Review Article | DOI: https://doi.org/10.31579/2690-4861/1182
Primary health care corporation, Qatar.
*Corresponding Author: Mohamad Omar Belali, Primary health care corporation, Qatar.
Citation: Mohamad O. Belali, Alhaj Ali MW, (2026), HPV-Associated Oropharyngeal Squamous Cell Carcinoma in Arab Populations: Histological Heterogeneity, Regional Evidence, and the Syrian Knowledge Gap, International Journal of Clinical Case Reports and Reviews, 37(4); DOI:10.31579/2690-4861/1182.
Copyright: © 2026, Mohamad Omar Belali. 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: 24 September 2026 | Accepted: 01 October 2026 | Published: 09 October 2026
Keywords: human papillomavirus; oropharyngeal squamous cell carcinoma; HPV-associated carcinoma; histopathology; histological heterogeneity; p16; Arab countries; Syria; tumor microenvironment; digital pathology
Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is biologically and clinically distinct from HPV-independent disease. Classically, HPV-associated OPSCC is nonkeratinizing in morphology, less desmoplastic in stroma, and more lymphoid-rich in background; however, it is increasingly recognized as histologically heterogeneous. Keratinizing, maturing, basaloid, papillary, lymphoepithelial, glandular, and other components can be encountered in an HPV-associated tumor, and recent evidence suggests that such micromorphological diversity may be prognostically significant after HPV association has been demonstrated through established assays. In contrast, research from Arab populations has focused largely on HPV prevalence, p16 expression, genotype, and clinical outcome rather than on detailed histology or tumor organization. This critical review synthesizes evidence from Arab countries (focused on Syria) into the contemporary international literature and suggests a regional framework for understanding HPV-associated OPSCC pathology. Studies from Jordan, Lebanon, Egypt, Saudi Arabia, and the United Arab Emirates have demonstrated HPV-related or p16-positive OPSCC, with widely varying estimates due to differing anatomical selection and testing strategies. Syrian studies identify high-risk HPV in head-and-neck squamous carcinomas but have not yet estimated the HPV-attributable fraction or histology of anatomically verified Syrian OPSCC. We speculate that future regional research should shift from dichotomous HPV categorization to quantitative characterization of squamous maturation, tumor architecture, stromal response, tumor-associated lymphocytes, front of invasion morphology, and spatial tumor heterogeneity. Digital pathology and interpretable artificial intelligence offer exciting opportunities to engage with these questions. A principal unresolved regional question is the extent and biological significance of HPV involvement in oropharyngeal SCCs, while an important research challenge is to understand how HPV-associated carcinogenesis is expressed through regional variations in tissue architecture.
Human papillomavirus (HPV)-associated OPSCC is one of the most important biological subdivisions of current head-and-neck oncology. HPV-associated tumors differ from those independent of HPV in terms of epidemiology, molecular pathogenesis, clinical presentation, nodal behavior, staging, response to treatment, and prognosis, determination of which has consequently become an integral part of pathological assessment [18,19,22-24].
The updated College of American Pathologists guideline recommends high-risk HPV testing in all newly diagnosed OPSCCs, irrespective of histological subtype, and p16 immunohistochemistry remains the recommended surrogate assay for routine tissue specimens in appropriate settings, whereas HPV-specific testing takes on particular importance in the case of discordance of p16 and morphology or in geographical populations in which the HPV-attributed fraction is relatively low [1].
Morphology is nonetheless highly informative. Classical HPV OPSCC displays proliferation of lobules, nests, sheets, or trabeculae of relatively uniform cells with a high nuclear to cytoplasmic ratio, brisk mitotic activity, frequent apoptosis, limited squamous differentiation, and only minimal desmoplastic stroma. The tumors tend to originate within the lymphoepithelial environment of the palatine or lingual tonsillar tissue and show extensive interaction with lymphocytes [18,20,21].
HPV-negative OPSCC more often demonstrates conventional squamous maturation, individual-cell keratinization, keratin pearls, irregular infiltrative nests, and a conspicuous stromal reaction, but none of these tendencies is universal [2,20,21].
In a study of 259 OPSCCs, nonkeratinizing morphology was seen in 59.4% of HPV-positive tumors but in only 11.4% of HPV-negative tumors, whereas conventional keratinizing morphology was present in 65.7% of HPV-negative tumors and only 4.0% of HPV-positive tumors [2]. Nonkeratinizing tumors with a tendency to show maturation and a number of other less common phenotypes were indicators that OPSCC was a morphologic spectrum rather than 2 distinct microscopic diseases.
Further, recent studies have expanded on this concept. Suchan et al. have shown that almost half of 102 OPSCCs that were simultaneously p16 positive and high-risk HPV-DNA positive presented with a non-classic morphology reminiscent of HPV-negative disease, which resulted in worse survival than tumors with classical HPV-associated morphology and differed genetically from tumors with classical HPV-associated morphology [3]. In 2026, Ghossein et al. have evaluated 379 HPV-associated oropharyngeal carcinomas and have identified an even greater variety of histological components, several of which had prognostic significance [4].
