Title: Cornual invasive hydatidiform mole: A rare case report and literature review
Version: 2 Date: 15 Aug 2023
Reviewer:  Aleksandar Rakic
Reviewer's report:
The authors presented an unusual and rare case of an invasive mole mimicking cornual ectopic
pregnancy.
The manuscript contains a brief and clear case presentation with sufficient background. The
images are high-quality and accompany the case well. Since the updates to our knowledge of
gestational trophoblastic neoplasia are provided with new case reports, this rare presentation
deserves to be published and presented to a wider gynecological community. Nevertheless, the
manuscript requires minor revisions to improve the scientific soundness of the draft.
Introduction
Firstly, the authors should clearly define the type of ectopic pregnancy. Clinicians frequently
utilize the phrase cornual ectopic pregnancy as a synonym for interstitial pregnancy. The present-
day understanding of cornual pregnancy is described as "a type of conception that occurs
within the rudimentary horn of a uterus exhibiting a Mullerian anomaly." On the other hand,
an interstitial pregnancy refers to the implantation of a gestational sac within the proximal,
intramural segment of the fallopian tube, surrounded by the myometrium. Therefore, I advise
the authors to mention the difficulties of the utero-tubal ectopic pregnancy definitions.
I also advise the authors to add the definition of an invasive mole as "penetration of molar tissue
into the myometrium and/or presence of extra-uterine metastases".
Case presentation
Check the grammar and spelling.
Examples: "pelvic MRI scan"; line 71 - change "obviously" to "significantly"; lines 76 and 77:
use "we decided to perform an explorative laparotomy and resect the described uterine mass";
line 79 - replace "uterine" to "uterus"; lines 81 and 82 - "The microscopic examination (standard
hematoxylin and eosin staining) of the surgical specimen showed...".
A figure with the histological signs of an invasive mole would improve the draft.
Discussion
I advise the authors to avoid using the past tense in the first paragraph.
Besides the paper by Khlifi et al, a quick literature search found two additional works:
Oskovi Kaplan ZA, #irvan AL, Topçu HO. Invasive molar pregnancy in rudimentary uterine
horn. J Exp Ther Oncol. 2018;12(3):207-210.
Hwang JH, Lee JK, Lee NW, Lee KW. Molar ectopic pregnancy in the uterine cornus. J Minim
Invasive Gynecol. 2010;17(2):239-41. doi: 10.1016/j.jmig.2009.11.010.
I advise the authors to mention these two papers in the Discussion.
Additional grammar check: lines 112 and 113: "Due to the rarity, the management of cornual
invasive hydatidiform mole is uncopied and guided by clinical conditions" - I advise changing
this sentence to: "Due to condition's rarity, the management of the cornual invasive hydatidiform
mole if undefined and guided solely by the presenting condition"; lines 113 to 115: "Whether
cornual invasive hydatidiform mole can be cured through mono-chemotherapy remained
unknown" - I advise changing the sentence to: "Whether monochemotherapy could be the only
management option for the cornual invasive hydatidiform mole has yet to be confirmed by the
future studies"; line 118: the authors should use one of these terms: "cornua" or "horn".