AUCTORES
Globalize your Research
Chat with us
Case Report | DOI: https://doi.org/10.31579/2690-4861/056
*Corresponding Author: Anubha Bajaj, Consultant Histopathologist, A.B. Diagnostics, A-1, Ring Road, Rajouri Garden, New Delhi, India.
Citation: Anubha Bajaj. (2020) Girdled and Hemmed In -Perivascular Epithelioid Cell Tumour. International Journal of Clinical Case Reports and Reviews. 3(5); DOI: 10.31579/2690-4861/056
Copyright: © 2020 Anubha Bajaj, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 25 September 2020 | Accepted: 25 September 2020 | Published: 30 September 2020
Keywords: Keywords
Abstract
Exceptional neoplasia with perivascular clear cell and epithelioid cell differentiation are diverse and constituted by angiomyolipoma, clear cell “sugar tumour” of pulmonary and extra pulmonary sites, clear cell myomelanocytic tumour of falciform ligament or ligamentum teres and lymphangioleiomyomatosis on account of distinctive histological manifestations. Variable genetic and malignant biological behaviour is exemplified within perivascular epithelioid cell tumours.
Perivascular epithelioid cell tumour (PEComa) is a contemporary neoplasm of mesenchymal origin emerging within diverse sites while representing a classified group with distinctive histology and immune histochemical staining. The tumefaction is composed of epithelioid cells which demonstrate dual properties of smooth muscle and melanocytes with pertinent immune reactivity. Cellular component tends to aggregate around and circumscribe blood vessels, thus engendering the acronym “PEComa”.
Perivascular epithelioid cell tumour was initially described by Bonetti et al in 1992 [1]. Zamboni et al in 1996 documented perivascular epithelioid cell tumour of the pancreas and denominated the neoplasm as “sugar tumour” on account of clear, glycogen rich, cytoplasm imbued within perivascular epithelioid cells. A normal counterpart of perivascular epithelioid cell tumour is absent [2].
Disease Characteristics
Perivascular epithelioid cell tumour occur within head and neck, nasal sites, gynaecological soft tissue as uterus, diverse cutaneous locations, soft tissue, bone, abdominopelvic sites, retroperitoneal sites as the kidney, orbit or skull base, although no site of tumour emergence is exempt. Perivascular epithelioid cell tumour occurs in the absence of tuberous sclerosis [3].
Perivascular epithelioid cell tumour of cervical region is an extremely exceptional mesenchymal neoplasm of unknown biological behaviour. Mean age of tumour emergence is 41 years although the neoplasm can appear within 24 years to 67 years. Uterine perivascular epithelioid cell tumour demonstrates a mean age of emergence at 51 years. The neoplasm depicts a female predilection wherein an estimated 80% to 90% of incriminated individuals are females and commonly appears in middle aged women [3].
The neoplasm can be benign or of uncertain malignant potential or malignant. Malignant neoplasms depict cogent features such as tumour magnitude exceeding >5 centimetres, infiltrative pattern of tumour evolution, enhanced nuclear grade, enhanced cellularity, mitotic activity exceeding >1 per 50 high power fields, necrosis and vascular invasion.
An estimated 9% of gynaecological perivascular epithelioid cell tumours are associated with tuberous sclerosis complex along with a history of childhood seizures, are aptly treated with lobectomy and demonstrate radiographic features of angiomyolipoma or sclerotic bone lesions [3]. Distinctive classification systems describe the neoplasm as “benign”, “malignant” or of “uncertain malignant potential” in order to appropriately prognosticate the tumours.
Classification system developed by Folpe et al proposes diagnostic criterion of malignant neoplasms as tumour magnitude exceeding >5 centimetres, mitotic activity ≥ 1 per 50 high power fields, necrosis, elevated nuclear grade and an infiltrative tumour architecture [4].
Classification system suggested by Schoolmeester et al demonstrates diagnostic criterion as tumour magnitude ≥ 5 centimetres, mitotic index ≥ 1 per 50 high power fields, significant nuclear atypia, necrosis and lympho-vascular invasion [5].
