Reviewer’s report
Title: 
A large ovarian steroid cell tumor-not otherwise specified with a unique
combination of benign and malignant features as a challenging cause of
oligomenorrhea and hirsutism in a 21-year-old Syrian female: a case report.
Version: 
0 
Date: 
04 Feb 2021
Reviewer's report:
BMC Women's Health
BMWH-D-20-01304
"A large ovarian steroid cell tumor-not otherwise specified with a unique
combination of benign and malignant features as a challenging cause of
oligomenorrhea and hirsutism in a 21-year-old Syrian female: a case report"
General remarks
In the present manuscript the authors report a case of a 21-year-old virgin female
who presented to their hospital with complaints of mild abdominal pain,
hirsutism, and oligomenorrhea for more than a year. Before her admission, the
patient had attended an external gynecologic clinic where she had been
prescribed oral contraceptives to regulate her periods. Nevertheless, on
presentation to their institution, physical examination revealed abdominal
tenderness with a palpable pelvic mass and mild hirsutism in the thigh.
Ultrasonography demonstrated a large left ovarian mass measuring 154 x 104
mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy
was performed, and interestingly, pathologic examination of the large
aforementioned mass alongside with immunohistochemical correlation revealed
the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a
unique combination of benign and malignant features.
Authors concluded that although ovarian steroid cell tumors represent a rare
category, they must be considered in the differential diagnosis for mild
virilization symptoms in young females due to the importance of early diagnosis
and management. Authors aimed to present the first case report from Syria that
highlights the crucial role of detailed morphological examination for challenging
cases despite the difficulties in differential diagnosis, and the absence of
ancillary techniques. Furthermore, they managed to discuss a brief review of
diagnostic methods, histological characteristics, and treatment recommendations.
The topic of the manuscript is very interesting because ovarian steroid cell
tumors represent a rare category of sex cord-stromal tumors that constitute less
than 0.1% of all ovarian tumors. These neoplasms are classified into three main
subtypes according to the cell of origin: leidyg cell tumors, stromal luteomas,
and steroid cell tumors not otherwise specified SCTs-NOS. The latter subtype is
defined as a neoplasm of an uncertain lineage that mostly affects middle-aged
women, whereas it's rare in younger ages.
There are some corrections needed before the article is suitable for publication,
which are marked in the attached document.
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 after the final decision on the manuscript has been made. 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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes