Reviewer ’s report  
 
Title: A PATHOLOGICAL AND CLINICAL STUDY OF 706 PRIMARY TUMOURS OF 
THE  OVARY IN THE LARGEST TERTIARY H OSPITAL IN GHANA  
 
Version: 1 Date: 21 Nov 2016  
 
Reviewer: Linda Kelemen  
 
Reviewer's report:  
 
In the manuscript "A clinic -pathological study of 706 ovarian tumors in the largest tertiary 
hospital in Ghana", Akakpo and colleagues describe the distribution of different ovarian tumors 
by age group in Ghana. This study helps to fill an important gap in  understanding geographical 
and racial distributions of these tumors.  
 
 
 
 
Recommendation: Major edits required.  
 
Generally, the manuscript could benefit from English language proofreading. Specifically, 
"commonest" should be rephrased to "most common". I have  some other specific suggestions for 
the authors to consider.  
 
 
 
Abstract and Results  
 
1. Because the ovarian tumor types are different, it is not informative to describe a "general" 
age or age distribution for all patients. The descriptions should be accordi ng to tumor 
type. I suggest updated the Abstract and deleting the first paragraph of the Results. 
Likewise, it may be more informative to describe symptomology according to tumor type 
rather than collectively.  
 
 
 
Materials and Methods  
 
2. 706 ovarian tumors w ere reviewed, but were any excluded because they were found not 
to be ovarian tumors?  
 
 
3. WHO 2014 criteria now exist for classification of ovarian tumor histotype. The authors 
should acknowledge these new guidelines and the possibility that the authors' fi ndings 
may be based on some existing misclassification of ovarian histology.  
Results  
 
4. line 15: "Ascites was present in 10.6% but in 10.6% the ovarian tumors were found 
incidentally." This sentence is unclear - are both percentages correct?  
 
 
5. line 26: N =172 - does this imply that only 172 of 706 patients reported symptoms? This 
needs to be clearer.  
 
 
 
 
Discussion  
 
6. The Discussion re -states much of the Results and could be streamlined by greatly 
reducing re -stating the percentages of tumors found in this stu dy. 
 
 
7. line 26 and line 41: reference #15 appears to be incorrectly cited in one of these 
instances.  
 
 
8. References #14 and #15 are heavily cited to refer to patterns of ovarian tumor 
distributions in the US and India. Ref #14 appears to be a textbook from 2004 - it would 
be better to cite most recent statistics obtained from the US SEER registry, for example 
(Surveillance, Epidemiology and End Results - available freely online).  
 
 
9. Page 8, line 10: please clarify if the authors mean to say that mucinous ova rian tumors 
represent 8.5% of all ovarian tumors (N=706) or of all epithelial ovarian tumors. Using 
the latter as the denominator would be more meaningful. Also, do the authors mean both 
invasive and borderline mucinous tumors? Please clarify because the m ost recent 
prevalence estimates for primary invasive ovarian mucinous tumors are 3 - 4% of all 
epithelial ovarian tumors in the US (after accounting for metastases and excluding 
borderline tumors). For example, see Seidman JD et al, Am J Surg Pathol. 2003; 27(7): 
985-93. Further, bilateral mucinous tumors tend to be metastatic - this should be 
mentioned.  
 
 
10. Page 8, line 46 and 57 - reference 14 is cited incorrectly.  
 
 
11. Page 9, line 4: the authors cite the Moorman study of Caucasians and African Americans 
in the US. It would be useful to compare age distribution in the author's study to the 
Moorman study for African patients (as they do for Caucasians).  
 
12. Suggest to  remove the subheading "Clinical Features" from the Discussion.  
 
 
 
 
References  
 
13. References 18 and 21 are the same.  
 
 
 
Tables  
 
14. These are generally fine. Please correct the adding error in Table 2 for "Total" - should be 
287 not 187. Also, under "Tumor Behav ior", please change "Ovarian Cancer" to 
"Invasive".  
 
 
 
Comments to Editor:  
 
1. The authors claim that partial results describing tumors in children and adolescents were 
published previously, potentially constituting overlap with the current manuscript. This 
should be checked.  
 
 
 
 
 
Are the methods appropriate an d well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn a dequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recom mended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
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