Atrophic Dermatofibrosarcoma Protuberans with Eosinophilic Infiltration

Round 1

Reviewer 1 Report

The presence of eosinophils should be explained in a better way. There is a relationship between eosinophils and fibrosis.Sometimes in such lesions is usefull the dermoscopic evaluation to differentiate with granulomatous lesions. Is the fusion gene COL1A1-CDGFB important in atrophic dermatofibrosarcoma?

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Reviewer 2 Report

The authors present a case of dermatofibrosarcoma protuberans in which the only peculiar feature is the presence of a eosinophilic infiltrate, a finding which is unusual and of unknown significance.

The histological pictures need improvement, especially figure 3 and, to a lesser extent, picture 4. The background is dark and bluish, especially in picture 3, and there is lack of contrast, which hinders appreciation of the main finding, namely the presence of eosinophils.

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Reviewer 3 Report

The manuscript could be improved by adding further points of discussion.

For example, the role of eosinophils in cutaneous cancers should be more discussed. Moreover, the role of eosinophils in the pathogenesis of atrophyc DFS could be speculated on the basis of the elastolytic activity of these cells in many cutaneous and not cutaneous pathologic processes.

Lastly, I would delete the the second sentence of the discussion regarding the pathogenesis of atrophic DFS as it sounds too speculative and also illogical.

As atrophic DFS with eosinophils inflammation may be a diagnostic challenge, I would emphasize this concept.  Other examples of inflammation rich cutaneous neoplasms could be mentioned. 

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Round 2

Reviewer 3 Report

The authors addressed all this reviewer suggestions.

Figure 1. A 2.5 cm erythematous to violaceous atrophic patch with a firm papule at the 48 inferior lateral aspect.     Please, use plaque instead of papule. 

Sentences from line 101 to  line 106 could be omitted, as they do not add  significant points in the discussion. 

 

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