These observations question the notion that determination of HPV positivity completes the pathological characterization of OPSCC. And more specifically, this issue is extremely relevant to the Arab population. Several regional studies confirm the occurrence of HPV-related OPSCC, but each is characterized by significant differences in anatomical definitions, laboratory methods, study periods, and cohort compositions. [6-13].
Moreover, the detailed analysis of tumor’s architecture, the stromal reaction, immune distribution patterns, and intratumoral heterogeneity were rarely the major focus of such studies. Hence, the current review intends to analyze the question of HPV-associated OPSCC in Arab populations from the particular point of view of histopathology, with Syria being the major region of the interest. Its central hypothesis is that the regional research question should be shifted from being positive about HPV presence to studying the organization of HPV-associated carcinogenesis.
Reference completeness was rechecked during revision. All in-text citations were cross-checked against the reference list, and the bibliographic entries were standardized for consistency. This article is a critical review rather than a prevalence meta-analysis, and regional studies were interpreted according to anatomical specificity and the biological meaning of the HPV assay used.
Furthermore, OPSCC-specific studies were distinguished from mixed head-and-neck cohorts in which an oropharyngeal subgroup could be extracted, as well as from broader HNSCC studies providing only contextual evidence; the latter category being particularly relevant for research in Syria, in which significant evidence on HPV-related head-and-neck malignancies has been published, but anatomically specific OPSCC data remain scarce.
In the same way, p16 positivity, HPV-DNA positivity, and biologically supported HPV-associated carcinoma were not considered synonymous: although the detection of DNA represents an essential step in the PCR diagnostic cascade, it does not by itself prove transcriptionally active viral oncogenesis, which is assumed to be necessary for transformation, and p16 overexpression, while a clinically validated surrogate for OPSCC, can also be present independently of demonstrable HPV-specific positivity, requiring separate consideration of discordant tumors [1,5,23,24].
Furthermore, the review differentiates between the conventional histological phenotype and intratumoral heterogeneity as distinct phenomena, the former representing the dominant appearance to which the carcinoma is assigned, whereas the latter refers to the coexistence and spatial organization of multiple morphological states in the same tumor; a crucial consideration in the context of the new understanding of OPSCC as a spatially organized tissue ecosystem [4,17].
3.1 Nonkeratinizing Morphology
The prototypical HPV-associated OPSCC is characterized by the feature of nonkeratinizing morphology. Most commonly, tumor cells were organized into relatively large cohesive nests and lobules with smooth borders and relatively little intervening desmoplastic stroma. The tumor cells generally have scant cytoplasm, high nuclear-to-cytoplasmic ratios, hyperchromatic nuclei, brisk mitoses, and numerous apoptotic bodies. Moreover, central necrosis can mimic the comedo-like pattern. In addition, keratin pearl formation is typically absent or limited in this classical phenotype [2,20,21].
Although this pattern is associated strongly with human papillomavirus (HPV), morphology alone cannot identify tumors that are positive or negative for HPV. Some tumors that are negative for HPV resemble nonkeratinizing HPV-associated carcinomas, whereas some tumors associated with HPV show striking squamous maturation [1,2].
3.2 Nonkeratinizing Carcinoma with Maturation
An important intermediate phenotype demonstrates an underlying nonkeratinizing architecture with focal squamous maturation (e.g., increased eosinophilic cytoplasm or cell-border definition, individual-cell keratinization, or abrupt mature squamous islands). Recognition of this pattern suggests that epithelial differentiation should be viewed as a continuum ranging from nonkeratinizing through focal and extensive maturation to keratinizing carcinoma. Thus, a tumor that demonstrated only focal maturation would be category 1, whereas a similar tumor with extensive maturation would be category 4. By contrast, quantitative scoring would assign different scores to these tumors, thereby retaining important biologic information that would not be apparent using an ordinal system [2,20,21].
3.3 Keratinizing HPV-Associated Carcinoma
Keratinization is more typical for HPV-independent tumors; however, its presence is not excluded in HPV-driven cancers. The 2025 study by Suchan et al. is of particular importance because all the tumors were positive for both p16 expression and high-risk HPV-DNA. Despite the similarity in molecular biology results, almost half (49%) showed non-classical histology characteristic of HPV-negative OPSCC and inferior overall survival [3]. Thus, it can be concluded that phenotypic information can provide clinicians with valuable insights beyond the mere identification of HPV infection.
3.4 Broader Morphological Diversity
HPV-associated OPSCC tumors may also show basaloid, papillary, lymphoepithelial, spindle-cell, adenosquamous, glandular, neuroendocrine-associated, and other rare features [4,18,20].
The 2026 series of 379 HPV-positive carcinomas reported minor papillary architecture in approximately 29%, lymphoepithelial components in approximately 10%, and basaloid components in approximately 7% of cases [4]. Several features, including basaloid differentiation, extranodal extension, and low stromal tumor-infiltrating lymphocytes, were associated with poor outcome. Thus, it is no longer possible to consider HPV-associated OPSCC interchangeable with one non-keratinizing histological pattern. The major morphological continuum considered in this review is summarized in Figure (1).
Figure 1: Histological spectrum of HPV-associated and HPV-negative oropharyngeal squamous cell carcinoma. The schematic represents the overlapping morphological continuum between classical HPV-associated nonkeratinizing carcinoma and conventional keratinizing HPV-independent disease. Mixed maturation and other phenotypes contribute to histological diversity; morphology should therefore guide but not replace HPV testing.
An OPSCC may consist of various regions, which are different at a microscopic level. A primarily non-keratinizing tumor can display a diverse range of features, including mature squamous foci, basaloid areas, zones of necrosis, lymphocyte-rich and lymphocyte-deficient regions, and a relatively desmoplastic invasive front. Conventional pathological assessment may well lump all of this together under one overall diagnosis [3,4,17].
A more informative approach would differentiate inter-tumoral heterogeneity (differences between tumors from different individuals) from intra-tumoral heterogeneity (differences seen within individual carcinomas) [3,4,17].
4.1 Architectural Heterogeneity
Tumor organization can be conceived as a continuum ranging from widely cohesive nests to interconnected lobules and increasingly fragmented tumor islands and ending with budding or single-cell invasions. This pattern contains information on epithelial cohesion, stromal interactions, invasion and plasticity [4,17].
4.2 Tumor-Stroma Architecture
A comparison of classical HPV associated tumors typically exhibit less desmoplasia than HPV negative keratinizing carcinomas [2]. The overall percentage of stromal area alone might not adequately capture the interactions that are occurring.
Broad stromal fields, narrow dissecting septa between tumor nests, fibroinflammatory stroma, and dense collagenized desmoplasia are distinct tissue patterns which have a similar proportion of stroma and could therefore be informative. Possible measurements include tumor/stroma ratio, tumor nest fragmentation, interface irregularity, stromal width, and variation between central and invasive tumor compartments [4,14,17].
4.3 Histological Transitions
The boundaries between tissue states may themselves encode biological information. For example, transitions from nonkeratinizing to maturing tumor, cohesive to fragmented tumor, tumor rich to stroma rich, immune rich to immune excluded, or pushing to infiltrating interfaces [14,17].
Two tumors with similar proportions of the different histological states, but different large-scale compartmentalization would differ substantially in their overall organization. Similarly, tumors with similar compartmentalization but differing in the proportion of different histological states or transition zones would also differ. This consideration has implications for the design of future measurements of morphological entropy, transition density, interface complexity, and phenotypic diversity. A spatial interpretation of within-tumor morphological diversity is illustrated in Figure (2) [14,17].
Figure 2: Spatial model of intratumoral heterogeneity in HPV-associated OPSCC. Different regions of one tumor may display nonkeratinizing, maturing, basaloid, immune-rich, immune-excluded, necrotic, or desmoplastic phenotypes. Biological information may reside not only in the abundance of these states but also in their spatial distribution and transitions.
The method used to define an association with human papillomavirus (HPV) is a significant source of heterogeneity among published OPSCC studies. The updated CAP guideline still recommends p16 immunohistochemistry as the surrogate marker for routine examination of oropharyngeal tissues, but with an emphasis on achieving HPV-specific tests in particular settings, including equivocal p16 results, and lower HPV-attributed fractions in specific regions [1].
The clinical significance of such discordance was underscored in the context of the HNCIG-EPIC-OPC cohort of 7,654 patients, among whom 3,805 had p16-positive cancers, of which 415 were HPV negative. The 5-year overall survival was 81.1% for p16+/HPV+, 54.7% for p16+/HPV-, 53.2% for p16-/HPV+, and 40.4% for p16-/HPV- tumors [5]. Moreover, the p16+/HPV- cancers were more frequent in areas with a lower proportion of HPV-associated OPSCC.
This observation is crucial for understanding patterns of HPV involvement in the Middle East, where reports of 55% p16-positive OPSCC and 28% of HPV-specific positive tumors have been published. In other words, the p16+ and HPV+ tumors in these reports cannot be compared directly. Therefore, a discussion of HPV involvement in locally available OPSCC cohorts should include a separate assessment of p16-positive tumors, HPV DNA-positive tumors, if tested transcriptionally, and double-positive tumors [5,7,10].
