Diagnosis, Management, and Long-Term Outcome of Esophageal Plasmacytoma in a Dog

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I appreciate the authors submitting their manuscript. This case report details the diagnosis, management, and long-term outcome of an esophageal extramedullary plasmacytoma in a dog. The case is intriguing; however, the manuscript requires improvements, particularly in the discussion section. I have provided some comments in the hope that they will be useful to the authors.

 

General comments

L34: The correct way to cite continuous references is 1-4; please correct this throughout the manuscript.

 

L37: Please include a background of similar studies or case reports on esophageal plasmacytoma. I also recommend describing the different clinical presentations of this type of neoplasia and the incidence and prevalence of its presentation in dogs, based on reported data in the literature.

 

L48: In L17, an age of eight years is mentioned.

 

L50-55: The description of the clinical history and laboratory tests lacks details. I recommend that the authors add this information, such as including a table of the laboratory test results.

 

L56: Given the evidence of hepatomegaly, it is necessary to show the results of the biochemical profile.

 

L63: Was the patient sedated or anesthetized? And which drugs were used? Please clarify.

 

L65: How many samples? What sizes? How were they preserved or transported for histopathological analysis? Please clarify.

 

L66: Home-made diet? Is this correct?

 

L71: Please provide an anatomical-pathological description of the lesion observed.

 

L99: For pharmaceuticals, include the country of origin along with the brand name and laboratory. Make these updates throughout the manuscript.

 

L103: Please indicate the vaporized fraction of isoflurane used during the anesthetic-surgical procedure, or the monitored ETISO.

 

L105: Please add the initial bolus doses of Fentanyl and Lidocaine.

 

L107: Recently published fluid therapy guidelines recommend 3-5 mL/kg/h; explain why a higher flow rate was chosen.

 

L123: Warm? Please state the temperature.

 

L179: I suggest the authors further elaborate on the discussion, as in its current state, they focus more on surgical procedures but do not mention treatment options or compare with studies showing recurrence. Similarly, no data are provided on breed predisposition, age, sex, or other factors, nor on recurrence in dogs. The limitations of the case report should be included at the end of the discussion.

 

L180: Please delete the word “rare”.

 

L181: Please remove the phrase "are extremely rare." I recommend that the authors improve their wording and include a comparative discussion of esophageal plasmacytoma in dogs, considering their frequency of occurrence and avoiding adjectives like "rare" or "extremely rare."

 

L248: I suggest the authors include more references.

Author Response

Thank you very much for your thoughtful comments and suggestions regarding our manuscript. We sincerely appreciate the time and effort you dedicated to reviewing our work. Your feedback has been invaluable in helping us improve the quality and clarity of the paper. Please, find below our responses to the comments you provided. For your convenience we have highlighted your comments with yellow color.

 

 

Comment 1 (L34): The correct way to cite continuous references is 1-4; please correct this throughout the manuscript.

Response 1: Thank you for this comment. Changed as suggested (Lines 37, 39, 78, 85, 88, 255).

 

Comment 2 (L37): Please include a background of similar studies or case reports on esophageal plasmacytoma. I also recommend describing the different clinical presentations of this type of neoplasia and the incidence and prevalence of its presentation in dogs, based on reported data in the literature.

Response 2: Thank you for this suggestion. We have added information about the prevalence of esophageal plasmacytomas (Lines 36, 39-41) and the clinical presentation of the other reported cases (Lines 83-85) Please note that the original reference number 2 has been replaced, because  as more detailed information was found in the new reference.

 

Comment 3 (L48): In L17, an age of eight years is mentioned.

Response 3: We apologize for this error. The age has been corrected (Line 17).

 

Comment 4 (L50-55): The description of the clinical history and laboratory tests lacks details. I recommend that the authors add this information, such as including a table of the laboratory test results.

Response 4: Thank you for the comment. More detailed history  a table of the complete blood count and chemistry profile results (Lines 92, 93, 98-100, 101, 105-115) have been added to the manuscript as suggested.

 

Comment 5 (L56): Given the evidence of hepatomegaly, it is necessary to show the results of the biochemical profile.

Response 5: Thank you for this comment. The liver enzymes are included in the chemistry profile in table 1 as mentioned in the previous comment (Lines 105-115).

 

Comment 6 (L63): Was the patient sedated or anesthetized? And which drugs were used? Please clarify.