•Absence of aforesaid criterion -benign cervical neoplasm
•One to three criterion – tumour of uncertain malignant potential
•Four or more criterion – malignant neoplasm [4, 5]
Malignant perivascular epithelioid cell neoplasm can demonstrate localized tumour invasion within petrous or occipital bone, clivus, foramen magnum, spinal canal and pulmonary parenchyma [3].
Clinical Characteristics
The neoplasm demonstrates a varied clinical representation and can be discovered incidentally or display chronic pain or vaginal bleeding. The neoplasm can masquerade as a postpartum retained placenta or induce spontaneous haemo-peritoneum. Individuals may be asymptomatic or manifest symptoms such as functional abdominal pain, abdominal mass, occasional diarrhoea. Perivascular epithelioid cell tumour can infiltrate the uterine myometrium. Perivascular epithelioid cell tumour can expand rapidly during gestation, thereby ensuring a subacute elevation of intrauterine pressure which may induce a rupture of the uterine wall [6].
Pelvic masses with aberrant vaginal bleeding can be concurrent to the genetic condition of tuberous sclerosis complex which is characterized by mental retardation, seizures and benign neoplasia such as cutaneous angiofibromas [6]. Perivascular epithelioid cell tumour typically enunciates benign biological behaviour although tumour relapse and malignant metamorphosis is documented at several primary sites wherein metastasis can commonly ensue to cutaneous locales or orbit [6].
As the clinical representation of perivascular epithelioid cell tumour is nonspecific and imaging evaluation such as ultrasound, magnetic resonance imaging (MRI) and positron emission computerized tomography (PET CT) scan may be inconclusive, assessment of cogent tissue specimen with pertinent immune histochemical assay is mandated and diagnostic [6, 7].
Histological Elucidation
Grossly, the neoplasm is well circumscribed, encapsulated and spherical. Cut surface is homogenous and light brown, circumscribed by an uninvolved, lobular parenchyma. Characteristically, the tumour demonstrates spindle-shaped or epithelioid cells disseminated around vascular articulations.Perivascular epithelioid cell tumour is typically comprised of epithelioid cells with clear or eosinophilic, granular cytoplasm demonstrating melanocytic and smooth muscle differentiation, possibly derived from perivascular epithelioid cells [7].Perivascular epithelioid cell tumour demonstrates distinct histological features such as epithelioid to spindle-shaped cells with clear, granular and eosinophilic cytoplasm, spherical to elliptical nucleus and inconspicuous nucleoli [7]. Perivascular epithelioid cell tumour is composed of flattened sheets of epithelioid cells with minimal cellular and nuclear pleomorphism, cytoplasmic pigmentation and a minimal mitotic index below <1 per 50 high power fields [7]. Perivascular tumour cells demonstrate a radial configuration with peri-luminal arrangement, epithelioid cells which abut blood vessels and spindle-shaped cells which are distant from blood vessel. Cells with clear to granular, eosinophilic cytoplasm, miniature, centric, spherical or elliptical nuclei with miniature nucleoli are discerned. Multinucleated giant cells are frequent and may exhibit features of malignant metamorphoses such as predominant cellular and nuclear atypia, mitotic activity and tumour necrosis [7, 8]. “Pecosis” may accompany the neoplasm denominated by a continuous layer of clear, perivascular cells which appears away from sites of tumour transitioning into invasive cell nests. Cells of perivascular epithelioid cell tumour appose and appear in direct contact with abluminal surface of capillary basal lamina [7]. “Pecomatosis” can be discerned which is designated as a perivascular aggregation of clear to eosinophilic cells, a phenomenon which may simulate a mesothelioma.The neoplasm can appear as an organizing haematoma enveloped by sheets of spindle- shaped cells with eosinophilic cytoplasm, elliptical nuclei, miniature nucleoli and minimal mitotic activity [7, 8]. The tumefaction consists of sheets of uniform, epithelioid, spindle- shaped cells imbued with abundant, granular, eosinophilic cytoplasm and distinctive, prominent nucleoli(8).On cytogenetic analysis, significant genomic aberrations are discerned in a majority of instances wherein frequent imbalances appear within chromosomes 19-, 16p-, 17p-, 1p-, 18p-, X+, 12q+, 3q+, 5+, 2q+. Deletion within chromosome 16p- is indicative of loss of TSC2 gene. On ultrastructural examination, the cells are incorporated with abundant cytoplasmic glycogen, pre-melanosomes, thin, attenuated filaments with occasional occurrence of dense bodies, hemi-desmosomes and inadequately configured cellular junctions [7, 8].
