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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
Primary Endobronchial Plasmacytoma with Mediastinal Lymph Nodes treated with Radical Radiotherapy: A Case Report with Review of Literature
Correspondence Address :
Rakhi Verma,
Ghaila Road 195, Sant Kabir Nagar, Gaurbheeth, Near Lucknow Lawn, Faizullahganj, Lucknow-226020, Uttar Pradesh, India.
E-mail: rakhiiiverma@gmail.com
Malignant proliferation of plasma cells arising outside the bone marrow or osseous sites is known as extramedullary plasmacytoma. Solitary Extramedullary Plasmacytoma (SEP) is commonly located in upper respiratory tract and sinuses. Involvement of lower respiratory tract is rarely seen in case of SEP. Here, the authors report a case of endobronchial plasmacytoma in a 41-year-old male patient, without any medical risk factors presenting with complaint of blood stained sputum. Radiological imaging confirmed an endobronchial mass in right main bronchus. Histopathology with immunohistochemistry confirmed the diagnosis of plasmacytoma. Work-up for multiple myeloma was negative. Thus, patient was subsequently planned for radical radiotherapy for the primary disease. The patient tolerated the treatment well and was asymptomatic at the time of last follow-up. Solitary Endobronchial Plasmacytoma (SBP) is a rare presentation of SEP. Radical radiotherapy yields excellent local control rates and symptomatic benefit. Close surveillance for development of multiple myeloma is required at periodic intervals.
Malignant proliferation, Right bronchus, Upper respiratory tract
A 41-year-old male patient, without any medical risk factors presented with complaint of blood stained sputum for the last two years. Computed Tomography (CT) of thorax revealed polypoidal endobronchial mass in right main bronchi and enlarged lymphnodes in pre-vascular, pre-tracheal, right tracheo-bronchial and right hilar region, largest at right para-tracheal measuring approximately 2.5×1.8 cm. Positron Emission Tomography-Computed Tomography (PET-CT) showed a large irregular metabolically active heterogeneously enhancing Fluorodeoxyglucose (FDG) avid (SUVmax: 28.47) soft tissue attenuation mass measuring approximately 6×5.6×3 cm (AP×TS×CC) in right hilar and supra-hilar location extending into right main bronchus, multiple FDG avid right para-tracheal, pre-vascular, pre-carinal and right internal mammary lymph nodes, largest measuring 2×1.4 cm (SUVmax: 2.71) and no osteolytic lesions elsewhere.
(Table/Fig 1) Pre-treatment PETCT representing mass in right hilar and supra-hilar region (SUVmax: 28.47) left hand side showing axial section of thorax (upper one is coloured film and lower one is black and white film) and right hand side showing whole body PET-CT black and white film, all images showing mass in hilar and supra-hilar region.
Haemoglobin (14.7 gm/dL), serum calcium (8.6 mg/dL), creatinine (0.7 mg/dL), beta 2 microglobulin (2328 ng/mL) and lactate dehydrogenase (150 U/L) were within normal limits. Serum protein electrophoresis with immunofixation (IgG -1360 mg/dL, IgM- 343 mg/dL, IgA- 117 mg/dL) did not reveal any M band and serum free light chain ratio was 1.1 (Kappa/Lamda). Bone marrow biopsy showed mild hypercellular bone marrow with 1% plasma cells and mild eosinophilia. Above findings points towards solitary plasmacytoma.
Bronchoscopy revealed right upper lobe mass lesion obstructing main bronchus lumen. Histopathology with immunohistochemistry showed plasma cells expressing Cluster of Differentiation (CD) 138, Epithelial Membrane Antigen (EMA), CD79a with lambda expression and limited kappa, cells were negative for CD38, Anaplastic Lymphoma Kinase (ALK), Synaptophysin, and chromogranin confirming the diagnosis of plasmacytoma. Pan Cytokeratin (CK), Leukocyte Common Antigen (LCA), Synaptophysin, chromogranin and kappa light chain were negative. Based on findings of bone marrow biopsy, biopsy of the specimen and IHC final diagnosis of SBP was made.
(Table/Fig 2)a,b: Histopathology findings depicted Photomicrographs of the polyps showing sheets of plasma cells (H&E Original magnification X40) and (Table/Fig 3) depicts Immunohistochemistry findings with photomicrographs showing CD 138 positive plasma cells (Table/Fig 3)a, Lambda positive cells (Table/Fig 3)b and Kappa negative plasma cells (Table/Fig 3)c.
Patient was treated with radical radiotherapy to the primary disease and involved lymph nodes to the dose of 45 Gray in 25 fraction over five weeks at 1.8 Gray per fraction followed by boost to primary disease to a dose of 5.4 Gray in 3 fraction over three days with 3-dimensional conformal radiotherapy on a linear accelerator. Gross primary disease as evident on CT imaging was taken as Gross Tumour Volume Primary (GTV-P) and nodal disease as GTV-N. A margin of 1.5 cm was given to GTV-P to generate primary Clinical Target Volume (CTV-P) and 1 cm margin was given to GTV-N to generate CTV-N. A margin of 1 cm each was given to CTV-P and CTV-N to generate the respective Planning Target Volume (PTV). Haemoptysis subsided after 10 fractions of radiotherapy.
