Reviewer's report
Title:Huge pyogenic cervical cyst with endometriosis, arising from a
myomectomy scar: a case report
Version:1Date:2 June 2014
Reviewer: Zachary Nash
Reviewer's report:
Re: Huge pyogenic cervical cyst with endometriosis, arising from a myomectomy
scar: a case report.
By Katsutoshi Oda and colleagues
The case presented makes a previously unreported association between
myomectomy and a pyogenic cervical cyst. It is particularly unusual given the
many years between myomectomy and cyst development. It has educational
value as it offers an additional differential diagnosis to malignancy or fibroid
recurrence when a pelvic mass is discovered in women who have undergone
previous abdominal myomectomy. It is therefore worth publishing.
The standard of writing is generally good, although there are some errors. For
instance the Case presentation says 'including one with 1.4kg in the lower...' and
should probably read 'including one weighing 1.4kg'. Such errors are likely
correctable by the authors proofreading.
The presentation of the case is greatly aided by its attached MRI images and a
clinical photograph.
There are however several issues with the paper which would require revision
before a recommendation about publication can be made.
Abstract
Major Compulsory revisions
1) Case presentation order gives Pathological findings before operative details.
Yet the pathology was unknown until time of exploratory laparotomy. This should
be reordered to say 'The patient underwent... pathological examination
revealed...' (or such like)
Background
Major Compulsory revisions
1) It is stated that 'the development of pyogenic cervical cysts is rare' however no
reference has been given to support this and the authors only go on to give Cho
(2008) as a single example after caesarean section. Have any other cases been
reported after caesarean/ GYN surgery/ General surgery?
Case presentation
Major Compulsory revisions
1) That the patient 'periodically underwent...endometrial cancer screening' is
surprising to a British reviewer as screening of asymptomatic women is not
mainstream practice in the UK or USA. Additionally, details of the screening
method should be given as if by trans vaginal ultrasound it is interesting that
cystic abnormality was not visualised earlier.
2) The timings in the presentation of the case appear confused and would benefit
from being re-ordered sequentially.
It is initially made clear that the patient presented 13 years after abdominal
myomectomy and the authors then say that '8 years after the surgery' MRI had
been undertaken and revealed no abnormality. Why was MRI undertaken then?
However in the next paragraph they say that pelvic examination noted
abnormality 5 years after myomectomy. It appears that this finding led to
ultrasound, MRI and CT which did reveal abnormality.
Why therefore was intervention delayed? Did the pathology appear at 5 years or
13 years after myomectomy?
3) Further, a description of any symptoms that the patient had should be made.
Particularly any that influenced the decision to operate.
4) The final paragraph concludes that the pyogenic cyst 'most likely originated
from the scar caused by the myomectomy.' This should be clarified to mean the
uterine scar or skin scar?
5) The abbreviation SCC should be clarified by giving the full name of 'Squamous
cell carcinoma antigen'.
Conclusions
1) Reference 6 do not support the claim made - West only reports 1 wound
infection in his case series and the review does not contain enough cases to say
that infection is associated with entry into the uterine cavity.
Other:
Suggested references for consideration by the authors
Provides an overview of E. Coli in the Vaginal tract: and differentiating my type
with that in bowel.
Obata-Yasuoka, M., Ba-Thein, W., Tsukamoto, T., Yoshikawa, H. & Hayashi, H.
Vaginal Escherichia coli share common virulence factor profiles, serotypes and
phylogeny with other extraintestinal E. coli. Microbiology 148, 2745–2752 (2002)
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests