Exploring Perforated Jejunal GIST: A Rare Case Report and Review of Molecular and Clinical Literature

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In line 45: How can be a tumor (GIST here) crucial for GI motility? Did you mean interstitial cells of Cajal are important for GI motility?

I suggest changing the introduction to be brief which can be more effective.

In line 206 and 207: The word 'and the' is repeated. The same for the case presentation, which can be made brief and more effective.

I was expecting a little more information on Management and adding the current European and American guidelines for medical and surgical management.

Author Response

Dear Reviewer 1,

Thank you immensely for your thorough and constructive feedback on our manuscript. Your insights have been invaluable in enhancing the clarity, accuracy, and overall quality of our work. Here are the detailed responses to your comments:

Point 1:

• Comment: In line 45, about the role of GIST in GI motility, questioning if the intended reference was to the interstitial cells of Cajal.
• Response: Your observation is spot on. It was indeed a misrepresentation to imply that GISTs play a role in GI motility. The correct reference should be to the interstitial cells of Cajal, which are crucial for this function. This error has been corrected in the revised manuscript. We are grateful for your attention to detail and apologize for the oversight.

Point 2:

• Comment: Suggestion to make the introduction more concise and effective.
• Response: Taking your valuable suggestion into account, we have restructured the introduction to be more succinct and focused, ensuring that it effectively sets the stage for the manuscript while being concise. We appreciate your guidance in improving the readability and impact of our introduction.

Point 3:

• Comment: Noting the repetition of 'and the' in lines 206 and 207.
• Response: The redundancy in the mentioned lines has been rectified. We are thankful for your meticulous review, which helps in maintaining the high standard of our manuscript.

Point 4:

• Comment: Expectation of additional information on GIST management and the inclusion of current European and American guidelines.
• Response: We have expanded the discussion in section 3.7, "Treatment of Gastrointestinal Stromal Tumors," to include a more comprehensive overview of management strategies, integrating the latest ESMO–EURACAN and 2023 GEIS guidelines. These additions not only enrich the content but also ensure that our manuscript reflects the current state-of-the-art in GIST management. Your suggestion was instrumental in broadening the scope and relevance of our discussion.

Your detailed review has been a significant contributing factor to the improvement of our manuscript. We are deeply thankful for your expertise and time invested in reviewing our work. Your comments have not only enhanced this particular manuscript but also provided us with valuable learning for future research endeavors.

With our sincerest gratitude and best regards.

 

Reviewer 2 Report

Comments and Suggestions for Authors

This paper report details a rare instance of a perforated jejunal gastrointestinal stromal tumor (GIST) in a 76-year-old female patient. The patient presented with acute abdominal pain and distension, without any changes in bowel habits or episodes of nausea and vomiting. Initial diagnostics, including abdominal plain radiography and ultrasonography, were inconclusive; however, a computed tomography (CT) scan revealed pneumoperitoneum and an irregular fluid collection suggestive of small intestine perforations. Surgical intervention uncovered a 35 mm jejunal GIST with a 10 mm perforation. Histopathological examination confirmed a mixed cell type GIST with high malignancy potential, further substantiated by immunohistochemistry markers CD117, DOG1, and vimentin. Molecular analysis illuminated the role of key oncogenes, primarily KIT and PDGFRA mutations, emphasizing the importance of molecular diagnostics in GIST management. Despite the severity of the presentation, the patient's postoperative recovery was favorable, high lighting the effectiveness of prompt surgical and multidisciplinary approaches in managing complex GIST cases. In the introduction, the authors analyze the specialized literature trying to outline their future directions of analysis. Only 6 bibliographic references are mentioned in this regard. In the discussion of the case considered, elements of morphofunctional, biochemical, imaging analysis are presented to support the diagnosis. Perhaps the description of the situation of gastrointestinal stromal tumors included in discussions with supported references should have been included in the state of art part of the article. By definition, the discussions refer to the author's way of viewing the analyzed subject, not to a review of already known situations. Otherwise, the analysis part is well done, maybe it should have been supported by images, graphs, statistics that lead to the conclusions of the article.The successful outcome in this case, post-surgical intervention and careful follow-up, demonstrates the potential for favorable prognosis even in rare and severe cases of GISTs when managed promptly and appropriately. 

Author Response

Dear Reviewer,

We are immensely grateful for your comprehensive review and insightful feedback on our manuscript. Your expert guidance has been instrumental in refining our work, ensuring it meets the highest standards of academic rigor and relevance. Here are our detailed responses to the points you raised:

Point 1:

• Comment: Concerning the introduction, which initially included only 6 bibliographic references.
• Response: Acknowledging the importance of a well-referenced introduction, we have thoroughly reviewed and expanded this section. The introduction now features 10 carefully selected bibliographic references, enhancing the context and background of our study. This augmentation not only aligns with the academic norms but also provides a broader landscape of the existing literature, enriching the foundation of our research.

Point 2:

• Comment: Suggestion to integrate the description of gastrointestinal stromal tumors into the state-of-the-art part of the article.
• Response: In alignment with your valuable suggestion, we have introduced a new subsection titled "3.8. Current Frontiers in Gastrointestinal Stromal Tumor Research: A State-of-the-Art Overview." This dedicated section delves into the latest research, emerging therapies, and advancements in the molecular understanding of GISTs. It encapsulates current trends, novel diagnostic approaches, and evolving treatment paradigms, offering a comprehensive overview of the cutting-edge developments in the field. This addition not only strengthens the manuscript but also ensures that our discussion is enriched with the most recent and pertinent information in GIST research.

Your meticulous review and constructive suggestions have been paramount in elevating the quality of our manuscript. We are deeply appreciative of the time and expertise you have devoted to reviewing our work. Your contributions have not only enhanced this particular manuscript but also provided us with valuable insights for our future scholarly endeavors.

With our deepest gratitude and best regards.

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I like this version but would still suggest one thing, we need to make the article brief and succinct without affecting the quality to keep the interest of the reader. I trust you that you can cut the length a little without affecting the quality.