Reviewer’s report
Title: 
Signet ring cell-like diffuse large B-cell lymphoma involving the breast: a
case report
Version: 
0 
Date: 
14 Dec 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 a case report describing a 66-year old woman
who presented to the clinic with a breast mass. After pathology analysis, the
patient was diagnosed with diffuse large B-cell lymphoma (DLBCL) with signet-
ring cells. This is a rare form of lymphoma and the report emphasizes the
importance of a good pathologic analysis to make the right diagnosis. 
Signet-
ring cell carcinoma of the breast can be a variant of lobular carcinoma (Eltorky
M. et al, Arch Pathol Lab Med 1994) and could be easily confused with signet-
ring cell DLBCL. The authors have described the case and added reports of
MRI, IHC staining for different markers to confirm diagnosis and FISH staining
for Bcl2-Bcl-6 and c-MYC. There are not many cases like this one described in
the literature, therefore I consider this is an important finding that should be
reported.
REQUESTED REVISIONS: 
Comments: 
- The sequence of events describing the case is difficult to understand. As it is
described it seems as if the patient had a mastectomy before pathology diagnosis,
in that case, it would not have been logical that a patient with a breast tumor >
2cm did not have chemotherapy before mastectomy. Can the authors be more
specific/organized when they describe the case and the sequence of events in
order to make sense of procedures.
- 
- Please explain this sentence (Line 130-31): "breast lobular carcinoma of
gastrointestinal origin". Are you referring to gastrointestinal metastasis that can
originate from a breast lobular carcinoma??. There are no breast lobular
carcinomas that originate from the gastrointestinal tract. 
- Eliminate sentence in line 145, Zhang et (Ann Diagn Pathol, 2017) also
described a DLBCL with signet cells that presented as a breast mass.
- FIG 3 d-e: authors described IgM staining in signet ring cell lymphocytes.
There is no co-staining with other markers to make this affirmation. Please
comment.
- Please rephrase lines 295-297, it seems it refers to IHC staining of mentioned
markers but it is not clear.
- Please be careful with verbs tenses, past and present are constantly mixed and
it's not grammatically correct. Review carefully grammar and spelling
throughout the manuscript.
ADDITIONAL REQUESTS/SUGGESTIONS: 
Grammar should be revised throughout the manuscript.
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of appropriate controls), and are the conclusions supported by the evidence
presented?
No
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No
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Yes
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No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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