The currently identified literature on the Arab nations confirms HPV-related or positive p16 OPSCC cases in several countries but shows great inconsistency in the methods used. The figures presented below must not be compared as if they were standard prevalence rates of the countries (Table 1). [6-13].
| Setting | Cohort | Anatomical evidence | HPV assessment | Principal finding | Major limitation |
| Syria [6] | 80 HNSCC | Contextual HNSCC | PCR/IHC | 35/80 high-risk HPV positive | Not OPSCC-specific |
| Jordan [7] | 69 oropharyngeal cancers | OPSCC-specific | p16 IHC | 55.1% p16 positive | Universal HPV-specific confirmation absent |
| Lebanon [8] | 30 OPSCC | OPSCC-specific | p16 + HPV DNA PCR | 27% double-positive; 20% p16+/HPV- | Small cohort |
| Beirut/Middle Eastern cohort [9] | 34 OPSCC | OPSCC-specific | E6/E7-region PCR | 29/34 HPV DNA positive | Long historical interval; predominantly Lebanese |
| Egypt [10] | 32 OPSCC within 99 SCC | Extractable OPSCC | p16 followed by HPV DNA ISH | 28% HPV positive | Small OPSCC subgroup |
| Saudi Arabia [11] | 28 OPSCC within 285 oral/OP SCC | Extractable OPSCC | HPV DNA; p16 subset | 6/28 HPV DNA positive | Small OPSCC subgroup |
| UAE-based cohort [12] | 61 HNSCC | Extractable/site-specific | hrHPV ISH + p16 | 5 hrHPV-positive SCC; 4 oropharyngeal | Multinational population |
| Sudan [13] | 6 oropharyngeal tumors within 150 carcinomas | Very limited extractable evidence | HPV16 PCR | 0/6 HPV16 positive | Very small subgroup; HPV16-only assay |
Table 1: Principal Arab-region evidence relevant to HPV-associated OPSCC [6-13].
6.1 Syria
Gupta et al. did a study on 80 tumors and found out that there is a high-risk HPV association with 35 (43.7%) of the Syrian patients diagnosed with head-and-neck malignancies (HNM). The article mentions that there was detection of HPV33, HPV16, HPV18, HPV45, HPV52, HPV58, HPV35, HPV51, HPV31, while there were 25 patients with concurrent detection of HPV and Epstein-Barr virus [6].
The study is significant to show that oncogenic HPV is present in Syria. What it fails to mention is that not 43.7% of all malignant tumors of the head and neck in Syria are related to HPV since they originate in various sites of the head and neck. However, the strongest possible conclusion that can be drawn from this study is that high-risk HPVs have been demonstrated to be present in Syrian head-and-neck carcinomas, but the fraction of HPV-attributable tumors and the histological spectrum of anatomically verified Syrian OPSCC cases have yet to be defined.
6.2 Jordan
Obeidat et al. assessed 69 oropharyngeal cancer biopsies from two Jordanian hospitals and reported positive p16 expression in 55.1% of cases [7]. The study evaluated several molecular proteins and represents one of the best characterized modern Arab OPSCC cohorts.
Notably, patients were categorized according to p16 expression rather than universally accepted HPV-specific molecular tests. Thus, despite the high prevalence of p16 positive cancers, the cohort should not be automatically considered as having equivalently high rates of HPV-related tumors. The architecture, degree of squamous differentiation, lymphocytic infiltration pattern, and intratumoral heterogeneity were not prioritized during the examination.
6.3 Lebanon
Mhawej et al. performed a study including 30 Lebanese OPSCC patients and found that 27% were simultaneously p16 positive and HPV-DNA positive, another 20% were p16 positive but HPV-DNA negative, while 53% were negative for both markers. HPV16 accounted for 75% of the HPV-positive tumors [8].
Another study on OPSCC conducted in Beirut and including 34 eligible patients found that 29 tumors (85.3%) were positive for HPV DNA by PCR testing of E6/E7 region, among which HPV16 was accounted for 26 of the positive ones [9]. The great majority of the patients were Lebanese, but there were also very limited numbers of patients coming from Syria, Iraq, Jordan, and Palestine.
The fact that in one study including only Lebanese patients, 27% of OPSCCs were concordant for p16 and HPV-DNA positivity while in another study, 85.3% of tumors were positive for HPV DNA highlights methodological differences between the two studies and not the variations of biological HPV invasion patterns specific to the Lebanese population.
6.4 Egypt
Tealab et al. performed a study on 99 cases of squamous carcinomas, 32 of which were diagnosed as OPSCC, at the Egyptian National Cancer Institute. After evaluating all cases for p16 expression, HPV DNA in situ hybridization was conducted for positive cases. Thus, the researchers found that 28% of the tumors in the oropharynx subgroup were positive for HPV. P16 and HPV DNA ISH showed concordant results in most of the cases [10]. This study provides fairly convincing virological regional evidence since the anatomical subgroup is clearly defined and one can argue in favor of the HPV-specific test. However, the analysis of histological heterogeneity was not the main focus of the researchers.
6.5 Saudi Arabia
Alsbeih et al. evaluated 285 oral-cavity/oropharyngeal HNSCCs. 28 were oropharyngeal; 6 of these were HPV-DNA positive (corresponding to ~21%) [11]. p16 was tested for in a subset of 50 cases, and was positive in 21, including all HPV positive tumors but also additional HPV-DNA negative cancers. The Saudi experience thus serves as an example of both the existence of HPV positive OPSCC, and a large degree p16/HPV discordance in mixed head-and-neck cohorts.
