Reviewer’ s report
Title: Dynamic contrast-enhanced MR and PET/CT findings of uterine sarcomatoid carcinoma: a
case report
Version: 1Date: 23 Aug 2020
Reviewer's report:
The paper has been satisfactorily revised though minor changes are still needed. Suggested
changes are provided for the authors" consideration1/ 10 ( line10)The incidence of SC is low,..2/ 16Ultrasound examination3/ 18-19the uterus was replaced by an ill defined and diffuse lesion with inhomogeneous intensity4/ 27-31USC with lymph node metastasis was diagnosed with the help of immuno-histochemical analysis.There was no treatment related complication and no evidence of tumour recurrence at thepostoperative 6-month follow-up.5/ 32-33MRI and PET/CT features are sufficient to indicate the malignant nature of a USC but they are notpathognomonic6/ 39-41SC is an aggressive malignancy with a high rate of metastasis. It responds poorly to treatment andhas a poor prognosis (5-year survival rate of 15-42%)
7/ 46-47
....PET/CT findings. delete " which may have implications for the preoperative clinical diagnosisof this tumour."8/ 50-51presented with postmenopausal bleeding for 10 days and fever. delete "Amenorrhea for 14 yearswas recorded."9/52-53Her family history was unremarkable. delete "No treatments had been performed."10/ 57were normal11/58-59Pelvic ultrasound showed a heterogeneous mass in the cervix. (Any comment on the uterinebody?) I wonder if the ultrasound showed an enlarged heterogenous uterine mass instead of thecervix based on the figures provided.12/ 62-63the uterus was replaced by an ill defined and diffuse lesion with inhomogeneous intensity13/ 69uterine lesion
14/70
uterine malignancy with nodal metastasis was diagnosed
15/ 75-82Histologically, haematoxylin and eosin (HE) stained sections showed that the uterine tumour wascomposed of spindle cells and nodal metastasis was confirmed. Immunohistochemical analysissupported the diagnosis of USC (Fig 3). The patient received postoperative systemic radiotherapyand chemotherapy. The patient remained well and has no evidence of recurrence at thepostoperative 6-month follow-up.16/84-86I am not sure what WHO guidelines you are referring to. Do you mean it is not listed in the WHO
classification as a separate entity but is included in the differential diagnosis of an aggressive
uterine lesion?
17/92-95
can be deleted because your focus is on imagining studies.18/107-109Our MRI and PET/CT findings of USC were different from previous reports and therefore may notbe specific for USC.19/ 110-114delete or rewrite these lines as I am not sure what you mean20/ 114-115Distinguishing USC from uterine sarcoma is not possible because....21 118-124Although a precise diagnosis of USC could not be established preoperatively, the combination ofclinical, MRI and PET/CT findings support the diagnosis of a malignant disease. The patient wasoperated by gynaeoncologist/doctor with proper expertise followed by adjuvant radiotherapy andchemotherapy> The patient remained well and has no evidence of recurrence at the postoperative6-month follow-up.
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