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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
Unilateral Carotid Body Tumour: A Case Report
Correspondence Address :
Shakti Sagar,
Junior Resident, Department of Pathology, Jawaharlal Nehru Medical College, Sawangi, Wardha-442005, Maharashtra, India.
E-mail: chiku.shakti@gmail.com
The carotid body, which is located bilaterally on the medial side of the carotid bifurcation, is the largest group of paraganglia in the head and neck. Chemoreceptor cells in the carotid bulb give rise to uncommon tumours known as Carotid Body Tumours (CBTs). The authors describe a case of a CBT in a 40-year-old woman who had a painful, pulsatile, lateral neck enlargement on the right side that had been developing over time. Due to the numerous difficulties and problems brought on by their high vascularity and close proximity to cranial nerves in the neck near the carotid bifurcation, they pose a surgical challenge. Based on the patient’s medical history, the results of clinical and radiological examinations, and the successful surgical removal of the tumour, the diagnosis was suspected. The results of histological analysis supported the diagnosis of a CBT.
Carotid space, Chemodectoma, Paraganglioma, Surgical excision
A 40-year-old female patient with otolaryngology symptoms arrived at the clinic with a right-sided neck swelling that has persisted for 20 years and pain over the swelling for 2-3 months. The swelling over the right side of the neck started gradually, has been progressing, and has reached its current size. The patient also complains of right-sided pain over the swelling that started gradually, is not getting worse, occurs intermittently, is of mild to moderate intensity, and radiates to the right-side of the neck and shoulder. Additionally, the patient experiences brief episodes of dizziness once every 1-2 days, lasting 2-3 seconds.
On physical examination, there is a single ovoid swelling measuring 4x2 cm over the right lateral part of the neck, just below the right side of the angle of the mandible. It extends from the posterior border of the right sternocleidomastoid muscle, 1 cm lateral to the right lateral border of the trachea. Superiorly, it extends from the level of the hyoid to 3 cm above the level of the thyroid prominence inferiorly. The margins are regular with well-defined borders, and the skin over the swelling appears normal. The swelling does not move during swallowing or protrusion of the tongue. Pulsation can be felt over the swelling. This patient has visible and prominent carotid pulsation in the neck, which is caused by the abrupt distention and quick collapse of the carotid arteries, known as “Dancing Carotids” (Table/Fig 1).
No aberrant catecholamine levels were found during the hormonal evaluation. To prevent the onset of a catecholamine crisis, it is important to perform a hormonal check-up to determine if the tumour is secreting catecholamines before considering surgery. It is crucial to establish the diagnosis of paraganglioma and determine if the lesion is secreting catecholamines before proceeding with surgery.
Magnetic Resonance Imaging (MRI) of the neck (plain and contrast) revealed an altered signal intensity lesion at the carotid bifurcation on the right side, measuring 3.6×2.6×2.5 cm. This lesion caused splaying of the external and internal carotid arteries. On T1-weighted images, the lesion appeared isointense compared to muscles, while on T2-weighted images, it appeared hyperintense compared to muscles with flow voids, giving it a salt and pepper appearance. Postcontrast imaging showed intense enhancement (Table/Fig 2).
Furthermore, mild luminal narrowing of the osteoproximal Internal and External Carotid Arteries (ICA and ECA) was observed, along with a well-defined space-occupying lesion in the right carotid space, leading to splaying of the carotid bifurcation. MRI angiography of the neck supported the diagnosis of a CBT.
After completing all necessary investigations and preanaesthetic check-ups, the patient underwent surgery. Bipolar coagulation was used to remove the heavily vascularised tumour. Complete removal was achieved, and a sample was sent for histopathological examination. The mass removed from the right neck was rubbery-dense and flexible, with whitish-red to brown tumour tissue (Table/Fig 3),(Table/Fig 4),(Table/Fig 5).
Histopathological examination revealed nests of round to oval main cells of neuroectodermal origin, surrounded by fine vascular septae forming the tumour’s Zellballen pattern. The tumour cells had homogeneous, round to ovoid, vesicular nuclei, and abundant transparent or granular, eosinophilic cytoplasm. Cellular pleomorphism was minimal, and mitoses were scarce (Table/Fig 6)a,b,(Table/Fig 7)a,b. These histopathological features suggested a CBT.
To confirm the diagnosis, Immunohistochemistry (IHC) staining {Haematoxylin and Eosin (H&E)} for synaptophysin and chromogranin was performed, which showed positive immune staining for both markers (Table/Fig 8),(Table/Fig 9).
The patient’s recovery phase proceeded smoothly, and they were discharged without any neurological abnormalities, except for minor symptoms of hypoesthesia on the right side of the neck. The patient stayed in the hospital for seven days and was released in good clinical condition. The surgical recovery was uncomplicated. After a month, the patient had a follow-up visit at the otolaryngology clinic and expressed satisfaction with the successful surgical resection.
Differentiating between secreting and non secreting tumours is crucial to prevent starting a catecholamine crisis. A hormonal check-up should be done to determine the hormone levels. Prior to using ionic contrast compounds from a previous era for a Computed Tomography (CT) scan, all patients should either undergo alpha blockade or have negative results from a biochemical catecholamine hypersecretion test (1).
The carotid body, the largest collection of paraganglia in the head and neck, is situated in the carotid area. Von Haller published the earliest account of the carotid body in 1743 (2). It is located in the adventitia of the carotid bifurcation and is innervated by the glossopharyngeal and vagus nerves. Normal carotid body sizes range from 2 to 6 mm, but people living at higher altitudes may have larger carotid bodies. Peripheral chemoreceptors, also known as arterial chemoreceptors, are found along the aorta, its major branches, and at the point where the common carotid arteries split (carotid bodies). Activation of peripheral chemoreceptors stimulates medullary centres, leading to sympathoexcitation and hyperventilation (3),(4). These components are also thought to influence the feeling of dyspnoea (5). Deactivating carotid bodies has shown promising outcomes in animal models and is being explored as a potential treatment method (6),(7),(8). Carotid Body Tumours (CBTs) are hypervascular, slow-growing tumours that account for about 0.03% of all neoplasms (9). Rightside tumours are more common (57%) compared to left-side tumours (25%), bilateral tumours (17%), and malignant tumours (10%) [10,11]. Carotid bodies have been shown to be the main structures involved in the reflex ventilatory response to hypoxia.
The traditional method for treating CBTs has been surgical excision. However, radiotherapy is an alternative treatment option that has the potential to slow or stop tumour growth, especially for patients who are unable to undergo surgery due to severe involvement, multiple tumours, or high operating and anaesthetic risks.
In the past, Digital Subtraction Angiography (DSA) was considered the gold standard for diagnosing CBTs. However, with the development of MRI and high-resolution Computed Tomography for Angiography (CTA), DSA is no longer the preferred imaging technique. Nonetheless, preoperative angiography can provide valuable information about the tumour’s vascular architecture and collateral circulation (12).
Ultrasound is frequently the initial imaging modality used in patients referred for unusual neck swelling.
A key hint is the displacement of the ICA and ECA, which should warrant further imaging analysis (13). The parasympathetic paraganglioma precursor was the CBT, which typically has a diameter of 6 cm and develops around or envelops the common carotid artery bifurcation. Tumour tissue ranged in colour from red-pink to brown. When examined grossly, the tumours are often well-defined and may have a pseudocapsule. Although there may be occasional regions of hemorrhage, the sliced surface was normally solid and had a smooth, rubbery feel. Tumour sizes might vary substantially in reality. Histopathologically, it was common to refer to the distinctive growth pattern of CBTs and paragangliomas as a “Zellballen” growth pattern. This term describes a tumour’s well-developed nested or organoid growth pattern, with a stromal component of fragile fibrovascular tissue in between. The majority of the tumour cells are chief cells, which have spherical, hyperchromatic nuclei, scattered chromatin, and copious granular cytoplasm that can range in colour from eosinophil to basophil. There are three different types of CBTs: sporadic, familial, and hyperplastic. Approximately 85% of CBTs are of the sporadic variety, making it the most prevalent kind. According to reports, the onset typically occurs around age 45 years on average. The familial form can occur in 10% to 50% of cases, and in this group, the average age of onset is lower, between the second and fourth decade. Bilateral CBTs are also associated with the familial type, being found in 30-40% of the cases compared to 3-4% of the sporadic type (14).
The hyperplastic type is related to patients with chronic hypoxia, including patients who have Chronic Obstructive Pulmonary Disease (COPD) or cyanotic heart disease. Patients living at a high altitude are also associated with the hyperplastic type (15). Neuroendocrine markers such as chromogranin, synaptophysin, neuron-specific enolase, and CD56 are heavily stained by the main cells. A network of spindle-shaped stromal cells that are positive for the S-100 protein and collectively known as sustentacular cells also supports the tissue. The precise site of the lesion is a key factor in determining the differential diagnosis of head and neck paragangliomas. Possible differential diagnoses for a tumour developing in the jugulotympanic region include middle ear adenoma, meningioma, and schwannoma. The histological characteristics of CBTs are easier to identify, and other neuroendocrine tumours, including pheochromocytoma and neuroendocrine carcinoma, are included in the differential diagnosis. The overall outlook is quite favourable after a full surgical resection. Nevertheless, ongoing monitoring is required, since metastasis and recurrence may occur in the future.
Rare, hypervascular, and slowly growing neuroendocrine tumours are called CBTs. A tentative diagnosis can be formed based on the patient’s medical history, physical examination, and radiography. When imaging, CBTs typically displace the ICA and ECA. Surgical resection is the recommended method of treating CBTs. For these uncommon tumours, a multidisciplinary approach involving professionals from different medical specialties enables accurate preoperative assessment, surgical planning, and safe excision, as demonstrated in the present case.
Authors contribution: SS drafted the case report and provided an overview of patient management, while SS reported on the excised specimen sent for histopathological investigation and provided the appropriate diagnosis. All authors have read and approved the final version of the present manuscript.
DOI: 10.7860/JCDR/2023/66551.18716
Date of Submission: Jul 18, 2023
Date of Peer Review: Aug 17, 2023
Date of Acceptance: Sep 06, 2023
Date of Publishing: Dec 01, 2023
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 19, 2023
• Manual Googling: Aug 22, 2023
• iThenticate Software: Sep 01, 2023 (11%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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