6.6 United Arab Emirates
Almarzooqi et al. performed an analysis on a cohort of patients diagnosed with human papillomavirus (HPV)-negative squamous cell carcinoma (SCC) who reside in the United Arab Emirates (UAE). They utilized the high-risk HPV in situ hybridization alongside the p16, p53, and Ki-67 immunohistochemistry for the study. The results revealed that 5 SCCs were positive for high-risk HPV; 4 cases originated from the oropharyngeal region, while all the cases were positive for p16 [12]. Since the majority of the clinical population in UAE consists of emigrants, one can argue that the results represent the local population rather than a homogenous group.
6.7 Sudan
Mohamed et al. assessed 150 carcinomas in various anatomical sites, among which six had oropharyngeal origin. No positivity for HPV16 was found in any of the six, although it was detectable in other tumor locations [13]. This is not an unexpected result, since the oropharyngeal subgroup was relatively small (n = 6) and the molecular analysis was specific for HPV16, not the entire oncogenic HPV spectrum. The provisional geographical depth of the Arab-region evidence identified in this review is presented in Figure (3).
Figure 3: Arab-region evidence maps for HPV-associated OPSCC. Evidence categories distinguish dedicated OPSCC cohorts, extractable or site-specific OPSCC evidence, contextual HNSCC or very small contributions, and countries for which no eligible country-level OPSCC study was identified in the current review. The map reflects depth of published evidence rather than biological prevalence.
Syria is separately considered because it highlights the distinction between viral oncogenic evidence and specifically OPSCC-related studies. The Syrian literature confirms oncogenic HPV involvement in head-and-neck cancer, particularly the presence of multiple high-risk categories in the oncogenic potential of these viruses [6]. Still, there are no answers to the most critical OPSCC-specific questions.
First, the frequency of molecularly HPV-associated carcinoma in true Syrian palatine tonsil and base-of-tongue tumors is unknown. In addition, there is a lack of information on p16/HPV discordance, classical nonkeratinizing morphology, the percentage of squamous maturation, keratinizing HPV-associated tumors, stromal desmoplasia, tumor-infiltrating lymphocytes, cystic nodal metastasis, and spatial histological heterogeneity [6].
This formulation is more accurate than asserting that relevant data on Syria are absent. There is evidence of HPV research in Syria, but it is not yet developed to the level of an anatomically specific, molecularly characterized, and histomorphologically diverse literature on OPSCC (Table 2). [6-13].
| Domain | Current status |
| High-risk HPV in Syrian HNSCC | Demonstrated |
| Multiple oncogenic HPV genotypes | Demonstrated |
| HPV/EBV co-detection | Demonstrated |
| True OPSCC-specific HPV-attributable fraction | Not established |
| p16/HPV concordance in Syrian OPSCC | Not established |
| Nonkeratinizing morphology | Insufficiently characterized |
| Keratinizing HPV-associated OPSCC | Unknown |
| Stromal desmoplasia | Unknown |
| Intratumoral/stromal TIL distribution | Unknown |
| Tumor-immune spatial organization | Unknown |
| Histological heterogeneity | Unknown |
| Digital whole-slide characterization | No established regional evidence identified |
Table 2: What is known and unknown regarding Syrian HPV-associated OPSCC [6].
The tumor microenvironment adds another layer of HPV-associated histological variability. A systematic review including 58 studies and 6,474 patients found that generally greater immune infiltration and several T-cell, B-cell, and immune-microenvironmental features were associated with favorable outcome in HPV-associated OPSCC [14].
However, absolute lymphocyte quantity might not convey the same information as spatial distribution: two tumors could present with a similar degree of overall lymphocyte infiltration while demonstrating fundamentally different spatial relationships between malignant and immune cells. In one tumor, immune cells might penetrate malignant epithelial nests deeply, while in another, they might be found only in the surrounding stroma. Relevant spatial phenotypes would include intratumoral infiltration, interface-dominant infiltration, stromal predominance, immune exclusion, and immune-poor architecture [14,17].
Recent high-dimensional spatial studies have reinforced this interpretation. More compellingly, Sievers et al. analyzed single-cell spatial gene-expression in an HPV-associated OPSCC and demonstrated that separate regions in the same tumor contained divergent immune environments and malignant-cell states [17]. Different tumor regions appeared to use locally-restricted mechanisms of immunosuppression.
These findings provide molecular support for an architecture-first interpretation of routine histology: spatial heterogeneity visible on H&E sections might represent the phenotypic manifestation of deeper differences in viral activity, hypoxia, immune pressure, stromal interaction, and malignant-cell state [14,17].
Digital pathology offers an opportunity to quantify dimensions of tissue organization that are not readily captured by conventional categorical reporting. Whole-slide analysis can potentially measure tumor-component areas, nest size, fragmentation, stromal fraction, lymphocyte density, tumor-immune contact, necrotic area, invasive-border complexity and center-to-edge gradients [15-17].
