Reviewer’s report
Title: 
Endometrioid adenocarcinoma arising in adenomyosis in a patient with
pelvic organ prolapse - Case report
Version: 
1 
Date: 
07 Feb 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (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?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
Not sure - key details are missing from the manuscript
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 - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: This is an interesting paper reporting on a relatively
rare entity. Additional clarifications would need to be made before the
manuscript can be considered for publication as listed subsequently
REQUESTED REVISIONS: 
1. Page 3 , line 50-1 : "…occur in less than 1 is extremely rare.." - Not clear less
than 1 what ?? please clarify
2. In the introduction section, it would be helpful for the authors to clearly define
pathologic criteria used to differentiate endometrial carcinoma coexisting with
adenomyosis (EC-A) vs EC arising in adenomyosis (EC-AIA) and comment on
how reproducible these criteria are in differentiating the 2 entities ?
3. Demographically, does the patient have any other past history of cancer or
family history of cancers specifically with respect to breast or colon cancers ?
Was she on any medications ? What was her past menstrual history ? Any
history of PCOS or oligomenorrhea or dysmenorrhea that would suggest prior
adenomyosis ?
4. Line 90 : Pathologically speaking - Was exact measurement of myometrial
invasion available ? Was myoinvasion more or less than 50% ? Any LVSI
presence ?
5. Line 96 : Any abnormal intraoperative findings ? Was surgery done by
laparotomy or laparoscopically ?
6. Line 99 : It would appear that this patient have early stage low-risk disease.
Why was post operative adjuvant therapy suggested and what form of therapy
was recommended to her ?
7. Line 101 : Please justify the use of CA 125 and HE4 for diagnosis and routine
monitoring of endometrial cancer ?
8. Line 104 : "….has a tendency towards malignant transformation" - please
provide a reference to this statement.
9. Line 168 : please provide a reference in support of this statement of expected
poor prognosis ?
ADDITIONAL REQUESTS/SUGGESTIONS: 
see comments above"
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
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No
Is the use of statistics and treatment of uncertainties appropriate?
No
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Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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