Immune Histochemical Elucidation
Immune reactivity to myogenic and melanocytic markers is observed.Perivascular epithelioid cell tumour is intensely immune reactive to human melanoma black -45 (HMB-45) antigen, cathepsin-K, smooth muscle markers desmin and actin and weakly immune reactive to melan-A [3].The neoplasm is immune reactive to melanocytic markers human melanoma black-45 (HMB-45)(92%) antigen, melan-A(72%), microphthalmia transcription factor (50%), NKI/ C3, tyrosinase, S100 protein (33%) and smooth muscle markers such as Myo D1, smooth muscle actin (SMA) (80%), desmin (40%), calponin and vimentin (80%). The tumour is immune non-reactive to cytokeratin, CD117/ c-kit and CD34. Also, reactivity to desmin and H-caldesmon is less frequent. A subset of tumours are immune reactive to TFE3 and depict a TFE3 chromosomal rearrangement [6, 7].Tumour cells are immune non-reactive to synaptophysin, chromogranin A, pan cytokeratin CK20, CK7 and S100 protein [7].
Differential Diagnosis
Perivascular epithelioid cell tumour requires a differentiation from neoplasms as Clear cell or oxyphilic carcinoma which is immune reactive to cytokeratin. Epithelioid or clear cell smooth muscle tumours are immune non-reactive to human melanoma black -45 (HMB-45) antigen.Malignant melanoma is intensely immune reactive to S100 protein.Undifferentiated or high grade sarcoma which depicts morphological features of malignancy such as cellular and nuclear pleomorphism, atypia, nuclear hyperplasia or hyperchromasia and prominent mitotic figures [3, 6].Cervical perivascular epithelioid cell tumour necessitates a segregation from primary and secondary cervical malignant melanoma. However, minimal cellular and nuclear pleomorphism with minimal mitosis favours a perivascular epithelioid cell tumour [6, 7].Perivascular epithelioid cell tumour of pterygopalatine fossa requires a segregation from lesions such as epidermoid cyst, meningocoele, mucosal carcinoma, schwannoma, chordoma, teratoma or neurofibroma. Majority of aforesaid masses are benign although localized tumour invasion can ensue [6, 7].Histological differentiation of pancreatic perivascular epithelioid cell tumour is required from pancreatic neuro-endocrine tumour (NET), malignant metastasis and carcinoma pancreas. Segregation is also mandated from pseudo-papillary neoplasm, gastrointestinal stromal tumour (GIST), acinar cell carcinoma of pancreas, metastasis of clear cell renal cell carcinoma (CCRCC) or malignant melanoma [7, 8].
