Dear Editor-in-Chief
BMC gastroenterology
Title:Microcystic/reticular schwannoma of the esophagus: the first case report and a
diagnostic pitfall
Date: 30 September 2014
I thank the editor and referees of the ‘BMC Gastroenterology’ for taking time to review my
article. I have made corrections and clarifications in the manuscript after going over the
referee’s comments.
The changes are summarized below (highlighted the change with the blue colored text in the
document)
Reviewer: NISHAT AFROZ
Reviewer's report:
Minor Essential Revisions:
1. A brief mention of type of surgery performed should be done.
→ This mass was removed by excision via Video-assisted thoracoscopic surgery (VATS). I added it
in clinical presentation.
On endoscopic ultrasonograpy, a homogeneously hypo to isoechoic mass measuring 2.3 cm size
was observed in the submucosal layer, and mass excision via Video-assisted thoracoscopic surgery
(VATS) was performed.
2.
If possible, images of macroscopic/gross appearance of tumor are to included.→ I added the
figure of gross appearance of mass. (figure 2)
3.
Microscopic pictures should include overlying mucosa as well as periphery of the lesions
depicting tumor - non tumor tissue interface.
→ The mass was only enucleated without overlying mucosa or surrounding esophageal tissue.
4. Immunohistochemistry panel should also include Synaptophysin/Chromogranin and GFAP.
On immunohistochemical stains, tumor cell was not stained for Synaptophysin, Chromogranin
and GFAP.
5. Differential diagnosis must include Low grade fibromyxoid sarcoma and ganglioneuroma with
abundant myxoid stroma.
→ I added the below sentences
Low-grade fibromyxoid sarcoma is characterized by spindle cell tumor with bland histological
findings, but fully aggressive behavior, with a higher rate of recurrence and metastasis. The
tumor composed of bland spindled to stellate cells in a myxoid and fibrotic stroma. However,
there are often prominent curvilinear and branching vessels in the myxoid area and the tumor
cells are negative for S-100. [8,9] Ganglioneuroma usually present as a large mass in the
retroperitoneum or mediastinum and composed of clusters of ganglion cells in a neuromatous
stroma. Ganglioneuroma with abundant myxoid stroma has led to confusion with
microcystic/reticular schwannoma. However, tumor location or careful searching for ganglion
cell can be helpful to distinguish from microcystic/reticular schwannoma. [10]
I hope the revised manuscript will better meet the requirements for publication.
I thank you again for constructive review by the referees.
Sincerely yours
Mi Jin Gu