Title: MRI and FDG PET/CT Findings for Small cell neuroendocrine carcinoma of the Ovary:
A Case Report and Literature Review
Version: 0 Date: 13 Oct 2024
Reviewer:  Yuquan Chen
Reviewer's report:
The manuscript titled "MRI and FDG PET/CT Findings for Small Cell Neuroendocrine
Carcinoma of the Ovary: A Case Report and Literature Review" presents a rare case of ovarian
small cell neuroendocrine carcinoma (OSCNEC) and provides a detailed discussion of its
imaging findings, particularly using MRI and FDG-PET/CT. The case is well-documented
and offers valuable insight into an underreported condition. However, significant revisions are
necessary for this manuscript to reach its full potential.
Firstly, there is inconsistent use of terminology regarding the classification of OSCNEC. The
manuscript shifts between the old and new WHO classification systems, particularly in reference
to SCCOPT and OSCNEC. It is recommended that the authors streamline the discussion to
adhere to the latest WHO classification and briefly refer to the older terminology only for context
to ensure consistency throughout the text.
Secondly, while the imaging findings of OSCNEC are well presented, there is a lack of
comparative analysis with other ovarian malignancies. Expanding on how these imaging results
differ from other tumors, such as mucinous adenocarcinoma or serous carcinoma, would
improve the clinical relevance of the manuscript.
The literature review section is superficial and does not provide an adequate summary of
previous cases of OSCNEC imaging findings. Although the authors correctly note that PET/CT
findings have not been previously reported, the review lacks a comprehensive analysis of other
imaging techniques for this type of carcinoma. The authors should expand this section to include
more extensive literature and provide a broader context for the case.
The discussion on serum markers, particularly NSE, is underdeveloped. While elevated NSE
levels are mentioned, there is insufficient exploration of its diagnostic and prognostic value in
OSCNEC. A more detailed comparison with other markers, such as CA125, and a discussion of
NSE in the context of other neuroendocrine and ovarian tumors would enhance the manuscript.
The presentation of surgical findings is somewhat unclear. The macroscopic and microscopic
pathology descriptions are detailed but lack integration with the broader clinical context. The
authors should expand on how the surgical findings correlate with the imaging results, linking
radiological observations to the histopathological evidence more effectively.
The manuscript highlights the PET/CT findings but does not make a strong case for the
diagnostic role of PET/CT in OSCNEC. The authors should provide a more robust argument on
how PET/CT improves diagnostic accuracy, staging, or treatment planning compared to other
imaging modalities. Strengthening this argument would significantly enhance the manuscript’s
impact.
Additionally, the manuscript briefly mentions that the patient received radiation therapy but
declined chemotherapy and subsequently died four months post-operation. However, there
is no discussion about treatment protocols or how the patient’s treatment decisions affected
her prognosis. A discussion of the potential therapeutic options for OSCNEC, including
chemotherapy, and an analysis of why radiation was chosen would add depth to the clinical
implications of the case.
Lastly, although the PET/CT detected metastases, there is limited discussion of the metastatic
patterns specific to OSCNEC, particularly hematogenous spread. A more in-depth exploration
of how the metastatic behavior of OSCNEC differs from other ovarian cancers, and whether
early detection of bone metastases could have altered the treatment plan, would add valuable
insights to the case.
In conclusion, major revisions are recommended for this manuscript to address the above
concerns before it can be considered for publication.