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ligne 15 : the presence of a 56*37 mm mass extending..
ligne 24 : preoperative chemotherapy rather than neoadjuvant chemotherapy
ligne 33: Synovial sarcomas often arises
ligne 41: O'keefee et al in 1993 (3)
ligne 43: Mackenzie et al suggested .. reference ??
Concerning imaging: is MRI better ??
experience in diagnosis and treatment of sarcoma.
Some articles published in other area.
Nice and original artcile,
I join the comments made by the other authors
I think this is a very interesting article. It shows us a very rare clinical case of a primary synovial sarcoma arising of the inner ear. The communication of these kind of rare clinical cases is understandable from the point of view of increasing the doctors´ awareness about the relevance of expedite diagnosis and treatment and also to increase the knowledge of these diseases to make doctors suspect about their existence. Despite of the comments above, I think this article could be somewhat improved. Sometimes it needs a language polishment.
In the introduction the authors should include more data about the synovial sarcomas in general, frequency, most usual locations and therapeutic approaches. Then, authors could focus (as they have done) on the ear tumours and the relevance of early diagnosis and treatment to get the best results.
In the section “Case report”, authors should explain the abbreviation they have used FNCLCC (French Federation of Cancer Centers Sarcoma Group).
I would like to have seen if this case was treated in a multidisciplinary committee and if radiation therapy was considered as neoadjuvant treatment as chemotherapy was.
I miss some pictures about histology.
I would like also to know why this patient had received oral cyclophosphamide as palliative treatment once she had got progressive disease with the combination of ifosfamide and doxorubicin and for how long was she receiving this treatment and also the evolution she presented (stable disease, partial remission or progressive disease). On the other hand the dosis of palliative radiotherapy and the clinical benefits she got from this technique.
I think all these points would improve our knowledge about this rare disease.
In the end the references need to be reviewed (there is a mistake in reference 3).
Esther Una Cidon, MD, PhD, Professor
Thank you for this interesting case report.
I was only able to see the CT image before treatment, not afterwards. Also, do you have an MRI? Do you have a PET/CT image? In your description of the CT, please give units of measurement.
Some of the abbreviations you used were unfamiliar to me. Could you please give the full description instead of just abbreviations?
Molecular imaging physician.
I suggest to:
refere to the grading system that was used
add the illustrations for the IHC for EMA, PSA100, CD34, HMB45, KL1, and desmine with the proper positive and negative controls
add the scoring system for these markers and illustrate why they have been used (e.g. desmine as myoepithelial marker, KL1 as epithelial marker .....etc)
Explain why diagnosis was not confirmed by molecular markers
Follow consistent method in writing refereces
I wish authors should elaborate on certain issues and also calrify few of them. Can they clarify the exact site of origin of the tumor as it appears clinically as well as on CT films to be involving external and middle ear, mastoid and temperomandibular area and not inner ear. There are case reports of the tumor arising from temperomandibular region (atleast 2). Authors should have provided illustration of microscopic findings. It is difficult to diagnose these tumors in small specimens even by experienced sarcoma pathologist. At present time diagnosis of monphasic synovial sarcoma needs demonstration of X;18 translocation which is characteristic of these tumors. Extensive articles on synovial sarcoma of head and neck and orbit can be found.
surgical oncologist in an academic institute
This manuscript reports a rare case of a primary case of synovial sarcoma localized in the middle ear.
The manuscript may need the addition of the histological analysis.
Minor corrections are also needed (e.g. consistency in the references).
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