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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.
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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.
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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 : 2012 | Month : September | Volume : 6 | Issue : 7 | Page : 1308 - 1310 Full Version

Endometriosis of Sigmoid Colon Mimicking Colon Cancer: A Case Report


Published: September 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2425
K.Chandramouleeswari, S. Anita, B. Shivali

1. Associate Professor of Pathology, Chengelpet, Medical College. Consultant Pathologist, Lister Metropolis, Chennai, India. 2. Chief of Laboratory Services, Lister Metropolis Labortaory, Chennai, India. 3. Junior Pathologist, Lister Metropolis, Chennai, India.

Correspondence Address :
Dr. K.Chandramouleeswari, Associate Professor of Pathology,
Chengelpet Medical College, Consultant Pathologist,
Lister Metropolis, Chennai, India.
Phone: 9444620097
E- mail: chandrkathir@yahoo.com; doctorshivali@gmail.com

Introduction
Endometriosis is defined as the presence of endometrial tissue outside the uterus, which causes a range of symptoms which include infertility, pelvic pain, dysmenorrhoea and constipation. The natural history of endometriosis is uncertain. In addition, its aetiology remains unknown, its clinical presentation is inconsistent, its diagnosis is difficult and its treatment has been poorly standardized. Mechanical, hormonal, immunological, environmental and genetic factors have been implicated in its aetiology, but they have provided only inconclusive explanations. The benign disease causes peritoneal inflammation, fibrosis, adhesions and ovarian cysts, but it displays the features of malignancy such as neo-vascularization, local invasion and distant metastasis. The implantation and the proliferation of the endometrial glands outside the uterus affect 8% to 15% of the women of child bearing ages (3). An intestinal involvement is common, and it is reported in 5% to 15% of the individuals with this disease. The sites which are most often affected are the sigmoid colon and the rectum (4). The incidence of endometriosis with mucosal involvement, as has been illustrated in this case, appears to be rare (2.5%–7%). Whole small bowel involvement is seen less frequently and it is confined to the distal ileum. The caecum (3.6%) and the appendix (3%) are the sites which are the least affected. The differential diagnosis of colonic endometriosis from other diseases of the colon is rather difficult, due to the lack of pathognomonic symptoms and the poor diagnostic yield of colonoscopy and colonic biopsies. In this manuscript, we are presenting the case of a young woman with intestinal endometriosis, in which the initial diagnostic workup suggested colon cancer.

Case Report

Case Presentation
A 35-year-old woman was admitted to the Surgical Department with rectal bleeding and bouts of abdominal pain. 9 months before her admission, the patient had begun to have rectal bleeding, that was related at first, to her menstrual cycles. She also reported episodes of severe lower abdominal pain that were irrelevant to her menses and were accompanied by abdominal distention and constipation, especially during the last 2 months. 3 weeks before her admission, she had started to almost daily have haematochezia and small-caliber stools. The patient had her menarche at the age of 13 years. Thereafter, she had 27-day to 28-day menstrual cycles and menstrual periods which lasted for 6 to 7 days, with normal blood loss. She also reported cramping in her lower abdominal pain, which accompanied her menstruation during the last 3 years. Her physical examination revealed mild lower abdominal tenderness. No masses were palpated. The bowel sounds were slightly Pathology Section K.Chandramouleeswari, S. Anita, B. Shivali increased. Her rectal examination showed bright red blood, but no distinct mass. On her gynaecological examination, her vulva, vagina and cervix appeared to be normal. Her uterus was normal in size and was anteverted. The laboratory work-up revealed mild anaemia (Hb-11.3 gr/dL, Hct- 34.5%, MCV- 91.7 fL) with an increased white blood cell count (12000/μL: Neut: 80.8%, Lymph: 12.1%, Mono: 4.6%) and ESR: 36mm. The coagulation parameters, serum urea, creatinine, electrolytes and liver function tests, all were within the normal range.CEA and CA-19.9 were normal and CA-125 was consistently elevated. Colonoscopy revealed an extensive polypoid lesion of the mucosa at the rectosigmoid junction, which infiltrated the wall of the sigmoid colon and partially occluded the lumen of the sigmoid colon, 19cm from the anal verge, along with erythema, oedema, and ulcerations that resulted in stenosis of the lumen. The endoscope could not be introduced beyond the lesion. A colonoscopic biopsy was done and the histology of the above lesion demonstrated a mild dilatation of the crypts without goblet cell depletion. The lamina propria was oedematous, with dilated capillaries and inflammatory infiltrates of lymphocytes and plasma cells. An abdominal CT scan which was obtained 2 days later, revealed an eccentric wall thickening of the sigmoid colon, which confirmed the filling defect. The clinical impression was that of a mass in the sigmoid colon. The patient was taken up for surgery to relieve the intestinal obstruction. A segment of the sigmoid colon which measured 22 cms long was received in the pathology laboratory. The gross examination revealed a 30 x 20 x 15mm, hard, submucosal polypoidal mass with a wall thickening and the serous membrane was indented by the mass. The cut section appeared to be haemorrhagic (Table/Fig 1). The colonic mucosa was ulcerated.Multiple sections which were studied in the histopathology lab showed the colonic mucosa to have superficial mucosal ulceration (Table/Fig 2). The lamina propria, the muscularis mucosa and the muscularis propria were infiltrated by bland looking glandular elements which were lined by epithelial cells, which had central nuclei and fine chromatin (Table/Fig 3). A dense spindle cell stroma with partial decidualization was seen around the glands. A histopathological diagnosis of endometriosis of the sigmoid colon was made.

