Reviewer’s report
Title: 
Idiopathic retroperitoneal fibrosis with endometrial cancer: A case report
and literature review
Version: 
0 
Date: 
18 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 concurrent
endometrial cancer and idiopathic retroperitoneal fibrosis. The authors also
performed a comprehensive literature review of idiopathic retroperitoneal
fibrosis in term of its diagnosis and management. The manuscript is well written
with good description of the case and patient management in the context of
published literature on this rare condition. I believe the authors had appropriately
outlined the risk of long term Tamoxifen exposure in potentially inducing
development of endometrial cancers. They also have drawn appropriate attention
to the intraoperative surgical challenges to assess nodal tissues in endometrial
cancer patients with retroperitoneal fibrosis. For these reason, the authors had
made a case for publication consideration as 
these two concurrent conditions had
not been previously reported in the literature.
REQUESTED REVISIONS: 
A number of clarifications / revisions would be needed to strengthen and
improve the readability of the case report as listed below :
1. page 3 line 55-56 : need references in support the use of glucocorticoids and
tamoxifen in the chronic management of retroperitoneal fibrosis.
2. page 3 line 60-61 :suggest revising the sentence to emphasize long term of of
Tamoxifen is recognized as a risk for endometrial cancer development. iRPF
does NOT cause endometrial cancer.
3. page 4 line 67-68 : please clarify what year did patient presented with irregular
vaginal bleeding? Also please add her prior menstrual and gynecologic history
for comparison. Please clarify if any bowel or bladder disturbances on
presentation. Does the patient have any risk factors for endometrial cancer?
BMI? family history? hx of hormone use?
4. page 4 
line 75 : please clarify when patient started to take Prednisone ? Why
was this stopped after 2 years? How was the patient monitored while on
Prednisone - was there any improvement? worsening?
5. page 5 line 86-89 : was there any other abnormalities on ultrasound? ovary?
ascite? pelvic abnormalities?
6. page 5 line 92-93 : what was the tumour MMR status in addition to POLE
positive? 
7. page 5 line 97-98 : has the enlarged pelvic nodes changed from previous
imaging investigations? if not it might not have been related to her endometrial
cancer and more due to the inflammatory nature of the fibrosis?
8. page 5 line 101-2 : Not sure what CTU means? Also please clarify what
"water accumulation" means?
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