Reviewer’ s report
Title: A Mayer-Rokitansky-Kuster-Hauser patient with leiomyoma and dysplasia of neovagina. A
case report
Version: 0Date: 29 May 2020
Reviewer's report:
Overall, this is an article about the combination of three different pathologic conditions: (a)
Mayer-Rokitansky-Hauser syndrome and Davydov neovagina creation (uncommon condition), (b)Uterine leiomyoma (very common condition), (c) HPV infection and dysplasia of neovagina (verycommon condition).
All the above conditions are well described in the literature. Their combination is indeed unusual,
although not unexpected because leiomyomas and/or cervical/vaginal dysplasia are very frequententities. Also, there are many case reports (>25 in the litarature) of MRKH patients with uterineleiomyoma, and a few case-series of women with HPV infection and dysplasia of neovagina.
Thus, this report does not describe an extra-ordinary finding.However, the manuscript is very well written, informative, up-to-date, and it is enriched with the
appropriate variety of clinical, sonographic, and pathology pictures. Moreover, the strong point ofthe report is the long-term follow-up (>30 years), something really informative for this group ofpatients.
Comment #1. I would suggest that the authors explain the possible mechanism the Davydov
neovagina (peritoneum is used in this technique) can be infected by HPV and develop dysplasia in
a way similar to the cervical or vaginal epithelium - contemporary knowledge accepts that cervicaland vaginal epithelium are susceptible to HPV infection in comparison with other epithelialtissues.
Comment #2. No histology has been obtained from the pelvic mass, so this not proven that the
definitive diagnosis is a leiomyoma (did the authors exclude the possibility of a sarcoma?).
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration of competing interests
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