Title: Disordered hypothalamus-pituitary-ovary axis in heterotopic extraovarian sex cord-
stromal proliferation: a case report of fallopian tube serous adenofibroma
Version: 0 Date: 29 Mar 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
N/A - there are no statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: A very interesting case report of hormonally active heterotopic
extraovarian sex cord-stromal proliferation from a fallopian tube serous adenofibroma. This is a
relatively rare entity  and a novel report. The authors included a detailed pathology description
as well as appropriate imaging tests as performed in this patient.
A few additional clarifications are suggested to improve the original manuscript as listed below.
REQUESTED REVISIONS:
-Line 30-31 : suggest including normal range for AMH/ FSH/ LH at authors institution on this
line as well as the included table 1.
-Line 30-31 : Suggest replacing ""resistant ovary syndrome""  with ""Gonadotropin-resistant
ovary syndrome"" to be clear to the readers
-Line 55-56 : ""A review of literature of earlier cases with clinicopathological presentation of
this tumor has recently been summarized "" - please expand on what was the main points of this
review for the readers to put this paper in context of previously published work
-Line 87 :Need more details regarding ""irregular cycles"". Was this acute in onset? what was the
frequencies of menses ?duration of menstrual flow. Please also provide patient prior menstrual
pattern prior to presentation for comparison purpose.
-Line 87 : Please confirm if there is any other abnormal clinical signs on physical examination.
Any signs of androgen/cortisol excess, thyroid abnormalities, galactorrhea that can cause
""irregular cycles"" in this patient ?
-Line 91 : suggest adding that other hormone tests as listed in table 1 were normal on this line
as well. Was there bHCG measurement done ?
-Line 92 : ""An ultrasound scan was suggested, but the patient hesitated: - please clarify why
was the hesitation ?
-Line 102  please describe further the nature of the ovarian cyst ? Simple vs complex ? septation ?
solid ?cystic ? internal blood flow ?excrescences ?ascite
-Line 104 : Suggest revising ""Laparoscopic operation ""  to ""Laparoscopic evaluation"".
-Line 104 : describe any other laparoscopic intra abdominal abnormalities if present ?
-Line 104-5 : ""A right fallopian tube cyst was completely excised (Figure 2A)."" please describe
exact location of cyst. How closely does it related to the ovarian surface ? Any adhesions ? Any
difficulty with laparoscopic removal that potentially could have included some ovarian tissues
in the specimen ?
-Line 203: Suggest changing  ""adenofribromas ""  to "" adenofibromas"" throughout the paper
and ""BRAC"" change to ""BRCA"".
ADDITIONAL REQUESTS/SUGGESTIONS:
see above"