Review for 10.1186/s12876-021-01628-5 (2021)

Reviewer’s report
Title: 
Cervical lymph node enlargement as the initial manifestation of rectal
cancer: a case report
Version: 
0 
Date: 
04 Dec 2020
Reviewer's report:
In the case report: "An Incidentally Discovered Neck Mass During Physical
Examination: A case report" by Xie and Hong the authors describe the clinical
history and therapy of a 57-year-old patient with cervical adenopathy of
unknown origin. The examination revealed that the adenopathy is a metastasis of
a rectum cancer and the patient underwent curative surgery + postoperative
chemotherapy. In the discussion section the authors further discuss the concept
of jump metastasis. 
Remarks:
1. The title is not very informative - please mention also that the cervical
adenopathy was the first manifestation of a rectum cancer. 
2. Were also other tumor markers analyzed? Please mention also the negative
results. 
3. Not clear if the breast was only biopsied or completely resected, please be
more specific. 
4. Please be more specific regarding the pathology of the neck mass that was
initially biopsied. Did you perform any IHC? Add also H&E images to the
manuscript and a description of the adenocarcinoma. 
5. Please be more descriptive regarding the resection, of the rectum. Also, during
this procedure were also the cervical lymph nodes operated?
6. Add the T stage, N stage and M stage.
7. Add data on the IHC of the rectum specimen, is it matching with the cervical
lymph nodes. 
8. Please discuss what does it mean when a tumor is positive for GCDFP, CK19,
CK20 and CDX-2.
9. Add detail regarding the follow-up. How long was the follow-up and how was
it performed?
10. Virchow lymph node is typically a sign for advanced gastric cancer, please
rewrite the fragment: "Rectal cancer metastases in the left supraclavicular lymph
node which is also known as the Virchow lymph node, is often a precursor for
malignant diseases." Also, this is no precursor of malignant disease but can be
the first sign of advanced malignant disease (stage IV). 
11. Add a list of reports from the literature in which CRC was first detected after
discovering an enlarged lymph node. 
12. The quality of the figures is very low, also please add in the figures
annotations like arrows and circles so that a reader can quickly recognize the
elements of interest. 
Overall, I consider this case report incomplete and multiple key data are missing.
The structure is not clear and needs to be rewritten. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
'I declare that I have no competing interests'
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes