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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 journals–No manuscripts–No 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
Case report
Full Version
Vascular Invasion of Papillary Thyroid Carcinoma into Neck Veins and Superior Vena Cava: A Case Report
Correspondence Address :
Dr. Gaurav Satish Pawar,
303, Plama Nest, Infront of Beary’s Building, Near K.S. Hegde Medical Academy, Derlakatte, Mangalore, Karnataka, India.
E-mail: DrGauravSPawar@gmail.com
Papillary thyroid cancer is the most common thyroid malignancy in women which spreads through lymphatic. Even though microscopic vascular invasion has been published in the recent past, direct venous extension is rare. This case report is about a rare presentation of a Fine Needle Aspiration Cytology (FNAC) proven papillary thyroid carcinoma in a 45-year-old female patient, who presented with a swelling in the neck. The Contrast Enhanced Computed Tomography (CECT) of the neck showed multiple nodular lesions of both lobes of thyroid extending to the retrosternal region and direct tumour thrombus extension to thyroid veins, External Jugular Vein (EJV), Superior Vena Cava (SVC) and subcutaneous veins of neck with lung metastases.
Thyroid malignancy, Tumour thrombus, Venous extension
A 45-year-old female presented to the Outpatient Department (OPD) of department of surgery with a history of swelling in the neck for one and half years, she had breathlessness and discomfort while swallowing of less than one-week duration. She was a known diabetic for one year and was on medication. Clinical examination revealed a large swelling measuring approximately 20×10 cm, in the thyroid region with more prominence towards left-side. The swelling was moving while deglutition. The surface was smooth with no local rise of temperature and no tenderness. Patients’ vitals were stable. Laboratory investigations for thyroid function tests revealed mild elevated serum Triiodothyronine (T3) and levels (2.71 ng/mL), low Thyroxine (T4) levels (3 ug/dL) and normal Thyroid Stimulating Hormone (TSH) levels (1.68 uIU/mL). Renal function tests (Blood Urea-16.5 mg/dL, Creatinine-0.59 mg/dL, Uric Acid-3.5 mg/dL) were normal. With this background features and clinical diagnosis of multinodular goitre, the patient was advised to undergo Ultrasonography (USG) of neck in the department of radiodiagnosis of our hospital for further evaluation.
The USG neck showed grossly enlarged thyroid gland with multiple heterogenous nodular lesions and significantly increased vascularity of left lobe nodular lesions. Since the lower extension of the gland and appearance of subcutaneous extension of nodular lesions were not very clear on ultrasound, further evaluation was carried out with plain and CECT using GE Revolution Evolution 128-Slice machine with slice thickness of 5 mm and postprocessing 1.25 mm multiplanar reformats.
The CECT revealed enlarged thyroid lobes (left>right) and isthmus with multiple enhancing nodular lesions replacing the parenchyma (Table/Fig 1)a with areas of necrosis and calcifications within. More local extension was noted on left-side than on right-side into carotid sheath, prevertebral and retropharyngeal spaces (Table/Fig 1)b. There was direct tumour thrombus extension into neck veins, which was obvious on left-side superiorly at the level of C2 vertebra and inferiorly at the level of root of aorta. At the level of C2 vertebra, direct extension was noted into the left External Jugular Vein (EJV) and its tributaries with involvement of entire course of the veins (Table/Fig 2). In the retrosternal region, there was extension into distal Internal Jugular Vein (IJV), brachiocephalic vein, SVC, subclavian vein on left-side, left EJV, left superior, middle and inferior thyroid veins (Table/Fig 2). Similar tumour thrombus was also noticed in the multiple subcutaneous neck veins. The involved vessels of the neck were grossly dilated, measuring up to 3 cm in the maximum diameter and showed a tortuous course in the subcutaneous plane of suprasternal notch.
Multiple bilateral lymph nodes of level II and IV were present with maintained normal morphology of size, shape, fatty hilum and absence of necrosis. Multiple, variable-sized, rounded and irregular shaped parenchymal nodular lesions measuring a maximum size of 18 mm were diffusely present in both the lungs (Table/Fig 3). No suspicious lesions of skeletal system and liver were observed at the time of examination. Based on local extension and lung features, the imaging diagnosis was made as malignant thyroid lesion with histological differentials of papillary and follicular thyroid carcinoma.
Fine Needle Aspiration Cytology (FNAC) was performed from left lobe thyroid lesion which showed clusters of highly cellular and follicular cells (Table/Fig 4),(Table/Fig 5). The cytological diagnosis impression was of papillary carcinoma of thyroid (Bethesda cytology category VI malignant lesion) (1). Surgery was not attempted as there was diffuse local extension and the patient was subjected to chemotherapy. Patient was advised to take Tablet Lenavatol 4 mg, Tablet Ultracet, Tablet Glimy M2 2/500 and Tablet Tenglyn 20 mg for one month and advised close monitoring of liver function tests, thyroid profile and blood sugar levels.