The feasibility of detecting HPV-related information directly from routinely prepared H&E sections has already been demonstrated. Klein et al., using material from 906 OPSCC patients, developed a deep-learning model that achieved a mean test AUROC of 0.83 for association with HPV status; performance increased to 0.88 after cases were filtered according to regional prediction variance which the authors suggested may act as a surrogate of HPV-related morphological heterogeneity [15].
A subsequent weakly supervised whole-slide study of 123 slides demonstrated that HPV status could also be predicted without manual region-level annotation. Attention maps focused principally on tumor-rich regions, while errors were enriched in technically suboptimal or p16/HPV-discordant cases [16].
The significance of these studies goes beyond automation of diagnosis. They show that HPV-associated biological information is encoded within routine morphology. The more innovative application of computational pathology may be to map regional phenotypic diversity rather than simply predict a binary HPV status [15,16].
Potential investigational variables would include morphological entropy, dominant phenotype fraction, tumor-nest fragmentation, transition density, tumor-immune interface length, immune-penetration indices, boundary complexity and center-to-edge gradients. These remain research concepts and should not currently be considered validated clinical biomarkers [15-17].
The conceptual progression from viral classification toward spatially resolved digital pathology is shown in Figure (4).
Figure 4: Proposed transition from HPV status to digital tissue ecology. The framework illustrates progression from viral exposure and oncogenesis through molecular phenotype, epithelial differentiation, histological phenotype, tumor-stroma and immune architecture, intratumoral heterogeneity, and digital pathology. HPV status is treated as a starting point for characterization rather than a complete representation of tumor biology.
Regional comparability would improve substantially if future investigations adopted a common minimum dataset (Table 3). [1,4,14-18].
| Domain | Recommended variable |
| Anatomical site | Exact oropharyngeal subsite |
| Specimen | Biopsy versus resection |
| p16 | Antibody, percentage, intensity, interpretation |
| HPV-specific assay | Method and high-risk types covered |
| Concordance category | p16+/HPV+, p16+/HPV-, p16-/HPV+, p16-/HPV- |
| Dominant morphology | Nonkeratinizing, NKM, keratinizing, special pattern |
| Squamous maturation | Approximate percentage |
| Keratinization | None, focal, extensive |
| Basaloid component | Presence and approximate extent |
| Papillary component | Presence and approximate extent |
| Lymphoepithelial component | Presence and approximate extent |
| Tumor architecture | Cohesive, mixed, fragmented/infiltrative |
| Desmoplasia | Minimal, mild, moderate, marked |
| TILs | Intratumoral and stromal separately |
| Necrosis | Pattern and approximate extent |
| Invasive front | Pushing, mixed, infiltrative |
| Nodal morphology | Cystic change; extranodal extension |
| Heterogeneity | Mixed components and regional variation |
| Digital pathology | Whole-slide analysis where available |
Table 3: Proposed minimum histopathological dataset for Arab OPSCC research.
This framework is deliberately achievable without requiring advanced artificial intelligence. The first objective should be better histopathology, not more complex technology.
The literature can be viewed as progressing through several levels of pathological resolution (Table 4). [3,4,6-17].
| Level | Description |
| H0 | SCC diagnosis and HPV/p16 result only |
| H1 | Basic grade, differentiation, or keratinization reported |
| H2 | HPV-related morphology characterized: nonkeratinizing, maturation, keratinizing, basaloid or other subtypes |
| H3 | Microenvironment incorporated: TILs, desmoplasia, invasive front, tumor-stroma relationships |
| H4 | Spatial or digital analysis: regional heterogeneity, whole-slide metrics, spatial immune organization or computational pathology |
Table 4: Proposed histopathological evidence-depth framework.
The presented framework was not meant to assess the methodological quality of the studies. A well-performed HPV prevalence study indeed could be limited to the level of H0 or H1. Instead, the classification was aimed at addressing a different research question: up to which level the tissue phenotype was actually investigated.
Indeed, while most of the studies included in this review originate from the Arab world and are mostly confined to the H0-H1 range, the recent international studies have reached the levels of H3-H4. This observation constitutes the central evidence gap identified in this study [3,4,6-17].
The proposed H0-H4 evidence-depth framework is visualized in Figure (5).
Figure 5: Histopathological evidence-depth framework for Arab OPSCC research. H0-H4 indicate increasing depth of tissue phenotyping from viral result only to spatial and digital pathology. The framework is not intended as a methodological quality score.
Several conclusions follow from the presented evidence. Firstly, it is evident that HPV-associated or p16-positive OPSCC is indeed present in Arab populations. The regional literature is thus far from bereft of evidence [6-13]. Secondly, the reported percentages are so variable that a simple geographical comparison is unwarranted. Consider the Lebanese studies: even within a single country, a 27% p16+/HPV-DNA+ portion in one study and an 85.3% positivity rate for HPV-DNA in another do not constitute equal measures of epidemiology [8,9].
