Reviewer's report
Title:An unusual case of a woman with multiple recurrent cystic ovarian
teratomas
Version:1Date:2 January 2014
Reviewer: Theophilus Nwankwo
Reviewer's report:
Reviewer’s Comments to the Authors.
Major revisions
Abstract:
1. This is not quite satisfactory; the 2nd and 3rd sentences are more of literature
review than the patient’s history and clinical features. Summarize the patient’s
history and peculiar clinical features.
2. It is usual for surgeons to look at the contra-lateral ovary even before
operating on the affected ovary. You conclusion should give something more
than this. Suggestion: the apparent features suggesting malignant may misled
the surgeon into more extensive surgery that might compromise fertility in this
young patient especially where there is poor facility for adequate diagnosis.
Case Summary:
3. What was the parity of your patient?
4. Your patient consistently presented with menstrual abnormalities
(dysmenorrheoa and prolonged menstrual bleeding), are they incidental
symptoms or due to the tumor? There was no mention of further investigation in
that direction at least to show that patient was comprehensively treated.
5. Were the two previous interventions done in your centre and by you? If yes it
should be stated.
6. Did the patient have laparoscopically assisted ovarian cystectomy or
laparoscopic cystectomy. The word assisted is commonly used in
laparoscopically assisted hysterectomy.
7. You did not give the size of the cyst before the first surgery and visual
characteristics supporting dermoid cyst before confirmation by histopathology
report, just to be sure that proper treatment modality was applied.
8. Concerning the second surgery in this patient, though appeared to have been
justified by subsequent recurrence, the description of the features didn’t show
convincing reason for surgical intervention in a reproductive age woman. This is
in view of the recommended conservative management of simple ovarian cyst of
that size in reproductive age women.
9. The last sentence in the case presentation needs be reframed. What do you
mean by resuming normal activity after 1.5 years? You should state how your
patient was followed up, what parameters were used? 1.5 years may better be
expressed as 18 months. The patient cannot be the one to demonstrate signs of
recurrence; the signs should be carefully sought by the care giver.
10. There was no reference to the raised ca 125 after the surgery. In your
discussion you mentioned of CA 9-19 as being more specific for MCT, why was it
not assayed in your patient?
Discussion:
11. The literature review in your discussion is detailed but you didn’t quite
discuss your patient effectively. You mentioned your patient only once at the end
of your discussion. I suggest that you describe how every aspect of the literature
(demography, presentation, clinical features, investigation and treatment) applied
to your patient. Emphasize peculiarities that made the case reportable.
12. Conclusion: What do you mean by silent ovary, and how does this relate to
you patients presentation? The comment on the conclusion in the abstract also
applies here.
Discretional revision:
Under Back ground information:
13. You may need to modify the definition on MCT; I suggest you delete the
“Solid”
Figures
14. It would have been interesting to show the ovaries after the cystectomy.
Topic:
15. I suggest that the title may need some modification. Suggested title: A case
of multiple recurrent and bilateral ovarian mature teratoma in a young woman
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing inetrest