Investigative Assay
Appropriate evaluation of tissue specimen obtained from incriminated sites as pterygopalatine fossa is indicated to eliminate a malignant metamorphoses, except in prominently vascular juvenile nasopharyngeal angiofibroma [9].Mild anaemia or elevated levels of chromogranin A may be discerned.The exceptional perivascular epithelioid cell tumour of pancreas can be pre-operatively discerned by endoscopic, ultrasound guided fine needle aspiration cytology (FNAC) [6, 7].Endoscopic ultrasound guided fine needle aspiration (EUS FNAC) is a superior imaging modality for obtaining tissue specimens for assessment. Ultrasound of the tumefaction demonstrates a spheroidal, well defined, hypoechoic mass. Pancreatic neoplasm depicts a well-defined, heterogeneous, predominantly hypoechoic mass with lateral shadow extending into homogenous, circumscribing pancreatic tissue and an absence of dilatation of pancreatic duct. Aforesaid manifestations can be confirmed upon computerized tomography (CT) and magnetic resonance imaging (MRI) [9, 10].On ultrasonography, a hypoechoic tumefaction is observed. Colour Doppler demonstrates a certain degree of internal vascular flow.Uterine neoplasms can be isointense, in contrast to encompassing myometrial tissue, upon T1 and T2 weighted imaging. Antenatal diagnosis is challenging as pregnancy associated pelvic magnetic resonance imaging is performed in the absence of gadolinium contrast. Several neoplasms depict oestrogen receptors (ER) and progesterone receptors (PR) which contribute to tumour evolution in context to hormonal alterations during pregnancy [9, 10].Diverse imaging techniques such as abdominal or endoscopic ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI) display a well circumscribed, spherical to elliptical mass with normal circumscribing soft tissue and lack of tumour infiltration. On colour Doppler or contrast- enhancement, arterial hyper-vascularity is observed. Elastography demonstrates a hard lesion with lateral shadowing, thus indicating an encapsulated tumour. Aforesaid features can simulate a neuro-endocrine tumour (NET). Contrast enhancement within an endoscopic ultrasound (EUS) may differentiate the lesion from NET. In contrast, an adenocarcinoma displays a poorly defined, infiltrative, hypodense tumefaction[9, 10].Magnetic resonance imaging (MRI) depicts a nodule of intermediate signal intensity.Positron emission computerized tomography (PET-CT) of the incriminated zone depicts a soft tissue mass with significant uptake of nuclear contrast, indicative of a malignant neoplasm. The tumour can be in proximity to abutting viscera although direct tumour invasion is absent.Tumour metastasis or abnormal, infiltrated lymph nodes are absent.In situ hybridization may or may not be able to discern EWS and TFE3 genomic rearrangements, features which support the diagnosis of conventional perivascular epithelioid cell tumour [9, 10].Nodules of pterygopalatine fossa can be detected with nasal endoscopy, computerized tomography (CT) and contrast- enhanced magnetic resonance imaging (MRI) [10].
Prognostic Outcomes
The neoplasm is usually benign although certain instances can demonstrate malignant metamorphoses and recapitulate a high grade sarcoma. Factors associated with inferior prognosis are tumour magnitude exceeding > 5 centimetres to 8 centimetres, infiltrative tumour articulation, enhanced nuclear grade with mitotic figures exceeding > 1 per 50 high power fields or atypical mitotic figures and coagulative cell necrosis [7, 8].
Therapeutic Options
Comprehensive surgical resection of the neoplasm is generally curative due to benign biological behaviour. Cervical perivascular epithelioid cell tumour is appropriately treated with total hysterectomy. Prognostic outcomes are superior than a uterine neoplasm. Localized surgical excision is accompanied by disease reoccurrence in around 8.3% of cervical lesions and nearly 21.5% of uterine neoplasms [3].Radical surgical excision of the neoplasm is contingent to tumour histology.As pancreatic perivascular epithelioid cell tumour is imbued with a malignant potential, cogent surgical extermination as pancreatectomy with splenectomy can be adopted. Neoplastic occurrence may be absent within the tumour perimeter, abutting viscera and resected lymph nodes.Surgical extermination is recommended for solid pancreatic tumefaction exceeding >2 centimetre magnitude or neuro-endocrine tumour.Nevertheless, clinical signs and symptoms, location of tumour, evidence of malignant metamorphoses and individual comorbidities are critical factors in selecting cogent therapeutic options(9,10).Majority of pancreatic perivascular epithelioid cell tumours are benign and associated with superior prognosis as the tumefaction is devoid of relapse or distant metastasis. Nevertheless, the neoplasm can delineate a potential for malignant metamorphoses. Hepatic metastasis can occur and malignant features such as tumour infiltration, necrosis or tumour magnitude exceeding > 5 centimetres can ensue. Adjuvant chemotherapy with epirubicin and ifosfamide can be adopted for metastatic lesions [9, 10].Radiation therapy can be therapeutically employed in instances with significant tumour progression. Nevertheless, established indications for adjuvant radiation are as yet undescribed [10].
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
