Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
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 Splenic Hodgkin Lymphoma and its Prognosis: A Report of Two Cases
Correspondence Address :
Madhumita Mondal,
Qr. No. C-12, 242, AJC Bose Road, Kolkata-700017, West Bengal, India.
E-mail: rgkarmadhumita@gmail.com
Primary Splenic Lymphomas (PSL) constitute an extremely uncommon variety of splenic neoplasm and can present with grave complications such as splenic rupture. Hodgkin Lymphomas (HL), a type of hematopoietic neoplasm, are typically diagnosed between the ages of 20 and 30 years and present with supra-diaphragmatic lymphadenopathy, often accompanied by systemic B symptoms. A histopathological diagnosis involving Reed-Sternberg (RS) cells in an inflammatory background is crucial. However, other differentials such as reactive hyperplasia, infectious mononucleosis, anaplastic large cell lymphoma, or various other lymphomas may mimic Hodgkin disease both clinically and histologically. Therefore, accurate diagnostic evaluation of Hodgkin lymphoma is crucial, especially as it is highly curable with combination chemotherapy, even in higher stage disease. In this report, the authors present two cases of primary splenic HL diagnosed through histopathological and immunohistochemical examination of splenectomy specimens from January 2020 to December 2021 at the Department of Pathology, IPGME&R, Kolkata, India. While reporting the histopathological sections, the authors also considered other differentials such as reactive changes, tuberculosis, and other non-Hodgkin lymphomas. Both patients were male, aged 10 years and 18 years, and presented with abdominal distension and fever, without any palpable peripheral lymph nodes, for the last six months to one year. After chemotherapy, the patients were regularly monitored to identify any signs of recurrence or relapse. Therefore, the initial recognition and proper diagnosis of Hodgkin lymphoma presenting in the spleen may vary in clinical presentation and morphology, but early accurate diagnosis carries a good prognosis, as survival is best determined by its histopathological type.
Haematopoietic neoplasm, Splenectomy, Supra-diaphragmatic lymphadenopathy
Case 1
A 10-year-old boy presented with fever and abdominal swelling for the last year. He had decreased appetite and mild weight loss without any palpable lymph nodes. The fever was mild and continuous in nature, without an evening rise in temperature. He had undergone routine blood investigations and fever work-up, including tests for malaria, dengue, typhoid, and others. Sputum for Acid Fast Bacilli (AFB) was negative. The erythrocyte sedimentation rate was elevated (110 mm/h) using the Westergren method. Tests for Hepatitis B and C, Human Immuno-deficiency Virus (HIV), and Epstein Barr Virus (EBV) serum were negative. Ultrasound showed splenomegaly. A Computed Tomography (CT) scan revealed a large mass in the spleen, determined to be neoplastic in nature (Table/Fig 1)a. Subsequently, a splenectomy was performed, and the specimen was sent for Histopathological Examination (H&E).
On gross examination, the spleen measured 15×8×6 cm, with the cut-section showing multiple small whitish nodules involving the majority of the splenic tissue (Table/Fig 1)b. Haematoxylin-Eosin stained sections revealed splenic tissue with the presence of a nodular mixed inflammatory infiltrate composed of small lymphocytes, plasma cells, with scattered admixed large abnormal cells having oval to occasionally multilobated nuclei, vesicular chromatin, prominent nucleoli, and abundant cytoplasm, consistent with Reed-Sternberg (RS) cells and mononuclear variants. There were also multiple Langhans giant cells present with the formation of granulomas (Table/Fig 1)c,d. Thus, based on morphology, HL was suspected, with a differential diagnosis of non-Hodgkin lymphomas such as diffuse large B-cell lymphoma, ALK positive lymphoma, peripheral T-cell lymphoma, and infectious aetiologies like tuberculosis and infectious mononucleosis also to be considered.
Results of immunohistochemical staining confirmed the presence of HRS cells: CD30 and CD15 were strongly positive, along with dim positivity of PAX5 (Table/Fig 1)e,f. Background cells showed expression of CD45, CD20, and CD4. To rule out other non-Hodgkin lymphomas, ALK, EMA vimentin, BCL6, BCL2, and ki67 staining were performed, which were negative on tumour cells. No acid-fast bacilli were detected in the acid-fast stain (Ziehl-Neelsen) smear. Therefore, the diagnosis of HL was confirmed. Postoperatively, a bone marrow biopsy revealed a reactive marrow. The patient received chemotherapy, and there was no recurrence of lymphoma in other sites after being regularly followed-up for one year.
