Reviewer’s report
Title: 
Primary Ovarian Endometrioid Stromal Sarcoma Presenting with Reno-
Ureteral Colic
Version: 
2 
Date: 
07 Jun 2022
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are minor issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: This is an interesting case report of a rare entity
(ovarian low grade stromal sarcoma) that presented with urologic obstructive
symptoms. This add to the current knowledge of this rare entity. The authors did
a good job in presenting the case as well as the pathologic findings as well as
follow up outcomes of the patient.
The literature review also support the rarity of this condition (only 41 cases
treated with surgery only in the world literature)
REQUESTED REVISIONS: 
-Additional information on clinical presentation would be helpful: any
postmenopausal bleeding ? any hormonal use ? any prior history of
endometriosis ?
-On clinical examination and fixation to the surrounding structure especially if
the mass is causing renal colic due to ? obstruction
-Please comment on US characteristics of the mass specifically with vascular
flow pattern and pulsatility index
-Was there any evidence of vascular invasion at the time of surgical exploration.
Low grade uterine stromal sarcoma often grows into venous channels.
-Was there any endometriosis involvement in the ovary ? Can this entity arise
from an ovarian endometrioma ?
-Pathologically : was margin of resection clear of tumour ? any necrosis ? any
vascular invasion
ADDITIONAL REQUESTS/SUGGESTIONS: 
See my suggestions above
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