopathological examination(Table/Fig 3).

Grossly, the larger mass which was labelled as the “right side”, was grey, completely encapsulated, 3.5×2.5×2.0 cm in size and was firm in consistency, with the cut surface being greyish white. The smaller second mass in the same container was 1×1 cm in size and soft in consistency. The pieces were processed from both the masses and also from the “left sided tonsil”. The histopathology from the larger mass on the right side revealed a tumour which showed hypo and hypercellular areas with the presence of elongated cells with cytoplasmic processes which were arranged in fascicles, with the presence of verocay bodies in areas of moderate to high cellularity with little stromal matrix and hypocellular areas with a loose meshwork of cells along with microcysts and myxoid changes. Thus, a diagnosis of schwanomma was suggested and imunohistochemical (IHC) studies were advised.

The light microscopic findings from the rest of the masses revealed tonsillar hyperplasia with chronic inflammatory changes. On IHC, the cells demonstrated a characteristic immunoreactivity for S-100. The light microscopic findings from the rest of the masses revealed tonsillar hyperplasia with chronic inflammatory changes. Thus, a final diagnosis of palatine schwanomma was made. It was thus proposed that the presence of schwanomma in the anatomical region led to atrophy of the tonsil of that side and to the various obstructive and other symptoms. Till the last follow up, the child was symptom free and had no other complaints.


Nerve sheath tumours which originate from the peripheral nerves are of two types: neurofibromas and schwannomas. Neurofibromas are benign neoplasms which are composed of neurites, Schwann’s cells, and fibroblasts within a collagenous or myxoid matrix, whereas schwannomas originate from the Schwann cells of the nerve sheath which cover the myelinated nerve fibres (2).

Shwannomas can reach upto considerable sizes, although they usually remain small. They account for only 1% of all the benign tumours in the oropharynx and in the oral cavity (3) with the tongue, palate, cheek mucosa, lip and gingiva being the most frequent locations in the oral cavity (8). They are often seen in the 2nd and 3rd decades of life, and are very rare below 10 years of age (9) , with no gender predilection.

Palatal schwannoma is generally asymptomatic and it usually presents as a slow growing painless nodule. The invasion of the submucosal area leads to pain and discomfort. Dysphagia and dyspnoea are present at times.

Apart from a diagnostic possibility, other ancillary investigations such as fine needle aspiration cytology (FNAC) and a radiological opinion can help to a certain extent. FNAC, though it is tedious in the oral region, can be attempted, though the information yield is often inadequate. Magnetic Resonant Imaging (MRI) can show not only the tumour and its capsule, but also in certain cases, the nerve from which it had developed. On imaging, schwannoma appears to be smooth and well-demarcated. This tumour is isointense to the muscle on the T1-weighted images and homogeneously hyperintense on the T2-weighted images (10). Radiology however has its limitations, as Schwanomma at times, is indistinguishable from other ecapsulated benign tumours on the basis of the imaging findings, and therefore, a definite diagnosis requires a histological examination. The histopathological features are classified into two patterns: densely packed spindle cells with a palisading arrangement (Verocay bodies) as Antoni A type, and a loose hypocellular arrangement with hyalinized blood vessels and no definite architecture as Antoni B type (11). A positive reactivity to the S-100 protein supports the Schwann-cell nature of this tumour on immunohistochemistry (12),(13),(14).

Other differentials which should be kept in mind with a mass in the palatal or in other locations in the oral cavity, include malignant lesions such as squamous cell carcinomas and sarcomas and benign lesions such as salivary gland tumours, leiomyomas, rhabdomyomas, lymphangiomas, hemangiomas, dermoid cysts, lipomas and inflammatory lesions (15). Shah et al reported a rare case of schwannoma with secondary erosion of the zygomatic arch. Here, the tumour may have originated from a branch of the infra orbital nerve and it may have extended into the zygomatic arch and caused bone destruction (16). Verma et al also reported a case which was close to the tip of the tongue (17).

A detailed clinical history, physical examination, cytology and radiological assessment helps in differentiating schwanomma in such settings. Surgical excision or enucleation is the treatment of choice. The prognosis is excellent, as malignant transformation and recurrence are rare after the complete resection.

This case was worth reporting, as it highlighted the importance of including schwanomma as an important differential diagnosis whenever a treating physician encountered a tonsillar mass or a mass of unexplained aetiology in oral cavity and described a schwanomma which arose at a rare site and caused a diagnostic dilemma.


Fawcett KJ, Dahlin DC. Neurilemmoma of bone. Am J Clin Path 1967; 47: 759-66
Benign tumours of peripheral nerves. In: Weiss SW, Goldblum JR (eds). Enzinger and Weiss’s Soft Tissue Tumors (4th ed). St. Louis: Mosby Inc; 2001; 1111-207.
Hatziotis JC, Asprides H. Neurilemoma (schwannoma) of the oral cavity. Oral Surg Oral Med Oral Pathol 1967; 24(4): 510-26.
Das Gupta TK, Brasfield RD, Strong EW, Hajdu SI. Benign solitary schwannomas (neurilemmomas). Cancer 1969; 24: 355–66.
Zachariades N. Schwannoma of the oral cavity: review of the literature and report of a case. J Oral Med 1984; 39: 41–43.
Chen CY, Wang WC, Chen CH, Chen YK,Lin LM. Ancient schwannoma of the mouth floor-A case report and review. Oral Oncology 2006; 42: 281-85.
Martin MD,Anunciato de JL, Fernandes KP, Bussadori SK, Taghloubi Sa, Martins MA, et al. Intra-oral schwannoma: case report and literature review. Indian J Dent Res. 2009; 20(1): 121-25.
Pfeifle R, Baur DA, Paulino A, Helman J. Schwannoma of the tongue: Report of 2 cases. J Oral Maxillofac Surg 2001; 59(7): 802-4.
Harada H, Omura K, Maeda A. A massive pleomorphic adenoma of the submandibular salivary gland which was accompanied by neurilemomas of the neck, which was misdiagnosed as a malignant tumour: report of case. J Oral Maxillofac Surg 2001; 59: 931-35.
Flickinger FW, Lozano RL, Yuh WT, Sachs MA. Neurilemoma of the tongue: MR findings. J Comput Assist Tomogr 1989; 13: 886-88.
Batsakis JG. Tumours of the head and neck. Clinical and pathological considerations. 2nd ed. Williams and Wilkins: Baltimore 1979: 313-33.
Van der Wall I, Snow GB. Benign tumours and tumour-like lesions of the oral cavitiy and the oropharynx. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, eds. Otolaryngology Head and Neck Surgery. 2nd ed. Mosby-Year Book: St. Louis 1993: 1237-47.
Yang SW, Lin CY. Schwannoma of the upper lip: case report and literature review. Am J Otolaryngol. 2003; 24: 351-54.
Kawakami R, Kaneko T, Kadoya M, Matsushita T, Fujinaga Y, Oguchi K, et al. Schwannoma in the sublingual space. Dentomaxillofac Radiol. 2004;33: 259-61.
Nelson W, Chuprevich T, Galbraith DA. Enlarging tongue mass. J Oral Maxillofac Surg 1998; 56: 224.
Shah AA, Latoo S, Ahmad I, Malik AH, Singh AP, Hassan S, et al. Schwannoma which caused the resorption of the zygomatic arch. J Oral Maxillofac Pathol 2011; 15/1: 80-84.
Verma RK, Dhingra S, Gupta K, Panda NK. Lingual schwannoma – A case report. Oral Surgery 2011; 4: 82-85.

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