Case 2
An 18-year-old male patient was admitted to the hospital with progressive abdominal swelling and a dragging sensation for six months. The patient also reported low-grade fever, significant weakness, decreased appetite, pallor, and weight loss. Routine blood investigations, biochemical, and microbiological parameters were conducted. The haemoglobin was 9 g/dL, and the Erythrocyte Sedimentation Rate (ESR) was 100 mm/hour using the Westergren method.
On examination, splenomegaly was found with no palpable lymph nodes. A CT scan revealed a large mass in the spleen, likely neoplastic in nature (Table/Fig 2)a, following which a splenectomy was performed. On gross examination, the spleen measured 15×7×6 cm, with the cut section showing a whitish homogenous area involving almost the entire spleen (Table/Fig 2)b.
Microscopically, the splenic architecture was replaced by a mixed inflammatory infiltrate composed of small lymphocytes, plasma cells, neutrophils, and numerous eosinophils, with scattered admixed large abnormal cells having oval to occasionally multilobate nuclei, vesicular chromatin, prominent nucleoli, and abundant cytoplasm, consistent with RS cells and mononuclear variants (Table/Fig 2)c,d. Primarily based on morphology, HL was diagnosed, although other non-Hodgkin lymphoma varieties like anaplastic large B-cell lymphoma, diffuse large B-cell lymphoma, T-cell lymphoma, and other infectious aetiologies like cytomegaloviral infection were also considered in the differential diagnosis.
These RS cells were positive for CD15 (Table/Fig 2)e and CD30 (Table/Fig 2)f, and weakly positive for PAX5, while CD20, CD45, and CD4 were positive for background cells. Other markers like ALK, EMA, vimentin, BCL6, BCL2, and ki67 were also used to exclude other non-Hodgkin lymphomas. Therefore, the diagnosis of HL was confirmed, and the patient received a chemotherapy regimen. Bilateral bone marrow aspiration and biopsy showed a reactive marrow. The patient was regularly followed for six months for any recurrence of the neoplasm or any involvement of other sites.
The summary of both cases of the present case report are depicted in (Table/Fig 3).
The PSL is a rare malignant tumour, accounting for only about 1% of all malignant neoplasms and representing about 1% of all malignant tumours. The incidence of splenic lymphoma has been gradually increasing in recent times, making it the most common primary splenic malignancy (1). Hodgkin’s disease in this location is particularly unusual. It is more prevalent in lymph nodes such as cervical, axillary, mediastinal, and para-aortic sites (2),(3).
PSL has been defined as a neoplasm that involves only the spleen, with or without involving splenic hilar lymph nodes, while maintaining the architecture of other organ systems. B cell non-Hodgkin lymphoma is the predominant type of PSL. Secondary involvement of the spleen as part of systemic involvement of haematological neoplasms with the inclusion of abdominal lymph nodes is more prevalent than isolated splenic malignancy (4). In the present case report, both cases presented with isolated splenomegaly without involvement of other organs or lymph nodes and there was no other haematological neoplasm.
By definition, PSL is described as a lymphoma involving only the spleen and hilar lymph nodes, but not other sites, and there will be no relapse within six months following splenectomy. PSL is a lymphoma with splenic involvement in which splenomegaly is the chief complaint. PSL can present with a variety of symptoms, including fever, night sweats, weight loss, weakness, and upper abdominal pain with a dragging sensation. Pancytopenia can also be a feature, with laboratory findings of elevated Erythrocyte Sedimentation Rate (ESR) and beta-2 microglobulin. The principal clinical finding is splenomegaly (5). A painless, enlarging, palpable lymph node is a common mode of presentation. Mediastinal and neck node involvement are seen in about 60% of patients, followed by splenic, axillary, abdominal, hilar, or inguino-femoral region involvement (6).
In the present report both cases presented with fever, decreased appetite, abdominal swelling, and a dragging sensation due to enlargement of the spleen, initially revealed by clinical palpation. Routine complete blood count was unremarkable, but the ESR value was increased, and other diagnostic workups for fever, such as viral markers, urine culture, and blood culture, came back as negative. There were no other palpable lymph nodes, but mild pallor was noted. On imaging, splenomegaly was evident with the presence of a splenic mass. Following splenectomy, on microscopic examination, Hodgkin lymphoma was provisionally suspected, but other differentials such as anaplastic large cell lymphoma or other non-Hodgkin lymphomas, tuberculosis, or reactive changes were also considered before arriving at the final diagnosis.
