Review for 10.1186/s12876-022-02209-w (2022)

Reviewer’s report
Title: 
Magnifying endoscopic findings of early-stage poorly differentiated
colorectal adenocarcinoma: a case report
Version: 
1 
Date: 
26 Dec 2021
Reviewer: 
Takashi Murakami
Reviewer's report:
Comments to the Author
Thank you for allowing me to review your manuscript, "Magnifying endoscopic
findings of early-stage poorly differentiated colorectal adenocarcinoma: a case
report."
There were some major drawbacks to this study. My comments are as follows:
1. It was concluded that poorly differentiated colorectal adenocarcinomas were
characterized by the lack of staining with crystal violet on magnifying
endoscopy. However, I think it is difficult to endoscopically characterize these
tumors based on a single case. More confirmatory evidence from a greater
number of cases is needed to clarify the endoscopic features of poorly-
differentiated colorectal adenocarcinoma.
2. The authors stated that this lesion presented as a pure poorly-differentiated
colorectal carcinoma. However, histologically, this does not seem to be the case
since Figure 2D reveals poorly-differentiated carcinoma mixed with moderately-
differentiated adenocarcinoma showing irregular crypt-like structures in the
mucosal layer.
3. Furthermore, the authors stated that magnifying endoscopy with crystal violet
staining demonstrated lack of staining with no pit-like structure on the lesion.
However, Figure 1D reveals many micro pit-like structure. These seemed to
reflect not only a few normal crypts surrounded by tumors cells but also
moderately-differentiated adenocarcinoma with irregular crypt-like structures.
4. It was stated that the lesion presented with dense irregular microvessels in
NBI mode (Figure 1B). However, in Figure 1B, it was difficult to identify this
feature. The authors should share a more representative image or more clearly
highlight this feature.
5. The authors misunderstand the meaning of p53 immunohistochemistry
expression. The TP53 gene mutation can be identified as immunohistochemical
overexpression of the p53 protein. Therefore, this lesion, showing complete
absence of p53 expression, appears to lack the TP53 mutation.
6. The authors stated that immunohistochemical staining of the lesion showed
normal Mismatch Repair (MMR), APC, and 
β
-catenin protein expression. The
concept of "normal" is inappropriate in this context. Immunohistochemically, the
presence or absence of protein expressions should be described in detail,
respectively.
7. Which exon of KRAS was examined for the analysis of the gene mutation?
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Declaration of competing interests
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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?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
No