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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 Series
Full Version
Clinicopathological features of Adult Granulosa Cell Tumour of Ovary- A Case Series of 14 Cases
Correspondence Address :
Dharmishtha Natvarlal Kapadiya,
277, 8th Cross, Anugraha Satellite Township, Periyakatupallayam-605007, Tamil Nadu, India.
E-mail: dharmishthakapadiya@gmail.com
Adult Granulosa Cell Tumour (AGCT) is the most common sex cord stromal tumour of ovaries. These tumours in comparison with epithelial tumours are of low-grade malignant potential and have low recurrence rate after surgical procedure. In this case series, a retrospective search for ovarian AGCT cases from January 2016 till January 2021 was done. A total of 14 cases were included. Parameters studied in this case series were age, laterality, gross, architectural pattern, call Exner bodies, nuclear grooves, necrosis, mitotic count and tumour staging. After studying all the cases, it was reported that mean age of presentation was 44 years (range 21-64 years), unilateral with right-sided dominance (71.4%), grossly 78.5% of the cases were solid cystic with haemorrhagic area, with mean tumour size of 9 cm, 57.1% of the cases had call Exner bodies, and all the cases showed nuclear groves. Most of the cases, 85.7% presented with low mitotic count of <4/10 High Power Field (HPF). Rare presentation of endometroid carcinoma-endometrium World Health Organisation (WHO) Female Genital Tract (FGT) fifth edition), and mature teratoma of contralateral ovary were observed in one case each. This case series outlines characteristic histomorphological feature, frequent presentation at lower stage, and low mitotic count, these characteristic features act as prognostic marker for recurrence prediction.
Ovarian, Pattern, Prognosis, Stage, Stromal tumour
Ovarian Granulosa Cell Tumour (GCT) comes under group of sex cord stromal tumour and accounts for 1% of all ovarian tumour (1). These tumours constitute two subgroups according to their clinical and histopathological features: Juvenile Granulosa Cell Tumours (JGCT) and AGCT (2). AGCT is the most common sex cord stromal tumour of ovaries. It is frequently seen in perimenopausal age group and clinically present with abdominal symptoms or hyper estrogenic state such as uterine bleeding, endometrial hyperplasia and carcinoma (1). These tumours in comparison with epithelial tumour were of low-grade malignant potential and have low recurrence rate after surgical procedure (3). Surgery is the main line of treatment and lymphadenectomy should be avoided in early stage of presentation. Adjuvant therapy advised in advanced cases, high grade, tumour rupture (4). The prognosis of the AGCT is generally good, overall survival and long-term survival reaching 75% and 90%. In Stage-I tumours, 5 years survival rate is between 92% to 100% (5).
A retrospective review of cases of ovarian AGCT was conducted from January 2016 to January 2021, after obtaining written permission from medical record department. The clinical details such as age, laterality, presenting complaints, surgical history and pathological findings including gross and microscopy of the lesions, were retrieved from Medical Record Department and distribution analysis was done.
During the period of six years from January 2016 to January 2021, 14 patients underwent surgery for AGCT of ovary. These 14 cases were included in this case series.
The mean age of patient was 44 years (Range 21-64), 64.2% of patients were <50 years. Most of the patients presented with post-menopausal bleeding (n=6, 42.8%) followed by abnormal uterine bleeding and abdominal pain in four cases each. One case presented with massive ascites. Ten cases (71.4%) involved the right-sided ovary. Nine cases (64.2%) underwent Total Abdominal Hysterectomy (TAH), and in five cases (35.8%) conservative surgery (salphingo-oophorectomy) was performed. Lymphnode dissection was performed in only two cases (14.3%), both the cases were free of tumour (Table/Fig 1),(Table/Fig 2).
Pathological Findings and Staging
Of 14 cases, 78.5% cases showed solid cystic gross with haemorrhage areas. Mean Tumour diameter was of 9 cm (range 4-22 cm), No pre-operative or peri-operative tumour capsule rupture seen. Histopathological examination showed predominantly mixed architecture pattern such as solid, nesting, insular and trabecular patterns [Table/Fig-1-5]. Microscopically, eight cases (57.1%) showed call exner bodies and all the cases showed nuclear groove (Table/Fig 6). Most of the cases (n=11, 78.6%) did not show any tumour necrosis. Twelve cases (85.7%) showed mitotic figure of <4/10 HPF. Along with AGCT, uterine corpus showed one case of each with Endometroid carcinoma- endometrium grade-1, and endometrial hyperplasia without atypia and in one other case along with AGCT, the contralateral ovary showed mature teratoma of ovary. Level of inhibin was assessed for follow-up and it was found elevated in 14 cases with mean value of 348 pg/ml and in one case CA 125 was elevated (>1000 U/mL) which was associated with massive ascites. International Federation of Gynecology and Obstetrics (FIGO) and American Joint Committee on Cancer (AJCC) prognostic staging was done for all 14 cases 92.8% (N=13) staged as FIGO IA, and one case of FIGO IIIC (elevated CA125, ascites case). Out of 14 cases only one case undergone adjuvant chemotherapy treatment and remaining 13 cases only follow-up was done as the stage was FIGO IA. Follow-up was done (ranging 11-84 months) by clinical examination and ultrasonography of pelvis and abdomen and serum inhibin levels every three months for the first two years and every six months till five years, no recurrence was noted (Table/Fig 3).