Thirdly, p16 and HPV-specific testing have to be dissociated from one another for populations in which the HPV-attributed fraction has not been firmly established. The multinational discordance study and current CAP guideline are both strong arguments for this view [1,5]. Fourthly, the regional literature is significantly more advanced in terms of viral identification than characterizing the histology of the disease. Most studies address variations of the question: Is HPV present? Fewer address: What morphological phenotype does HPV-associated disease take on? Almost none address the more advanced question: How does that phenotype vary spatially within an individual tumor? [6-17].
This is indeed important since contemporary evidence demonstrates increasing heterogeneity in HPV-associated OPSCC. Of relevance is a 2025 study by Suchan et al. that identified clinically-relevant histological subgroups within a molecularly HPV-positive disease [3], and a 2026 series by Ghossein et al. that identified a broad spectrum of major and minor morphological components across 379 HPV-associated tumors [4].
The concept is further supported at the spatial molecular level. Different regions of the same HPV-associated carcinoma can indeed contain divergent malignant and immune states [17]. It follows that the progression of the field can be conceptualized as: HPV detection -> HPV attribution -> histological phenotype -> intratumoral heterogeneity -> spatial tissue architecture.
Arab-region research has made significant contributions to the first two stages but is underrepresented in the latter stages. In particular, Syria is illustrative of this trend. Despite evidence of high-risk HPV in Syrian HNSCC, anatomically-verified OPSCC with standardized HPV attribution and detailed histomorphology remains inadequately characterized [6]. It is thus not an example of no data, but an example of a transition from viral epidemiology to spatial pathology.
The current review has several shortcomings. The literature of the region has small OPSCC cohorts combined with anatomically different head and neck malignancies, and HPV methodologies vary substantially from series to series. (p16 immunohistochemistry, HPV DNA PCR, DNA insitu hybridization, and RNA testing are not equivalent) [1,5,23].
Several cohorts occur over large time frames in which both epidemiological variables (e.g., HPV, smoking) and diagnostic practices (e.g., histology, laboratory techniques) may have changed, and detailed morphology was not an aim for most of these regional investigations, meaning that absence of a particular finding cannot be considered equivalent to presence. Additionally, country of treatment may not equal nationality or ancestry (in a multinational, Gulf region sample), and the present article is a critical review rather than a completed PRISMA-ScR synthesis. A true scoping-review would also require reproducible database searching (and removal of duplicates), independent screening and reason-for-exclusion documentation, and a PRISMA flow diagram before exhaustive claims about country-level evidence could be made. These limitations highlight gaps in evidence, rather than evidence of gaps.
Future Arab OPSCC research should initially focus on anatomically relevant patient cohorts with standardized HPV assignment. Detailed morphological assessment should then aim to quantify rather than simply describe major phenotypes [1,4,18]. The amount of nonkeratinizing tumor, squamous maturation, keratinization, desmoplasia, and lymphocytic infiltration can all be expressed quantitatively or semiquantitatively. Whole-slide digital pathology could subsequently take this approach one step further into spatial measurement, without requiring transportation of tissue blocks between countries [4,14-17].
An Arab digital OPSCC atlas would be especially valuable. Such a resource would ultimately include material from Syria, Jordan, Lebanon, Iraq, Egypt, Saudi Arabia, the UAE, other Gulf states, and North Africa. Most importantly, artificial intelligence should not be introduced just for the sake of technology. The most scientifically valuable computational models would likely be interpretable systems that could identify which histological regions contribute to classification, and in what ways those regions differ. The ultimate goal should thus be digital tissue ecology rather than simple black-box prediction [15-17].
HPV-associated OPSCC occurs across the Arab populations, but the published evidence is geographically uneven and methodologically heterogeneous. Most of the studies focused on detecting HPV, expression of p16, genotype, and clinical outcome, while the histological characterization lacks details [6-13]. Syria serves the best example for this inconsistency. Indeed, High-risk HPV was detected in Syrian head-and-neck cancers, but the HPV-attributed portion and histological presentation of anatomically confirmed Syrian OPSCC are insufficiently characterized [6]. Meanwhile, the international research community is recognizing that HPV-associated OPSCC appears to be a non-homogeneous disease in terms of morphology. Moreover, apart from non-classical lesion appearance, minor histological components, stromal immune-phenotype, and focal tumor-immune states can carry additional diagnostic and prognostic information beyond the mere presence or the absence of HPV [3,4,14,17,20,21].
Thus, regional studies should shift the focus from the mere detection of a virus to the attribution of viral participation to malignancy; from qualitative to quantitative morphology; from major histological phenotype to intra-tumor heterogeneity; and from individual histological features to tissue architecture [1,4,14-17]. The main question for future research would then be, not only “is a given case of OPSCC HPV positive or negative?” but rather, “how does HPV-associated carcinogenesis organize malignant epithelium, stroma, and immune cells in individual tumors, and is this organization similar across different Arab populations?” The answer to this question, particularly in the poorly characterized region of Syria, would be important to contemporary head-and-neck pathology [6-17].