Discussion

Intestinal endometriosis may present with rectal bleeding, bowel obstruction and rarely with perforation or malignant transformation (5). The symptoms can be cyclical in about 40% of the patients, they can vary, depending on the site and they can include crampy abdominal pain, distention, diarrhoea, constipation, tenesmus and haematochezia (5),(6). The clinical, radiological and the endoscopic picture may be confused with neoplasms, ischaemic colitis, inflammatory bowel disease, postradiation colitis, diverticular disease and infection. Usually the endoscopic appearance, even if there is mucosal involvement, is not diagnostic. Moreover, the endometriotic deposits can induce secondary mucosal changes which can mimic the findings of other diseases such as inflammatory bowel disease, ischaemic colitis, or even a neoplasm (7). Recently, the CD10 (CALLA) expression in the normal endometrial stroma was found to aid in identifying the areas of endometriosis, especially when there was a paucity of glandular elements and/or when there was a background of chronic, active inflammation on histopathological examination. CT scan or barium enema usually demonstrates an extrinsic bowel compression, a stenosis or a filling defect. MRI seems to be the most sensitive imaging technique which can be used the diagnosis of intestinal endometriosis (8),(9). Yet, the gold standard for its diagnosis is laparoscopy or laparotomy. The treatment options include surgery or hormonal manipulations, depending on the patient’s age and on her desire to maintain fertility and also on the severity and the complications of the disease (10). Recently, the laparoscopic treatment of colorectal endometriosis, even in its advanced stages, has been proven to be feasible and effective in nearly all the patients (11). The medications which are used in the treatment of endometriosis are danazol, high dose progestins and GnRH agonists with almost equivalent efficacies (12). The choice of which to use is based on the side effects and the costs. The frequency of malignant transformation is estimated to be up to 1%, with endometrial carcinoma being the most prevalent pathologic type (40%) (13). There is an association with unopposed oestrogen stimulation and malignant transformation to generally a low-grade neoplasm with an 83% survival rate. The addition of progesterones may prevent this iatrogenic complication. Our patient represented a case of symptomatic gastrointestinal endometriosis with mucosal involvement, without a previous history of pelvic endometriosis. The symptoms of abdominal pain, constipation and haematochezia and the presence of anaemia in combination with the radiologic and the endoscopic findings were suggestive of a neoplasm. On the other hand, the patient’s long history of dysmenorrhoea, her normal levels of CEA and CA19-9, and the absence of neoplastic infiltration in all the biopsy specimens were against the diagnosis of colon cancer. Moreover, this patient had elevated serum levels of CA-125, which has been established as a useful marker for determining the severity of endometriosis (8),(9). The symptoms alone are thus not helpful for the diagnosis of endometriosis. Some reports have described a pre-operative confusion between this disease and cancer according to colonoscopy and CT with barium enema, particularly in patients with mucosal involvement, where only a post-operative histopathology had established the diagnosis of endometriosis. This disease should always be considered in the differential diagnosis for the women of child bearing ages, who present with gastro-intestinal tract symptoms, as the conditions basically involve a benign lesion which requires minimally invasive treatment. In conclusion, intestinal endometriosis is often a diagnostic challenge which mimicks a broad spectrum of diseases and it should be considered in any young woman with symptoms in the lower gastrointestinal tract.

References

1.
Hoang CD, Boettcher AK, Jessurun J, Pambuccian SE, Bullard KM. An unusual rectosigmoid mass: endometrioid adenocarcinoma arising in colonic endometriosis: case report and literature review. American Surgeon .2005;71(8):694-97.
2.
Ferguson CM, Compton CC. Case records of the Massechusetts General Hospital (case 28-1996); a 45-year-old woman with abdominal pain and a polypoid mass in the colon. The New Eng J Med .1996;335:807-12.
3.
Berger DL, Mohammadkhani MS. Case records of the Massechusetts General Hospital (case 13-2000); a 26-year-old woman with bouts of abdominal pain, vomiting, and diarrhea. The New Eng J Med. 200; 342:1272-78.
4.
Jubanyik KJ, Comite F. Extrapelvic endometriosis. Obstetrics and Gynecology Clinics of North America. 1997;24(2):411-40.
5.
Deval B, Rafii A, Dachez MF, Kermanash R, Levardon M. Sigmoid endometriosis in a postmenopausal woman. American Journal of Obstetrics and Gynecology. 2002;187(6):1723–25.
6.
Schwartz JL, Schwartz LB. Gastroenterol Clin North Am.1994 , 23:21-52.
7.
Kane SV, Sable K, Hanauer SB. The menstrual cycle and its effect on inflammatory bowel disease and irritable bowel syndrome: a prevalence study. Am J Gastroenterol. 1998 , 93:1867-72.
8.
Heitkemper MM, Cain KC, Jarrett ME, Burr RL, Hertig V, Bond EF. The symptoms across the menstrual cycle in women with irritable bowel syndrome. Am J Gastroenterol. 2003 , 98:420-30.
9.
Bozdech JM. The endoscopic diagnosis of colonic endometriosis. Gastrointest Endosc. 1992 , 38:568-70.
10.
Crosby DJ. Catamenial pneumothorax. Ariz Med.1973;30.260-61.
11.
Hibbard LT, Schumann WR, Goldstein GE. Thoracic endometriosis: a review and report of two cases. Am J Obstet Gynaecol .1981;140: 227-32.
12.
Agrawal A, Nation J, Ghatage P, Chu P, Ross S, Magliocco A. Malignant chest wall endometriosis: a case report and literature review. J Obstet Gynaecol Can. 2009;31:538-41.
13.
Giangarra C, Gallo G, Newman R, Dorfman H. Endometriosis in the biceps femoris. A case report and review of the literature. J Bone Joint Surg Am. 1987;69:290-92.

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Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: Feb 16, 2012
Date of Peer Review: May 17, 2012
Date of Acceptance: Jul 02, 2012
Date of Publishing: ???, 2012

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