Response 6: Thank you for pointing this out. To maximize the patient’s safety, the dog was anesthetized. We have added in the manuscript the details about the anesthetic protocol (Lines 123-130).

 

Comment 7 (L65): How many samples? What sizes? How were they preserved or transported for histopathological analysis? Please clarify.   

Response 7: Thank you for this comment. We included additional information about the biopsy samples in the manuscript (Lines 133-136).

 

Comment 8 (L66): Home-made diet? Is this correct?

Response 8: Thank you for your comment. Indeed, we advised the owner to feed the dog a high-moisture home-made diet at an upright position until the histopathologic results were available.

 

Comment 9 (L71): Please provide an anatomical-pathological description of the lesion observed.

Response 9: We have added the anatomical-pathological description in the legend of the figure as suggested (Lines 141-143).

 

Comment 10 (L99): For pharmaceuticals, include the country of origin along with the brand name and laboratory. Make these updates throughout the manuscript.

Response 10: Thank you for this comment. The information has been added to the manuscript (Lines 124, 125, 126, 127, 129, 171, 172, 173, 175, 177, 198, 200, 201, 202).

 

Comment 11 (L103): Please indicate the vaporized fraction of isoflurane used during the anesthetic-surgical procedure, or the monitored ETISO.

Response 11: Thank you for this comment. The information has been included in the manuscript (Line 176).

 

Comment 12 (L105): Please add the initial bolus doses of Fentanyl and Lidocaine.

Response 12: The initial bolus doses are now included (Lines 178, 350, 353) in the manuscript. Please note that all the doses are now in the appendix A based on suggestion of the second reviewer.

 

Comment 13 (L107): Recently published fluid therapy guidelines recommend 3-5 mL/kg/h; explain why a higher flow rate was chosen.

Response 13: Thank you for this comment. The previous guidelines (AAHA 2013) regarding fluid therapy in dogs and cats recommended an initial fluid rate in normovolaemic dogs at 5ml/kg/h and in cats 3 ml/kg/h. In dogs that are at risk for developing hypotension during anaesthesia (which was our case), or are not normovolaemic, the recommended dose is starting at 5ml/kg/h and adding boluses of fluids or increasing the rate to <10ml/kg/h, following measurements of blood pressure. If this is proven insufficient then vasopressors should be instituted. The fluid rate chosen in our case is within the spectrum of the recommendation of the guidelines for fluid therapy and our patient was in risk of developing hypotension due to its ASA status, the ventilatory support, the thoracotomy and the anaesthetic drugs (acepromazine, isoflurane, fentanyl, methadone etc.). We initially started the fluid rate at 5 ml/kg/h and gradually increased to 7 ml/kg/h to maintain mean arterial pressure at 60-80mmHg. Although, the most recent guidelines (AAHA 2024) were published after the date of the surgery, still the dose rate for fluid therapy remains the same. In that publication the authors state: " In the absence of evidence-based anesthesia fluid rates for animals, the authors suggest initially starting at 3 mL/kg/hr in cats and 5 mL/kg/hr in dogs". A dose rate of 5-7 ml/kg/h in dogs is considered common practice especially in dogs that are in risk of developing hypotension during surgery.

 

Comment 14 (L123): Warm? Please state the temperature.

Response 14: Thank you for this comment. The saline solution was at body temperature. This has been added to the manuscript (Line 196).

 

Comment 15 (L179): I suggest the authors further elaborate on the discussion, as in its current state, they focus more on surgical procedures but do not mention treatment options or compare with studies showing recurrence. Similarly, no data are provided on breed predisposition, age, sex, or other factors, nor on recurrence in dogs. The limitations of the case report should be included at the end of the discussion.

Response 15: Thank you for this comment. We included the treatment options in general as suggested (Lines 63-78). We have also expanded the discussion about other case reports (Lines 264-283). We have also added information about predisposition etc. (Lines 41-49) and limitations (Lines 312-314)

 

Comment 16 (L180): Please delete the word “rare”.

Response 16: We agree with this. The word “rare” has been deleted as suggested (Lines 253)

 

Comment 17 (L181): Please remove the phrase "are extremely rare." I recommend that the authors improve their wording and include a comparative discussion of esophageal plasmacytoma in dogs, considering their frequency of occurrence and avoiding adjectives like "rare" or "extremely rare."

