AI Peer Review Prompt for Q1 High-Impact Factor Journals
Instructions for the AI:

You are an expert peer reviewer for high-impact Q1 journals in the relevant field. Your task is to provide a detailed and constructive peer review of the provided manuscript titled “Concurrent Kaposi's sarcoma and peripheral T-cell lymphoma in an HIV-positive patient: A diagnostic challenge and therapeutic dilemma”. The review should be thorough, objective, and aimed at evaluating the manuscript's suitability for publication in a top-tier journal.

Please structure your review using the following sections and guidelines:

1. Manuscript Summary
Objective:
Provide a concise summary (2-3 sentences) of the manuscript’s main objectives and scope.
Key Findings:
Summarize the primary findings or conclusions of the study.
Significance:
Highlight the significance of the research in its respective field.
2. Overall Assessment
Originality and Novelty:
Does the manuscript present original research?
Are the findings novel and significant to the field?
Suitability for the Journal:
Is the manuscript aligned with the journal’s scope and aims?
Does it fit within the types of articles the journal publishes (e.g., original research, reviews, case studies)?
Impact Potential:
Could the findings influence future research, policy, or practice?
Does the study address a critical gap in the literature?
Recommendation:
Select one of the following and provide a brief justification:

Accept without revision
Accept with minor revisions
Revise and resubmit
Reject
3. Detailed Comments
A. Title and Abstract

Title:
Is it concise, informative, and reflective of the study’s content?
Abstract:
Does it effectively summarize the background, methods, results, and conclusions?
Is it within the word limit and free of jargon?
B. Introduction

Background:
Does it provide sufficient context and rationale for the study?
Objectives/Hypotheses:
Are the research questions or hypotheses clearly stated?
Literature Review:
Is the relevant literature adequately reviewed and appropriately cited?
C. Methods

Study Design:
Is the study design appropriate for the research questions?
Participants/Samples:
Are the selection criteria and sampling methods clearly described?
Procedures:
Are the procedures and protocols detailed enough to allow replication?
Instruments/Measures:
Are the tools and measures used validated and reliable?
Data Analysis:
Are the statistical or analytical methods appropriate and correctly applied?
Ethical Considerations:
Are ethical approvals and consent procedures adequately addressed?
D. Results

Clarity and Organization:
Are the results presented clearly and logically?
Data Presentation:
Are tables, figures, and charts used effectively and appropriately?
Statistical Analysis:
Are the statistical analyses sound and correctly interpreted?
E. Discussion

Interpretation of Results:
Are the findings interpreted accurately and in the context of existing literature?
Implications:
Does the discussion highlight the practical or theoretical implications of the research?
Limitations:
Are the study’s limitations acknowledged and discussed?
Future Directions:
Are suggestions for future research provided?
F. Conclusion

Summary of Findings:
Does the conclusion succinctly summarize the key findings?
Relevance:
Are the conclusions justified based on the results?
G. References

Relevance and Currency:
Are the references relevant and up-to-date?
Citation Style:
Are they formatted according to the journal’s guidelines?
H. Language and Style

Clarity:
Is the manuscript written clearly and concisely?
Grammar and Syntax:
Are there grammatical or typographical errors?
Terminology:
Is appropriate technical terminology used consistently?
I. Figures and Tables

Quality:
Are figures and tables of high quality and readable?
Relevance:
Do they complement and enhance the text?
4. Strengths of the Manuscript
Highlight the key strengths, such as innovative methodology, robust data analysis, significant findings, or comprehensive literature review.
5. Weaknesses and Areas for Improvement
Identify major and minor weaknesses.
Provide constructive suggestions on how to address these issues.
Examples include methodological flaws, insufficient data, lack of clarity, or gaps in the literature review.
6. Additional Comments
Include any other observations or suggestions that could help improve the manuscript.
Mention if certain sections require reorganization or if supplementary materials are needed.
7. Confidential Comments to the Editor (Optional)
Share any concerns about the manuscript that are not meant to be communicated to the authors directly.
Discuss potential ethical issues, conflicts of interest, or reasons for the recommendation if they differ from standard criteria.
8. Reviewer’s Declaration
Confirm that the review is unbiased and based solely on the manuscript’s content.
Declare any potential conflicts of interest.