The most common finding of PSL on diagnostic radiological observations is hypodense splenic lesions on contrast-enhanced CT scans (5). The prognosis of patients with PSL can significantly improve with splenectomy (7). In this case report, both patients were primarily treated by surgical removal of the spleen after the confirmation of a splenic mass on radiology. HL is a hematopoietic neoplasm diagnosed in individuals aged 20-30 years, characterised by the presence of RS cells in an inflammatory background. Patients present with fever, night sweats, and lymphadenopathy. Even in cases presenting in higher and advanced stages, it is highly curable with a combination of the ABVD (Adriamycin – Bleomycin – Vinblastine- Dacarbazine) chemotherapeutic regimen and radiation therapy (6).
HL is usually categorised into two subdivisions based on histomorphology and immunohistochemistry: classical HL (cHL) and Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL). Further, cHL is divided into nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted types. The malignant HRS cells in all subtypes of cHL exhibit a characteristic immunophenotypic pattern of CD30 (with its membrane and/or ‘dotlike’ staining), CD15, PAX-5 positivity, and CD45 negativity. FDG-PET (18 fluorodeoxyglucose positron emission tomography) plays a key role in staging and prognosis. Although there are other work-ups like physical examination, chest X-rays, chest and abdominal CT scans, and bone marrow biopsy, which are helpful for Ann Arbor staging. Along with Hodgkin R-S cells, there is the presence of non-neoplastic T lymphocytes, plasma cells, macrophages, mast cells, and eosinophils. R-S cells arrange their survival and expansion through many cytokines and chemokines, which interact with the non-neoplastic surrounding microenvironment (8).
In presently discussed two cases, both patients aged under twenty and male underwent splenectomy. Clinically, fever, decreased appetite, and upper abdominal distension were the most significant complaints. On H&E of splenic sections, the presence of diagnostic RS cells and their mononuclear variant and lacunar variant were revealed. In the first case, it was the nodular sclerosis variety, and in the second case, there were plenty of eosinophils, lymphocytes, and plasma cells. Provisionally, HL was diagnosed, and immunohistochemical examination was done to confirm the diagnosis and exclude other mimickers of Hodgkin’s disease, such as diffuse large B-cell lymphoma, anaplastic large cell lymphoma, or other non-HL. In both cases, RS cells showed CD15, strong CD30, and weak PAX-5 positivity. In the background, T cells and B cells were positive for CD4 and CD20, respectively, on IHC.
The presentation of this extremely uncommon lymphoma can vary from vague symptoms to grave complications such as hypersplenism and splenic rupture, along with ascites. A precise histopathological diagnosis combined with immunohistochemistry is of utmost importance (5),(9). In this case report there was no history of splenic rupture or ascites at the time of presentation.
HL can be associated with a granulomatous reaction characterised by the presence of histiocytes, Langhans giant cells, and necrosis. Consequently, it is sometimes misdiagnosed as an infectious granulomatous reaction. The recognition of Hodgkin and Reed/ Sternberg (HRS) cells in microscopy, along with immunohistochemical expression of CD15 and CD30, allows confirmation of the diagnosis of HL. To exclude concomitant tuberculosis, an acid-fast stain must be performed on histological specimens (10).
In this case series, one case revealed plenty of Langhans giant cells with granuloma formation in the splenic region. However, AFB staining revealed no acid-fast organism, but immunohistochemistry of CD15 and CD30 confirmed the diagnosis of HL. Postoperatively, for staging, a bone marrow examination was performed to exclude involvement of the bone marrow by lymphoma cells, and it revealed a normocellular marrow uninvolved by any malignancy.
The treatment of HL has an excellent prognostic impact even on incurable disease. Stage-adapted treatment consisting of chemotherapy and/or radiotherapy as a first-line treatment results in cure rates of approximately 80% (11). In advanced stage disease, it is highly treatable with combination chemotherapy, radiation, or combined modality treatment. Although the mainstay of therapy for over the last 30 years has been the same ABVD chemotherapeutic regimen (6). Both patients received chemotherapy of the ABVD regimen after diagnosis, and they are being regularly followed-up to identify any treatment failure or history of relapse.
Primary splenic lymphoma, especially HL, is very rare in presentation. Sometimes, the coexistence of granuloma may lead to an inappropriate diagnosis. Therefore, careful H&E, along with immunohistochemistry and other ancillary investigations, are of utmost importance for a better prognosis and survival of patients with splenic HL.
DOI: 10.7860/JCDR/2024/62199.19126
Date of Submission: Dec 10, 2022
Date of Peer Review: Jan 17, 2023
Date of Acceptance: Mar 17, 2023
Date of Publishing: Mar 01, 2024
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. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 13, 2023
• Manual Googling: Jan 14, 2023
• iThenticate Software: Feb 07, 2024 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com