Response 17: Thank you for your comment. We have removed the word “rare” from the manuscript. Moreover, we further discuss the prevalence of esophageal and extramedullary plasmacytomas in general (Lines 33-49).  

 

Comment 18 (L248): I suggest the authors include more references.

Response 18: We totally agree with this point. We have added more references (Lines 375-388).

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

 

The authors present a rare clinical case of canine esophageal plasmacytoma and a detailed clinical analysis of the case.

The article has several shortcomings:

• The discussion section compares the findings with previous cases rather superficially; a broader analysis of the biological behavior of plasmacytomas, the risk of metastasis, and treatment alternatives is lacking.
• The rationale for the surgical approach is provided, but it would be useful to discuss in more detail why other treatment options (e.g., radiotherapy, chemotherapy) were ruled out.
• Although it is mentioned that relapse occurred, it is not discussed how relapse would affect the long-term prognosis or what further treatment options would be.
• There are editorial and linguistic inaccuracies (e.g., “extinction” instead of “excision”) that may detract from the professionalism of the publication.
• Since this is a very rare case, it would be useful to include additional data from other sources on the overall survival and treatment success rates of extramedullary plasmacytomas.
• The description of the surgical technique is quite detailed, but some doses (anesthesia, analgesia) are given in redundant form and may be referred to the appendix of the clinical protocols.
• No search for metastases outside the thoracic cavity (e.g., abdominal CT or bone marrow aspiration) was performed, although this could be important in the case of plasmacytomas.

Author Response

    Thank you very much for your thoughtful comments and suggestions regarding our manuscript. We sincerely appreciate the time and effort you dedicated to reviewing our work. Your feedback has been invaluable in helping us improve the quality and clarity of the paper. Please, find below our responses to the comments you provided.

 

Comment 1: The discussion section compares the findings with previous cases rather superficially; a broader analysis of the biological behavior of plasmacytomas, the risk of metastasis, and treatment alternatives is lacking.

Response 1: Thank you very much for this comment. We have expanded our discussion based on the reviewer’s recommendation (Lines 50-62).

 

Comment 2: The rationale for the surgical approach is provided, but it would be useful to discuss in more detail why other treatment options (e.g., radiotherapy, chemotherapy) were ruled out.

Response 2: Thank you for this comment. We clarified that in the manuscript (Lines 269-274)

 

Comment 3: Although it is mentioned that relapse occurred, it is not discussed how relapse would affect the long-term prognosis or what further treatment options would be.

Response 3: Very interesting point. We added more information in the manuscript (Lines 302-307)

 

Comment 4: There are editorial and linguistic inaccuracies (e.g., “extinction” instead of “excision”) that may detract from the professionalism of the publication.

Response 4: We apologize for this mistake. We corrected this error in the manuscript (Lines 23, 220, 225, 232, 237, 241, 250, 275, 278, 318, 320).

 

Comment 5: Since this is a very rare case, it would be useful to include additional data from other sources on the overall survival and treatment success rates of extramedullary plasmacytomas.

Response 5: We totally agree with this point. We have included additional  information in the manuscript (Lines 63-78)

 

Comment 6: The description of the surgical technique is quite detailed, but some doses (anesthesia, analgesia) are given in redundant form and may be referred to the appendix of the clinical protocols.

Response 6: Thank you for pointing this out. We added the drug dosages in the appendix of clinical protocols (Lines 203, 341-357).

 

Comment 7: No search for metastases outside the thoracic cavity (e.g., abdominal CT or bone marrow aspiration) was performed, although this could be important in the case of plasmacytomas.

Response 7: Very interesting point. Unfortunately, no further metastases search was performed due to economical restrictions. We added this information to the manuscript (Line 312-314).

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I appreciate the authors for considering some of my comments on the first revision of their manuscript. I should note that the manuscript has improved significantly; however, in the new version, I have found some points that need the authors’ attention.

 

General comments

L34: Your first reference is number 2; please correct the order. In fact, this same reference appears multiple times in your manuscript, so I suggest that authors avoid overusing it.

 

L101: Table 1 shows a slight increase in BUN and CRE, which could indicate hemoconcentration caused by the rise in HCT that is also reported.

Author Response

Please find the responses to the new comments suggested in the word file attached below. Thank you!!

Author Response File: Author Response.docx