Glomangioma Supply from Profunda Femoris Artery in Peripheral Artery Disease
Round 1
Reviewer 1 Report
Reading this report I had a few remarks:
1. There is no novelty in this report. PAD does not mean an absence of vasculature. On the contrary, collaterals are significantly developed in the ischemic. It makes the case just another case with a soft-tissue tumor.
2. Histological findings are scarce (one sentence in the text, one photo) despite an extensive description in the discussion.
3. Surgical treatment complication is shallowly described.
4. Part of the case description is moved to the Discussion section.
5. Multiple vocabulary and spelling mistakes.
Author Response
Comment 1: There is no novelty in this report. PAD does not mean an absence of vasculature. On the contrary, collaterals are significantly developed in the ischemic. It makes the case just another case with a soft-tissue tumor.
Response 1: True; however, to our knowledge, there are not many cases of glomangiomas ( this size and in the geriatric population) described in the literature.
Comment2: Histological findings are scarce (one sentence in the text, one photo) despite an extensive description in the discussion.
Response 2: An extensive description was added to the text: ,, Abnormal collections of glomus cells are noted. Unlike venous malformations, they present single or multiple rows surrounding cuboidal glomus cells. The glomus cells stain positively for vimentin and α-smooth-muscle actin but are negative to desmin, von Willibrand factor, and S-100. The 3 components needed for diagnosis are observed: glomus cells, blood vessels, and smooth muscle cells respectively: glomus cells: are small and uniform, round to oval shaped, with distinctive cell borders, centrally located punched-out nuclei, light eosinophilic or amphophilic cytoplasm; blood vessels: thin-walled, capillary sized, dilated; smooth muscle cells: elongated, mature looking,,
Comment3: Surgical treatment complication is shallowly described.
Response3: the following text was added: Dehiscence of the surgical incision was observed. The edges of the wound no longer meet after suture removal. The defect interested only the skin and connective tissue and was not observed in muscles and profound planes. The defect was lined on 2 centimeters (a total of 5 centimeters).
Comment 4: Part of the case description is moved to the Discussion section.
Response 4: corrected
Comment 5: Multiple vocabularies and spelling mistakes.
Response5: corrected
Reviewer 2 Report
The authors present an interesting case report regarding a glomangioma in a 66-year old male patient with supply from the profunda femoris artery.
Before publication, some passages need to be improved:
1. Abstract:
- Please do not change between present and past tense:
.) Doppler exam demonstrates --> demonstrated
.) Although the patient’s PAD is (--> was) severe `the lesion presents (--> presented) increased size with a burst in dimensions weeks before surgery.(This sentence has to be rewritten, e.g. (..) the lesion presented with a burst in dimensions ...
- please correct: 66-year-old
- the following sentence needs to be rewritten: The main clinical findings were a nodular mass located laterally on the left foot, elastic, covered with a thin skin, and mobile.
2. Methods
LIne 37: instead of white --> Caucasian
Line 39: what do you mean by "my history"?
Line 39/ 40: alcohol and tobacco
3. Results : This section is completely missing - I suggest to describe the applied methods (anamnesis, physical examination, all diagnostics and surgery) and thereafter present the case in the results.
- How severe was the PAD? Please classify according to Fontaine stages.
- Did you perform oscillography (pneumatic segmental oscillogryphy)? Please include measures and ABI.
- Please also include some more pictures from the CT scan (e.g. 3-4 pictures). I can see the supplying vessel, but not the departure from the profunda femoris artery.
- Figure 3: please use a, b, c instead of left, middle...
- Line 58/59: please rewrite: followed by three weeks of total wood healing in 3 weeks.
4. Discussion
This section needs to be rewritten. The occurrence of malignant tumors is discussed extensively, however, if I understood correctly, this patient suffered from a benign tumor. Please discuss in the context of the presented case. Please include the patient's symptoms and anamnesis in the discussion. It is essential to know and discuss the location of PAD - is it located in the iliac arteries or in the common femoral artery/ at the origin of the profunda femoris artery, so that the blood supply was limiting? Is an outpatient visit planned? I would suggest to perform a follow up at least three months after the surgery.
5. Conclusion: needs to be included
Altogether, this is a very interesting case, please rewrite the manuscript accordingly and perform a language correction.
Author Response
- Abstract:
- Please do not change between present and past tense:
.) Doppler exam demonstrates --> demonstrated
Response1: corrected
.) Although the patient’s PAD is (--> was) severe `the lesion presents (--> presented) increased size with a burst in dimensions weeks before surgery.(This sentence has to be rewritten, e.g. (..) the lesion presented with a burst in dimensions ...
- please correct: 66-year-old
Response2: corrected
- the following sentence needs to be rewritten: The main clinical findings were a nodular mass located laterally on the left foot, elastic, covered with a thin skin, and mobile.