Patient is on regular follow-up every three monthly and monitored for multiple myeloma at every six months interval. PET-CT done at five months showed a large irregular metabolically active heterogeneously enhancing Fluorodeoxyglucose (FDG) avid (SUVmax: 11.7 vs 28.47) soft tissue attenuation mass measuring approximately 5.1×4.4×6 cm in hilar region showing favourable response to therapy.
(Table/Fig 4): Post-treatment PET-CT representing mass in right hilar and supra-hilar region (decrease in SUV uptake from SUVmax: 28.47 to SUVmax: 11.7), left hand side showing axial section of thorax (upper one is coloured film and lower one is black and white film) and right hand side showing whole body PETCT black and white film, all images showing mass.
At the time of last follow-up on 36 months, patient was asymptomatic with no respiratory complaints.
Malignant proliferation of plasma cells arising outside the bone marrow is known as extramedullary plasmacytoma. SEP are solitary non-osseous lesion, comprising approximately 3-5% of all plasma cells neoplasms and in approximately 80% of cases, it is located in the mucosa of nasopharynx and upper respiratory tract arising from sub-mucosal lymphoid tissues (1),(2). For diagnosis of extramedullary plasmacytoma, following points should be considered: the presence of a biopsy proven plasma cell tumour, bone marrow specimen showing fewer than five percent plasma cells, systemic signs and symptoms associated with multiple myeloma such as anaemia, hypercalcaemia, and bone pain should be absent (2). Here, the authors report a rare case of SBP in a middle aged man presenting with haemoptysis.
SEP which involves the lung are uncommon form of plasma cell neoplasms that present outside of the bone marrow. Upper respiratory tract and nasopharynx is involved in approximately 85% of SEP, and they commonly presented with epistaxis, rhinorrhoea or a nasal obstruction (1). SEP is more common in males than females with median age of presentation is 55 years, almost 10 years earlier in comparison to multiple myeloma (1). In aero-digestive system, most common sites include pharynx, nasal cavity, oral cavity and paranasal sinuses (1). Less than 15% of overall SEP involve non head and neck region and are associated with poor survival (3).
In a similar case report on SBP, diagnosis was made based on blood test which was normal. Imaging revealed mass obstructing left bronchus, biopsy revealed atypical tumour cells with an abundant basophilic granular cytoplasm and eccentrically located round nuclei, CD38 positive, serum and urine protein electrophoresis were normal, skeletal bone examination was also normal, bone marrow biopsy revealed a normocellular pattern with no increase in plasma cells (4). Differential diagnosis included carcinoid, adenoid cystic carcinoma and, less likely, primary lung cancer.
Non head and neck SEP is treated by surgical resection of tumour and head and neck SEP is treated by combination of surgery and radiotherapy or radiotherapy alone (1),(3). Conservative surgical resection has been done for benign endobronchial tumours with occasional requirement of thoracotomy. For the treatment of small tracheo-bronchial tumours, bronchoscopic intervention has been found to be safe and effective. Since, SBP is very rare, no standard guidelines are available. (Table/Fig 5) represents 10 cases of SBP that has been in literature (1),(2),(4),(5),(6),(7),(8),(9),(10),(11).
Two cases were treated by bronchoscopic removal using Nd-YAG laser ablation (6),(7), four cases underwent surgical resection [5,8-10], three were treated by radical radiotherapy (1),(4),(11) and in one case both surgery followed by radiotherapy was done (2). In the present case, patient was treated by radical radiotherapy. As these tumours are radiosensitive, for non-resectable tumour, treatment of choice is radiotherapy with a curative intent to a dose of 40-50 Gy over a period of four weeks as stated by United Kingdom Myeloma forum. If tumour is less than 5 cm then radiotherapy should be given to dose of 40 Gy for 20 fractions and if more than 5 cm, then 50 Gy in 25 fractions should be given (12).
Variable response rates have been reported in literature. Etienne G et al., reported complete or partial responses in 64%, while 14% cases developed multiple myeloma within three years (13). Chao MW et al., treated 16 patients of Embden-Meyerhof-Parnas pathway (EMP) with radiotherapy and observed local control in all patients. Multiple myeloma developed in five patients within five years of plasmacytoma diagnosis with 10 year overall survival (OS) of 54% (14). Weber D reported 10 year OS ranged as 50-80% (15). Patient having extramedullary SP results in best outcomes when treated with moderate-dose RT.
The SBP is a rare presentation of SEP. Radical radiotherapy yields excellent local control rates and symptomatic benefit. Close surveillance with long term follow-up (atleast 5 years) is recommended as they can develop into multiple myeloma and this conversion can be insidious. Although SBP is rare, SEP should be considered in the differential diagnosis of an endobronchial tumour because non-surgical treatment options exist. At 3 years of follow-up, the present case in the report remained without any recurrence.
DOI: 10.7860/JCDR/2023/60394.17935
Date of Submission: Oct 13, 2022
Date of Peer Review: Dec 01, 2022
Date of Acceptance: Feb 01, 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? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 14, 2022
• Manual Googling: Dec 14, 2022
• iThenticate Software: Jan 10, 2023 (10%)
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