In general, papillary thyroid carcinoma has an excellent prognosis with mild biological behaviour, however, factors like age, gender, tumour size, lymphatic metastases, distant metastases, capsular invasion and vascular invasion might worsen the clinical outcome (2). The common presentation of papillary thyroid carcinoma in a locally advanced disease is either lymph nodal metastases and/or symptoms like dysphagia, dyspnoea and dysphonia. Direct invasion to the regional veins is not a common feature in papillary thyroid carcinoma (2-14%) but associated with high mortality (3),(4). Vascular invasion is the presence of tumour cells either within the lymphatic channels or blood vessels (angio-invasion) and is associated with a high frequency of lymph node metastases, distant metastases and recurrence in many other malignancies (2).
The first two cases of papillary thyroid carcinoma associated with vascular tumour thrombosis were reported by Kauffmann and Graham in 1879, one in the jugular vein and another in the thyroid vein. Since then, few studies of thyroid carcinoma with tumour thrombus into the veins have been published (4). There are published reports about vascular recurrence of papillary thyroid carcinoma in the jugular vein (5), tumour thrombus extension to IJV (6), cerebral venous thrombosis and pulmonary embolism (7).
Tumour thrombosis of large veins is observed more frequently in hepatocellular carcinoma and renal cell carcinoma where there is direct extension of tumour thrombus into adjacent draining veins (6). This type of extension in thyroid malignancies was documented in Hurthle cell carcinoma and follicular carcinoma with microscopic invasion into great cervical veins (6),(8). Whereas, papillary thyroid carcinoma has most common documented spread through lymphatics than haematogenous spread. The intravascular extension is even rarer in Papillary Thyroid Carcinoma (PTC), which can vary in extent (8). The intravascular extension starts at thyroid veins where there is intraluminal invasion of tumour cells and deposition of fibrin, which prevents tumour cells invasion of endothelium (9). This intravascular extension has to be differentiated from extravascular extension which is common in anaplastic thyroid carcinoma (6). However, any type of vascular invasion has poor out come with high chances of pulmonary and distant metastases (10).
The lymph nodal metastases in papillary carcinoma may correlate with lymphatic channel invasion whereas angio-invasion may be associated with distant metastases (2). According to studies conducted by Mete O and Asa SL, Gardener RE et al., Nishida T et al., and Chung DJ et al., papillary carcinoma with vascular invasion are more aggressive than those without (3),(11),(12),(13). The study conducted by Cao J et al., in 412 patients, the incidence of tumour multifocality in patients with vascular invasion PTC was slightly higher than in those without vascular invasion and following aggressive therapy regimens they showed decreased distant recurrence-free survival compared to patients, who had no vascular invasion stating that vascular invasion is an independent risk factor for distant recurrence free survival, which necessitates need for postoperative treatment and follow-up (2).
Clinical diagnosis of vascular tumour thrombus is difficult, which is solely dependent on site and extent of tumour thrombus. However, features like presence of dilated neck veins and or unilateral upper limb swelling might indicate extensive involvement of large veins such as subclavian vein or superior vena cava. Preoperative imaging with USG combined with Doppler and/or CECT in arterial and venous phase, has a significant role in its diagnosis (6),(10). The study reported by Al-Jarrah Q et al., showed that USG neck was helpful in identifying the solitary lesion which showed local extension. However, tumour thrombus extension to the ipsilateral jugular vein was identified preoperatively (6). In the present case due to extensive local spread of the lesions of both thyroid lobes, CECT was more helpful in identifying the superior and inferior extension of the thyroid lesions, tumour thrombus extension into the EJV, and to the SVC resulting in multiple varices in the neck region. In addition to these CECT had added advantage of identifying lung metastases which further supported the finding of vascular invasion of the tumour thrombus. Lymph nodal metastases was not a prominent feature in patient in the present case, as none of the lymph nodes met the criteria of pathological lymph nodes on CT/USG.
Intravascular extension of tumour thrombus in papillary carcinoma of thyroid is uncommon and might be associated with serious complications, distant metastases and recurrence. Hence, preoperative diagnosis is important, which might alter treatment plan and management. In addition to USG neck with Doppler, CECT would definitely help in diagnosis of local extension and vascular invasion.
DOI: 10.7860/JCDR/2022/58829.17327
Date of Submission: Jul 05, 2022
Date of Peer Review: Aug 18, 2022
Date of Acceptance: Oct 11, 2022
Date of Publishing: Dec 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 08, 2022
• Manual Googling: Sep 29, 2022
• iThenticate Software: Oct 10, 2022 (5%)
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