"Concurrent Kaposi's sarcoma and peripheral T-cell lymphoma in an HIV-positive patient: A diagnostic challenge and therapeutic dilemma

Mohammadreza Eslami1,2, Mahdi Mehrabi1,2, Mazaher Ramezani3, Amirabbas Rashidi4*

1. Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
2. Department of Clinical laboratory sciences, School of paramedical, Kermanshah University of
Medical Sciences, Kermanshah, Iran
3. Molecular Pathology Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
4. Department of Internal Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
* Correspondence

Abstract
Background: The co-occurrence of Kaposi's sarcoma (KS) and peripheral T-cell lymphoma (PTCL) in HIV-positive patients is extremely rare and poses special diagnostic and therapeutic challenges.
Case presentation: We report the case of a 34-year-old woman who presented with disseminated skin lesions and subsequently diagnosed with both KS and PTCL. The initial misdiagnosis as primary cutaneous T-cell lymphoma highlights the complexity of evaluating multiple malignancies in immunocompromised patients. Despite chemotherapy, the patient experienced recurrence of KS, highlighting the need for tailored treatment approaches in such cases.
Conclusions: This case emphasizes the importance of a comprehensive diagnostic workup in HIV-positive patients with atypical presentations. It also illustrates the potential for concurrent AIDS-defining malignancies and the need for multidisciplinary treatment strategies.
Introduction
Kaposi's sarcoma (KS) and peripheral T-cell lymphoma (PTCL) are distinct malignancies associated with immunosuppression, particularly in the setting of HIV infection (1). KS, caused by human herpesvirus-8 (HHV-8), typically manifests as skin lesions and is considered an AIDS-defining disease (1). It often manifests as skin lesions, most commonly in the lower extremities (2). PTCL, a heterogeneous group of aggressive T-cell neoplasms, accounts for approximately 15% of non-Hodgkin lymphomas and can present with diverse clinical features (3).
The simultaneous occurrence of these two malignancies in a single patient is extremely rare and only a few cases have been reported in the literature. This rarity presents significant challenges in diagnosis and treatment, as the clinical and pathological features of one disease can make or mimic the other. Here, we present a case that illustrates these challenges and provides insights into the complexities of treating multiple AIDS-related malignancies.
Case presentation
Patient Information
A 34-year-old woman presented to our clinic in January 2023 with a two-month history of progressive skin lesions. The patient had no significant medical history and was not taking any medications. She reported no recent travel or notable revelations.
Timeline
November 2022: First appearance of skin lesions
January 2023: Presentation at the clinic; initial misdiagnosis as lichen planus
Early February 2023: Spread of the lesions to the oral mucosa; first unsuccessful skin biopsy
Mid-February 2023: Repeat skin biopsy; Hematology consultation; Bone marrow examination
Late February 2023: Admission to Imam Khomeini Hospital
March 2023: Transfer to Imam Reza Hospital; Confirmed diagnoses of KS and PTCL and diagnosis of HIV infection
April-June 2023: Six cycles of CHOEP chemotherapy
July 2023: Completion of chemotherapy
August 2023: Development of new extensive skin lesions
Diagnostic Assessment
Initial laboratory tests revealed anemia (hemoglobin 10 g/dL) and thrombocytopenia (platelet count 70 × 109/L). The first skin biopsy was inconclusive, but a repeat biopsy showed lymphocytic infiltration with an angiocentric pattern suggestive of lymphoma.
Bone marrow studies were crucial in establishing the diagnosis (Figure 1). The aspiration smear revealed a hypercellular bone marrow with predominantly medium to large atypical lymphoid cells, that had irregular nuclear contours and dispersed chromatin. The biopsy section showed diffuse infiltration of these cells, destroying the normal bone marrow architecture. These findings were consistent with PTCL.
Immunohistochemical staining of skin lesions was positive for HHV-8 in endothelial cells (Figure 2), confirming the diagnosis of KS (4). Serological tests confirmed HIV infection.
Therapeutic Intervention
The patient was started on antiretroviral therapy for HIV. She received six 21-day cycles of CHOEP chemotherapy (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) for the malignancies.
Follow-up and Outcomes
One month after completion of chemotherapy, the patient developed extensive new skin lesions on the abdomen, genitals, back, and limbs, associated with local numbness and urinary retention. Imaging showed mild cardiomegaly and slight pericardial effusion, but the lymphoma appeared to be in remission. The patient's anemia had improved slightly to a hemoglobin level of 10.7 g/dL.
For the recurrent KS lesions, treatment with paclitaxel was initiated, which resulted in a significant therapeutic response and symptom improvement. The patient continues antiretroviral therapy under close monitoring. 
Discussion
This case raises several important clinical and pathophysiological considerations:
Diagnostic challenges: Initial misdiagnosis as primary cutaneous T-cell lymphoma highlights the difficulty of distinguishing between multiple malignancies in immunocompromised patients. The case emphasizes the need for a comprehensive workup, including multiple biopsies and immunohistochemical studies.
Concurrent Malignancies: The co-occurrence of KS and PTCL in this HIV-positive patient is exceptionally rare. It raises questions about possible shared pathogenic mechanisms or risk factors beyond immunosuppression alone (5,6).
Complexity of Treatment: Treating concurrent malignancies presents a therapeutic challenge. While the CHOEP regimen appeared to be effective in PTCL, it failed to prevent recurrence of KS, necessitating additional targeted therapy.
Immunological Implications: The case provides insights into the complex interplay between HIV infection, immune deficiency, and the development of multiple malignancies. It highlights the importance of early HIV diagnosis and treatment for the prevention of AIDS-related cancers.
Follow-up Considerations: The rapid recurrence of KS lesions after chemotherapy highlights the need for close monitoring and long-term follow-up in such cases. It also raises questions about optimal maintenance strategies for patients with multiple AIDS-related malignancies.
This case contributes to the limited literature on concurrent KS and PTCL in HIV-positive patients. It underscores the importance of maintaining a high index of suspicion for multiple malignancies in immunocompromised individuals with atypical features. Furthermore, the need for individualized treatment approaches and multidisciplinary care in managing these complex cases is highlighted.
Future research should focus on elucidating possible common pathogenic mechanisms between KS and PTCL in the context of HIV infection (7). Furthermore, prospective studies on optimal treatment strategies for patients with concurrent AIDS-related malignancies are needed to improve outcomes in this challenging patient population.
Patient Perspective
The patient made the following statement: “At first, I was overwhelmed by the multiple diagnoses. The treatment journey was challenging, but I am grateful for the comprehensive care I received. I hope my case can help doctors better understand the situation and treat others with similar complex conditions.”
Informed Consent
Written informed consent was obtained from the patient for publication of this case report and associated images.
Conflicts of Interest
The authors declare that they have no conflicts of interest related to the subject matter or materials in this article.
Acknowledgements
The authors thank the Razi and Avesta laboratories in Tehran for their cooperation and assistance in reviewing this case. The authors would also like to thank Claude, an artificial intelligence assistant developed by Anthropic, for improving and modifying this article.