“I would like to express my sincere gratitude to Ms. Sarah Jacobs, Editorial Coordinator of the IJCCR, for her excellent collaboration and exceptional support throughout the entire process, from article submission and peer review to financial matters and successful publication. Everything went very quickly and smoothly. I would also like to thank the reviewers, whose comments were helpful and contributed to an even better article. I wholeheartedly recommend this deservedly renowned journal to my colleagues for publication.” Best regards, Andreas Schapowal.
Dear Editorial Team, Clinical Medical Reviews and Reports. My experience with the journal was highly positive. The peer-review process was rigorous, constructive, and completed in a timely manner. The reviewers provided valuable comments that helped improve the quality and clarity of our manuscript. The editorial office was professional, responsive, and supportive throughout all stages of the publication process. Communication was clear and efficient, and any questions were addressed promptly. Overall, I found the journal to maintain high scientific standards and an excellent publication workflow. I would be pleased to consider submitting future work to this journal. Best wishes from, Elena Popa.
It was my pleasure to submit my testimonial concerning the Reviewer Board of our Scientific Journal “Brain and Neurological Disorders”. The Reviewers focused on some modifications and their contribution was helpful. The ladies of our Editorial Office were also supported my efforts. It was my honor to have such a co-operation and I am looking forward for more collaboration.
Dear Grace Pierce, Editorial Coordinator of Journal of Clinical Research and Reports, Thank you for the speedy and efficient peer review process. I appreciate the fact that your peer reviewers do not take months to respond like with some other journals. I would also like to thank the editorial office for responding quickly to my questions. It is an excellent journal. I plan to submit more manuscripts in the future. Best wishes from, Robert W. McGee
Dear Grace Pierce, Editorial Coordinator of Journal of Clinical Research and Reports, Working with you and your team on our recent publication in JCRR has been a truly wonderful and enjoyable experience. The responses were prompt, and the reviewers were patient, constructive, and highly professional. One reviewer in particular gave me the feeling that a professor was carefully reading and commenting on my coursework, which was deeply touching. The entire process was straightforward and hassle‑free, with no tedious online forms to complete. I highly recommend this journal. Best wishes from, DR Aibing Rao, Head of R&D
I Appreciate the Opportunity to Share my Experience with the Journal of Clinical Research and Reports. The peer review process was timely and constructive, and the feedback provided helped improve the quality of our manuscript. The editorial office was professional, responsive, and supportive throughout the process, ensuring smooth communication and efficient handling of the submission. Overall, it was a positive experience collaborating with your team.
Dear Mercy Grace, Editorial Coordinator of Obstetrics Gynecology and Reproductive Sciences, We would like to express our gratitude for your help at all stages of publishing and editing the article. The editors of the magazine answer all the necessary questions and help at every stage. We will definitely continue to cooperate and publish other works in the Obstetrics Gynecology and Reproductive Sciences! Best wishes from, Alla Konstantinovna Politova,
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Reader: We have published several articles in the Auctores Publishing, LLC, journal, Clinical Medical Reviews and Reports in recent years (CMRR). This is an ‘open access’ journal and the following are our observations. From the initial invitation to submit an article, to the final edits of galley proofs, we have found CMRR personnel to be professional, responsive, rapid and thorough. This entire process begins with Catherine Mitchell, Editorial Coordinator. She is simply outstanding, and, I believe, unparalleled in her capacity. I cannot imagine a more responsive and dedicated Editorial Coordinator. As I read the dates and timing of her correspondence with us, it seems that she never sleeps. I hope Auctores Publishing, LLC, appreciates her efforts as much as these authors do. Thank you to Auctores Publishing, LLC, to the Editorial Staff/Board, and to Catherine Mitchell from a grateful author(s).
Dear Maria Emerson, Editorial Coordinator of - Journal of Clinical Research and Reports. ''I am pleased to provide this testimonial following the publication of our recent case report in this journal. The peer review process was rigorous, constructive, thorough, and conducted in a timely manner. The reviewers’ comments were thoughtful, detailed, and highly constructive, contributing substantially to the refinement, clarity, and scientific robustness of our manuscript. The process was conducted with professionalism and academic integrity throughout. The support provided by the editorial office was exemplary. Communication was consistently prompt, clear, and courteous at all stages of the submission and publication process. The editorial team demonstrated a high level of organization and responsiveness, ensuring that all queries were addressed efficiently and that the process remained transparent and well-coordinated. The overall quality of the journal is reflected in its strong editorial standards, commitment to scientific excellence, and dedication to publishing clinically meaningful research. It has been a privilege to publish our work in this journal, and we would welcome the opportunity to contribute further in the future.'' Best wishes from, Dr. Efstratios Trogkanis, Cardiologist.
Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. 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.
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
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!”
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, 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.
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.
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, 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.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
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.
“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”.
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.
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.
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 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.
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 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 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 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!
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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