Pediatric Hemangiomas in the Female Genital Tract: A Literature Review

Round 1

Reviewer 1 Report (Previous Reviewer 2)

The authors revised their manuscript. The method section has been sufficiently described, but as the authors have replied, the number of cases involved was too small to allow for statistically analyses. In addition, although the contents listed in the table have been added, they only listed the contents of case reports and were not able to produce comprehensive results. This cannot be said to have been a scientifically meaningful analysis, and the message it sends to readers is extremely weak. If the number of cases obtained from the literature is too small to bear analysis, it should be written as a case report with a review of the literature rather than as a comprehensive study.

Author Response

If hemangiomas are rare entities, the ones of the female genital tract are even rarer. This influenced our research as evidenced by the relatively small number of reports we were able to review. For this reason, since a statistical analysis was not possible, we prefer to call our paper a literature review instead of a “comprehensive analysis”. Despite the limited material available, we worked to create a simple, and hopefully useful, tool to help clinicians with the diagnosis and treatment of all female genital tract hemangiomas, since all the papers analysed were either ones addressing all kinds of body hemangiomas (and very little was dedicated to genital ones) or small case reports with only one diagnostic tool or treatment described.

Reviewer 2 Report (Previous Reviewer 3)

I had already refereed the article and it was not approved by me. But according to the changes made by the authors in the article, the condition of the article has improved. There is still only one major objection that the authors need to address in the paper. For the three patients whose conditions are described in the article, the treatment measures should be given separately for each patient and whether they have improved the disease or not, and other treatment measures that the medical team intends to implement should also be mentioned. My overall recommendation is accepted after minor revision. 

Author Response

Unfortunately, the three case reports came to our clinic only for a second opinion in the diagnosis, but never returned, so we don’t know the outcome of their treatment. For this reason, as the editor suggested, we decided to remove them and concentrate on the review. We kept the pictures only for iconographic purpose.

Round 2

Reviewer 1 Report (Previous Reviewer 2)

The authors successfully revised their manuscript. The title has been suitable for the content of the paper. This would be helpful for management of pediatric vulvovaginal hemangiomas.

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

After a thorough review of the manuscript titled "Pediatric Hemangiomas in the Female Genital Tract: A Comprehensive Analysis," I would like to commend the authors for their valuable scientific endeavor. The focus of this article on a rare and underexplored area of pediatric hematology and gynecology is notably significant. The primary data provided through the case series is a commendable addition, especially given the rarity of pediatric vulvovaginal hemangiomas. These insights are not only novel but also essential for the medical community.

However, there are certain areas in the manuscript that, if developed further, could greatly enhance its value and suitability for publication.

Positive Considerations for Publishing: 

1. Significant Clinical Relevance: The article's focus on pediatric vulvovaginal hemangiomas is commendably relevant and timely. Given the rarity of this condition, your comprehensive review serves as an invaluable resource for medical professionals seeking guidance in diagnosis, management, and treatment. This contribution is particularly crucial in filling the gaps in existing literature and practice.

2. Original and Valuable Insights: The inclusion of a case series involving these rare events is a noteworthy strength of your work. The primary data and firsthand case descriptions you provide are not only original but also add a much-needed dimension to the understanding of pediatric hemangiomas. Such unique contributions are highly valued in the academic and medical community.

Areas to Develop More:

1. Broader Scope in Literature Review: While focusing on recent literature offers contemporary insights, considering earlier publications could provide a more comprehensive historical perspective. Integrating foundational research might enrich the review, offering a more holistic understanding of the topic.

2. Enhanced Focus on Differential Diagnosis: Expanding on the differential diagnosis could further refine the article's utility. A detailed exploration in this area would greatly assist in differentiating pediatric vulvovaginal hemangiomas from similar conditions, thereby enriching the diagnostic accuracy.

3. Clarification of Review Methodology: Elaborating on the guidelines and criteria used for the literature review would enhance the article's methodological transparency. This clarity would be greatly appreciated by your readers and peers, as it underscores the rigor of your research process.

4. In-Depth Discussion of Case Management: A more detailed analysis of therapeutic choices and follow-up in the case series would be a valuable addition. Such information is pivotal for understanding the long-term management and outcomes of the treatments employed.

5. Detailed Imaging Findings: Incorporating a more thorough discussion on imaging findings related to pediatric hemangiomas could significantly enhance the article. This would provide practical insights into the diagnostic process, which is instrumental in clinical settings.

Minor Typographical Adjustment: On line 90, kindly consider revising "latertherapy" to "lasertherapy" for clarity and accuracy.

Reviewer 2 Report

 The authors presented a literature review and case series of pediatric hemangiomas in female genital tract. They chose and reviewed nine papers of case report. In addition, their three cases were shown in this paper. Their study and case presentations were insufficient to provide scientific evidence. The proposed presentation does not respect the elementary rules of a scientific writing. 

1. What they presented was a just review of some case reports, not a comprehensive analysis. They must perform statistical analysis on the cases reviewed in order to draw scientifically meaningful conclusions.

2. They should add the article selection criteria in more detail in the Method section.

3. Since the number of cases included in this study is too small, the paper search period should be extended to yield meaningful data.

4. They should specifically state the aims of their research. Although they wrote their aim “to analyze the clinical characteristics of pediatrics vulvovaginal hemangiomas” in the manuscript, analysis is a just method.

5. In addition, they must show results and conclusions that correspond to their aims.

6. They should clearly describe the reason why they focused on infantile hemangiomas in female genial tract, excluding other sites.

7. The table of results should be an integration of data, not just a list.

8. They should add materials and methods of case series.

9. They also should state the aims of case presentation. They merely listed cases, and it is unclear what kind of findings can be obtained from these cases and how this relates to the review that is the focus of this report.

Reviewer 3 Report

Dear Editor

The manuscript explored the pediatric hemangiomas in the female genital tract: a comprehensive analysis. They examined the hemangioma in the genital area of three female patients aged 17 years and older. My overall evaluation of the manuscript is negative. There are a number of major revisions, formal and scientific aspects that should be addressed.

1.       The article does not mention the treatment method for the 3 mentioned diseases. It is necessary to put the photos before and after the treatment together so that the right solution can be found between different treatment methods.

2.        The age of the patients is over 17 years old, considering that hemangioma in the genital area in women can cause many problems in marital relations and childbirth, because therapeutic measures such as beta-blockers, corticosteroids, and laser therapy were not used in childhood. If it is used and does not work, it should be mentioned in the article.

3.        Necessary measures for prevention such as genetic and epigenetic tests should be included in the article. It is necessary to investigate whether the parents of these people were also affected.

4.        The abstract and conclusion part is very vague and does not provide a specific solution, so it is necessary to rewrite it.