References

1. 	Cesarman E, Chadburn A, Rubinstein PG. KSHV/HHV8-mediated hematologic diseases. Vol. 139, Blood. 2022. p. 1013–25. 
2. 	Cesarman E, Damania B, Krown SE, Martin J, Bower M, Whitby D. Kaposi sarcoma. Nat Rev Dis Prim. 2019;5(1). 
3. 	Fiore D, Cappelli LV, Broccoli A, Zinzani PL, Chan WC, Inghirami G. Peripheral T cell lymphomas: from the bench to the clinic. Vol. 20, Nature Reviews Cancer. 2020. 
4. 	Pantanowitz L, Caponetti G, Dezube BJ. The Immunohistochemistry of Kaposi’s Sarcoma. Methods Cancer Diagnosis, Ther Progn [Internet]. 2010 [cited 2024 Oct 19];405–31. Available from: https://link.springer.com/chapter/10.1007/978-90-481-2918-8_33
5. 	Carbone A, Vaccher E, Gloghini A, Pantanowitz L, Abayomi A, De Paoli P, et al. Diagnosis and management of lymphomas and other cancers in HIV-infected patients. Nat Rev Clin Oncol 2014 114 [Internet]. 2014 Mar 11 [cited 2024 Oct 19];11(4):223–38. Available from: https://www.nature.com/articles/nrclinonc.2014.31
6. 	Gonçalves PH, Uldrick TS, Yarchoan R. HIV-associated Kaposi sarcoma and related diseases. AIDS [Internet]. 2017 Sep 10 [cited 2024 Oct 19];31(14):1903–16. Available from: https://journals.lww.com/aidsonline/fulltext/2017/09100/hiv_associated_kaposi_sarcoma_and_related_diseases.2.aspx
7. 	Bhutani M, Polizzotto MN, Uldrick TS, Yarchoan R. Kaposi Sarcoma–Associated Herpesvirus-Associated Malignancies: Epidemiology, Pathogenesis, and Advances in Treatment. Semin Oncol. 2015 Apr 1;42(2):223–46. 

Figures:
  Figure 1: Bone marrow studies demonstrating peripheral T-cell lymphoma infiltration. (A) Bone marrow aspiration smear (Wright-Giemsa stain, 400x magnification) showing hypercellularity with predominantly of medium to large atypical lymphoid cells. These cells have irregular nuclear contours, dispersed chromatin, and low to moderate amounts of basophilic cytoplasm. (B) Bone marrow biopsy section (H&E stain, 400x magnification) showing diffuse infiltration by atypical lymphoid cells, effacing the obliterating normal bone marrow architecture. In both samples, the normal hematopoietic elements are markedly reduced, which explains the patient's cytopenias.

 
Figure 2: Immunohistochemical analysis of human herpesvirus 8 (HHV8) expression in skin tissue. Positive intranuclear immunoreactivity for HHV8 LANA (brown staining) is observed in endothelial cells, confirming the presence of HHV8 infection and supporting the diagnosis of Kaposi's sarcoma."