Reviewer’s report
Title: 
The multistep process of vaginal cancer arising from deep infiltrating
endometriosis: a case report
Version: 
0 
Date: 
07 Mar 2021
Reviewer's report:
English should be largely improved, please correct the introduction with a deep
proofreading, taking in account the verbs and the structure of the sentences.
"Endometriosis is defined as the abnormal presence of endometrial tissue, most
often on the ovaries,
fallopian tubes, or elsewhere in the pelvis, and more rarely in extrapelvic
locations, such as bowel,
rectum, and bladder [1, 2]." I will add a statement regarding the presence, not so
infrequent, of endometriosis around the ureters, that are instead a common site
of pelvic endometriosis when compared to rectum and bowel. You can add this
paper as reference https://doi.org/10.1177/2284026518808159
"However, the malignant process of endometriosis is not well understood." I will
discuss the topic regarding the transformation from endometriosis to cancer also
taking in account extra abdominal sites, for example the cesarean scar. Authors
should consider also transformation from endometriosis to clear cell cancer
(degenerating endometriosis), and they can add this citation
https://doi.org/10.1111/jog.14635 to better emphatise this event.
"Since the hormonal milieu may influence the pathogenesis of these two
diseases, women with endometriosis have an increased risk of subsequent
endometrial cancer." Please add a proper reference to this sentence, such as
https://dx.doi.org/10.1097%2FIGC.0000000000000384
The description of the case report was disorganized; please kindly reorganize the
diagnostic and biopsy process and subsequent treatment section.
Please report the presence or abscense of Perineural invasion in the specimen of
the vagina. Infact, the presence of perineural invasion in vagina or vulva should
prompt the linfonodal dissection of the inguinal lymphnodes (refers to
https://doi.org/10.1016/j.ejso.2019.07.029 )
"In the case, rectovaginal endometriosis might have invaded the vaginal and
rectal wall with a polypoid protruding
appearance." Please cite another relevant case report:
https://dx.doi.org/10.1136%2Fbcr-2017-222431
Please enlarge this topic "The case showed the difference in the degree of
malignant change according to the organ where endometriosis is implanted; the
finding was not found in the literature." taking in account this marvellous paper:
https://link.springer.com/article/10.1007/s40944-019-0279-0
The discussion is not well organized, the authors should reshape and better focus
on the most important step. there is too much verbosity.
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