The Rarity in the Rarity: Presentation of Three Cases of Cutaneous Carcinosarcoma with Clinical and Histopathological Insights
, Anna Colagrande 1, Valentina Caputo 2, Giuseppe Ingravallo 1, Eliano Cascardi 1, Francesco Fortarezza 3, Emanuela Bonoldi 2 and Franco Rongioletti 4
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
The authors have described an interesting case series of Cutaneous Carcinosarcoma. There are only limited case reports or series of these distinct entities in the literature. The manuscript is well written with nice figures. However, there are some minor language errors as well as typos that need to be corrected.
Minor Points:
1. Line 82 - “After that, the patient underwent to enlargement of the surgical exeresis area without any residual tumour”. --- Please rephrase this sentence for better understanding.
2. Line 110 – “US Scan” – I believe you mean ultrasound, please mention full form.
3. Line 111-112: “After that, at histopathological examination was revealed a lymph node metastases…” – please review this sentence. Maybe it can simply be written as “Histopathological examination revealed a lymph node metastases…”
4. Figure 3 legend: typo “rhabdomioblastic differentiation” please correct as “rhabdomyoblastic differentiation”
5. Line 132 “To histology, a biphasic tumour with an infiltrative growth pattern” – please rephrase as maybe “Histologic sections demonstrated a biphasic tumour with an infiltrative growth pattern”
6. Line 184 and 186 – “Firstly” as First and “frequently” as frequent, respectively
7. Line 192 – “left upper helyd” is a typo – please correct
8. Line 200 “indifferentiated” please correct
Author Response
Reviewer n’1: The authors have described an interesting case series of Cutaneous Carcinosarcoma. There are only limited case reports or series of these distinct entities in the literature. The manuscript is well written with nice figures. However, there are some minor language errors as well as typos that need to be corrected.
Answer n’1: Dear Reviewer n’1, thank you very much for your words.
Reviewer n’1: Minor Points:
- Line 82 - “After that, the patient underwent to enlargement of the surgical exeresis area without any residual tumour”. --- Please rephrase this sentence for better understanding.
- Line 110 – “US Scan” – I believe you mean ultrasound, please mention full form.
- Line 111-112: “After that, at histopathological examination was revealed a lymph node metastases…” – please review this sentence. Maybe it can simply be written as “Histopathological examination revealed a lymph node metastases…”
- Figure 3 legend: typo “rhabdomioblastic differentiation” please correct as “rhabdomyoblastic differentiation”
- Line 132 “To histology, a biphasic tumour with an infiltrative growth pattern” – please rephrase as maybe “Histologic sections demonstrated a biphasic tumour with an infiltrative growth pattern”
- Line 184 and 186 – “Firstly” as First and “frequently” as frequent, respectively
- Line 192 – “left upper helyd” is a typo – please correct
- Line 200 “indifferentiated” please correct.
Answer n’2: Dear Reviewer n’1, all done. Thank you very much.
Reviewer 2 Report
Comments and Suggestions for Authors
This article reports three cases of exceptionally rare cutaneous carcinosarcomas: pilomatrical carcinosarcoma, Merkel cell carcinosarcoma and basal cell carcinosarcoma, which differ in the origin of the epithelial component. Although all cases are interesting, the following points should be clarified before acceptance.
1) The evidence that the epithelial component in case 3 is basal cell carcinoma (BCC) seems weak. Is the BCC component positive for Ber-Ep4, a specific marker for BCC? BCC has characteristic dermoscopic findings. Did the authors perform a dermoscopic analysis of the BCC region?
2) Compared to cases 1 and 2, where multiple immunostainings of the mesenchymal component were performed, there is less evidence in case 3 that the mesenchymal component is a sarcoma. Could case 3 be a basosquamous carcinoma with spindle cell type SCC?
3) Case 3 appears to be a collision tumor in Figure 4B.
4) The single progenitor cell theory is presented in the Introduction. In this paper the epithelial component is derived from pilomatrix, Merkel cell and BCC; can this be explained by the single progenitor cell theory?
5) Upper and lower case are mixed in the title of some references.
Author Response
Comments 1: This article reports three cases of exceptionally rare cutaneous carcinosarcomas: pilomatrical carcinosarcoma, Merkel cell carcinosarcoma and basal cell carcinosarcoma, which differ in the origin of the epithelial component. Although all cases are interesting, the following points should be clarified before acceptance.
Answer n'1: Thank you very much dear Reviewer n'2, and thanks for your words.
Comments 2: 1) The evidence that the epithelial component in case 3 is basal cell carcinoma (BCC) seems weak. Is the BCC component positive for Ber-Ep4, a specific marker for BCC? BCC has characteristic dermoscopic findings. Did the authors perform a dermoscopic analysis of the BCC region?
Answer n'2: Dear Reviewer n'2, the third case is an old case from Genoa. The only immunohistochemistry done to my recollection was vimentin which was positive in the stromal spindle component. Ber-Ep-4 was not even there. No dermoscopy was done. So if you are satisfied with vimentin it's OK, otherwise we can withdraw the 3rd case and keep the 2 accepted.
Comments n'3: 2) Compared to cases 1 and 2, where multiple immunostainings of the mesenchymal component were performed, there is less evidence in case 3 that the mesenchymal component is a sarcoma. Could case 3 be a basosquamous carcinoma with spindle cell type SCC?
Answer n'3: Thank you very much for this tip. Case 3 is clearly a biphasic tumor with positivity for Vimentin of the sarcomatous component. Anyway, it's clear that the spindle cells component is no a subtype of SCC.
Comments n'4: 3) Case 3 appears to be a collision tumor in Figure 4B.
Answer n'4: Thank you dear Reviewer. After immunohistochemical reaction and, particularly, with morphological features, the lesion is a biphasic tumour.
Comments n'5: 4) The single progenitor cell theory is presented in the Introduction. In this paper the epithelial component is derived from pilomatrix, Merkel cell and BCC; can this be explained by the single progenitor cell theory?
Answer n'5: Thank you for this point. Yes, we added a sentence about this topic in discussion section.
Comments n'6: 5) Upper and lower case are mixed in the title of some references.
Answer n'6: Corrected it.