Response3: the corrected sentence was rewritten.
- Methods
LIne 37: instead of white --> Caucasian
Response4: corrected
Line 39: what do you mean by "my history"? typo corrected with the history
Response5: corrected
Line 39/ 40: alcohol and tobacco
Response6: corrected
- Results : This section is completely missing - I suggest to describe the applied methods (anamnesis, physical examination, all diagnostics and surgery) and thereafter present the case in the results.
Response 7: corrected as suggested
- How severe was the PAD? Please classify according to Fontaine stages.
Response 8: The PAD was Fontaine IIA.
- Did you perform oscillography (pneumatic segmental oscillography)? Please include measures and ABI.
Response 9: Oscilography was performed. The following text was added: Peripheral artery disease (PAD) was classified according to Fontaine classification as Fontaine IIA. Oscillography retrieved a 0.9 ABI for the right foot and 0.8 ABI for the left foot.
- Please also include some more pictures from the CT scan (e.g. 3-4 pictures). I can see the supplying vessel, but not the departure from the profunda femoris artery.
Response10: included as supplemental material S1
- Figure 3: Please use a, b, and c instead of left, middle...
Response11: corrected as suggested
- Line 58/59: please rewrite: followed by three weeks of total wood healing in 3 weeks.
Response12: the sentence was rewritten.
- Discussion
This section needs to be rewritten. The occurrence of malignant tumors is discussed extensively; however, if I understood correctly, this patient suffered from a benign tumor. Please discuss this in the context of the presented case. Please include the patient's symptoms and anamnesis in the discussion. It is essential to know and discuss the location of PAD - is it located in the iliac arteries or the common femoral artery/ at the origin of the profundal femoris artery, so that the blood supply was limiting? Is an outpatient visit planned? I would suggest to perform a follow up at least three months after the surgery.
Response12: correctd as suggested. The following paragraph was added: The majority of glomus tumors are benign. They are usually located superficially (on or just below the skin -like in this case) and produce pain, swelling, and skin discoloration. Some of them may also be located deeper inside the body tissues. The exact cause of developing glomus benign glomus tumor is not determined, even if several genetic mutations have been detected. Most commonly, young adults are affected by these benign tumors in contrast with the age of the presented patient. The diagnosis of benign glomus tumor is performed by clinical examination and biopsy. No major complications are reported. Surgical removal of the tumor is the most effective treatment for tumors with significant signs and symptoms. The prognosis of benign glomus tumors with appropriate treatment is excellent. Glomus tumors can present a significant size if the tumor vascular pedicle is connected to a major artery, even if the patient is present with peripheral occlusive disease. In this case, the patient presented intermittent claudication at 400 meters. PAD was located on the common femoral artery bilaterally and the profunda femoris artery on the left leg.
- Conclusion: needs to be included
Response13: Conclusions were added were added.
Altogether, this is a very interesting case, please rewrite the manuscript accordingly and perform a language correction.
Round 2
Reviewer 2 Report
The authors have revised their article follwowing my suggestions. There are, however, some minor corrections necessary before publication:
1. Please ensure that a native speaker will correct the manuscript. Please provide his/ her name in the acknowledgements.
2. In the abstract, last sentence, line 18 please remove the typo before "the".
3. Please ensure that you do not change time during case description, e.g. line 79: the edges of the wound "are" --> were
4. Line 80: please replace the word "interested" with an appropriate description.
5. Line 125: lib--> limb
6. Methods and Results can still be improved: ad Methods: you have assessed the patient's PAD stage and perfomred oscillography. However, the fact that the patient has PAD Fontaine IIA and his ABI values should be reported in the results. Further, results can be structured in for e.g.: Anamnesis, diagnostics and disease course
7. Line 38: what do you mean by "flowed"?
Author Response
Comment 1. Please ensure that a native speaker will correct the manuscript. Please provide his/ her name in the acknowledgments.
Reponse1: performed special thanks to Miss Jany T. Higgs
Comment 2. In the abstract, last sentence, line 18 please remove the typo before "the".
Response2: corrected
Comment 3. Please ensure that you do not change time during case description, e.g. line 79: the edges of the wound "are" --> were
Response3: corrected
Comment 4. Line 80: please replace the word "interested" with an appropriate description.
Response4: corrected
Comment 5. Line 125: lib--> limb
Respnse5: corrected
Comment 6. Methods and Results can still be improved: ad Methods: you have assessed the patient's PAD stage and perfomred oscillography. However, the fact that the patient has PAD Fontaine IIA and his ABI values should be reported in the results. Further, results can be structured in for e.g.: Anamnesis, diagnostics, and disease course
Response6: corrected as suggested
Comment 7. Line 38: what do you mean by "flowed"?
Response7: typo corrected: followed
