Myxofibrosarcoma Mimicking Inflammatory Lesion of Temporomandibular Joint—Case Presentation
Round 1
Reviewer 1 Report
The revision has improved the quality and informative value of the manuscript. I congratulate the Authors for the interesting case presentation.
Reviewer 2 Report
Dear authors,
The manuscript is significantly improved. I believe that it can be published.
Reviewer 3 Report
The manuscript has been appropriately revised
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
I have read the case presentation with interest to the topic. I regret to say that, in the present form, the paper is far from accurate and some aspects are very questionable:
- the case presented is a low-grade sarcoma of the TMJ misdiagnosed as chronic arthritis. A better histologic support should be provided to the reader oh this central aspect (immunohistochemistry);
- the initial diagnosis, based on MRI and scintigraphy, should be explained and discussed more accurately (the only mention on this point is the sentence "The history of our patient’s complaint and general medical anamnesis, diagnostic tests, radiographs, consultations (rheumatologist) as well as extra and intraoral examinations indicated arthritis", in the Discussion). In fact, the MRI image provided seems indicative of neoplastic tissue around the joint, more than of inflammation;
- the second operation is described as "extended resection of glenoid fossa and subtemporal fossa with supraomohyoid lymphadenectomy"; at least a post-op CT scan should be provided and the rational for lynphadenectomy explained (as it is questionable);
- the Abstract mentions the use of adjuvant radiotherapy, while in the case description the use of chemotherapy is stated;
- the abstract states that the second operation was "extended resection of glenoid fossa and subtemporal fossa contents when the mandible was reconstructed using UHMW-PE". Apart from the consideration that a mandible may not be reconstructed with just polyethylene (I suppose the Authors meant "a UHMW-PE/Titanium prostheses"), the text describes a different situation, i.e. extended resection without reconstruction;
- (most relevant point) the Conclusion states two important concepts which are not supported:
1) "The case highlights the importance of increased oncological awareness in the everyday dental practice as well as the use of immunohistochemical staining in the postoperational material". A consideration on the importance of accurate preoperative instrumental diagnosis should be usefully added.
2) "The use of the individual prostheses of the TMJ significantly increases the rate of success of the surgery as well as quality of life of the patient". This statement seems far from being appropriate in the present case.
Reviewer 2 Report
An introduction of manuscript should present prevalence of LGFMS worldwide. Furthermore, more issues related to LGFMS should be analysed in the introduction.
The material and methods lack information about the date of this case, patient history (diseases stage of LGFMS and ect.) and the protocol of performed treatment.
Results are clearly explained.
Discussion - comparison with similar studies is too less.
Reviewer 3 Report
The authors presented the rarity of malignant tumor in the TMJ and the case treated well, althouh serious lack of data.
The authors emphasize the immunohistochemistry for the definitive diagnosis of the LGFMS. However, they do not show its immunohistocheminstry and detailed description of the histlogical figure.
The authors do not present the intraoperative pictures of the second operation. Was the UHMW-PE system removed in the second operation to additional radical resection?
In the initial diagnosis, "chronic arthritis" was considered. This is an ambiguous diagnosis. What is the etiology in the context? Rheumatoid disease, which is described in DISCUSSION, usually involves the bilateral TMJ.