The GCT of ovary was first described by Rokitansky in 1855 as depicted in study by Diddle AW (3). It is a rare ovarian tumour accounting for 1% of all ovarian tumours (1). The age of presentation of GCT varies in a wide range from 21-64 years (4). It is frequently seen in peri-menopausal age group and the mean age of presentation in the present case series was 44 years (5),(6). As the clinical presentation varies with age, abdominal pain and estrogenic manifestation such as abnormal uterine bleeding with endometrial hyperplasia was more frequent in reproductive age group and post-menopausal bleeding in older age group (5). Androgenic manifestation was not observed in this cases series. Rarely endometrial carcinoma, can occur with GCT it was observed in one of the cases (4). Elevated tumour markers such as β inhibin of sex cord tumour origin and CA125 in epithelial origin help in diagnosis and prediction recurrence in ovarian tumours. Pre-operative elevated serum CA 125 (5) has been observed in one of the cases which was associated with massive ascites (7). It is predictive marker for recurrence but in this case series there were no recurrence observed. But contrary serum inhibin was elevated in all the present cases (100%) and serum levels were reduced post-surgery so it can be considered as marker for follow-up (8).
GCTs are usually unilateral and are typically solid and cystic with areas of haemorrhage and occasional solid with grey white homogenous cut surface. In this case series all 100% of the cases were of unilateral, with right-sided dominance (71.4%) (9),(10). A 78.5% of cases grossly solid cystic with haemorrhagic cut surface and in 21.3% of cases solid, grey white homogenous areas was observed. Rarely in GCTs preoperative or perioperative tumour capsule rupture occurs but it was not observed in any of the cases (Table/Fig 1). GCTs have wide range of tumour size (4-22 cm), the authors observed the mean tumour size of 9 cm (11).
GCTs are usually diagnosed in early stage due to its evident clinical presentation. Surgery is the main line of treatment in early stage and adjuvant therapy advised in advanced cases; tumour with high-grade histology and with preoperative tumour rupture (9). In the present series, 64.2% of cases underwent total abdominal hysterectomy of which in two cases lymphnode dissection was performed which was negative for metastasis. A 35.8% of cases underwent conservative surgery without lymphnode dissection (4),(12). Stage of the tumour is an independent prognostic factor. In this case series, most of the cases (92.9%) were of Stage-IA (4),(6),(9),(13),(14), one case presented as Stage-IIIC who received adjuvant chemotherapy and recurrence was not observed (7). The findings in this case series highlight the lower stage of presentation and good prognostic characters of the tumour with no recurrence.
GCTs usually have varied architectural pattern and in this case series, on observation showed combination of microfollicular, diffuse sheet, solid nest, and trabecular pattern (4),(15). The call Exner bodies are considered characteristic feature of the tumour, and is reportedly present in 30-60% of these tumours. The call exner bodies were present in 57.1% of cases discussed in this series (5). On the other hand, coffee bean appearance of the nucleus (nuclear fold) was seen in all cases in this case series (11). Histopathological examination further revealed necrosis in very few cases 21.4% which was not associated with high nuclear grade in our study. GCTs have low mitotic index which directs towards low grade tumour, which was observed in this case series with low mitotic count of <4/10 HPF in 85.7% (4),(16). In one case along with AGCT of the ovary the contralateral ovary showed mature teratoma. GCTs have excellent prognosis, and low recurrence rate (17). In the present series, most of the cases presented without capsule rupture, Stage-I, no necrosis and low mitotic index, on follow-up of all 14 cases does not show recurrence of malignancy (5).
This cases series was prepared because of rare presentation of AGCT with low grade malignant potential but it has good prognosis if diagnosed at earlier stage. The findings restate characteristic estrogenic clinical manifestation, microscopic picture with call Exner bodies and nuclear groves, helps in early diagnosis. Rare necrosis, low mitotic count and lower stage of presentation had predictive and prognostic importance. Serum inhibin levels helped in tumour diagnosis conformation in this case series and the post-surgical values were used for recurrence follow-up. Further studies with a larger cohort and molecular markers will aid in the understanding of the tumour.
DOI: 10.7860/JCDR/2023/62933.17961
Date of Submission: Jan 19, 2023
Date of Peer Review: Feb 16, 2023
Date of Acceptance: Apr 03, 2023
Date of Publishing: May 01, 2023
Author declaration:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. Yes
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