Resection of a Large Growing Mediastinal Germ Cell Tumor Using a Multidisciplinary Approach

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors describe an interesting case of a mediastinal GCT that contained within it a component of RMS. The description of the case is interesting and the authors argued rightly for the inclusion of a multidisciplinary team in the management of these patients.

Additional information that may be helpful to the manuscript:

1. Please clarify the title: as is, the title is a little misleading. GCT are widely known to contain components such as RMS or other types of sarcomas. The title made it sound like the entire tumor eventually identified as RMS rather than a large GCT with a component of RMS

2. were there any additional investigations done for the tumor; were there novel molecular or pathologic findings that were not previously reported?

3. Could the authors provide additional intraop images to help guide surgeons and other specialists who may read with interest?

4. The authors may benefit from adding a more robust discussion regarding the challenge of managing these findings

There is one minor grammatical error: in line 133, did you mean "resectability" rather than "respectability" as it is currently in the manuscript.

Thank you for submitting this manuscript for review.

Author Response

1. Please clarify the title: as is, the title is a little misleading. GCT are widely known to contain components such as RMS or other types of sarcomas. The title made it sound like the entire tumor eventually identified as RMS rather than a large GCT with a component of RMS

Thank you for your comment. The title has been changed to “Resection of a Large Growing Mediastinal Germ Cell Tumor Using A Multidisciplinary Approach“

2. were there any additional investigations done for the tumor; were there novel molecular or pathologic findings that were not previously reported?

Thank you for your question. No additional novel molecular or pathologic findings were identified that have not been included in the manuscript.

3. Could the authors provide additional intraop images to help guide surgeons and other specialists who may read with interest?

Thank you for your question. Unfortunately, no other intraop images aside from the photo of the gross specimen which was obtained at the end of the procedure.

4. The authors may benefit from adding a more robust discussion regarding the challenge of managing these findings

Thank you for your comment. A paragraph discussing surgical approach has been added to the discussion. Two case reports describing resection of similar large GCT have also been included.

There is one minor grammatical error: in line 133, did you mean "resectability" rather than "respectability" as it is currently in the manuscript.

Thank you for identifying this grammatical error. It has been correct on line 133.

Reviewer 2 Report

Comments and Suggestions for Authors

Overall, the content is insightful and informative. However, I would like to suggest a few revisions to enhance clarity and coherence:

1、Introduction: Expand the introduction to provide a more comprehensive overview of the transition from Germ Cell Tumor to Rhabdomyosarcoma. This will help set the stage for readers unfamiliar with the topic.

2、Discussion: Strengthen the discussion by incorporating more comparative analysis between cases and emphasizing the significance of the multidisciplinary approach in managing this transition.

Comments on the Quality of English Language

Ensure consistency in terminology and maintain a formal tone throughout the article.

Author Response

Overall, the content is insightful and informative. However, I would like to suggest a few revisions to enhance clarity and coherence:

1、Introduction: Expand the introduction to provide a more comprehensive overview of the transition from Germ Cell Tumor to Rhabdomyosarcoma. This will help set the stage for readers unfamiliar with the topic.

Thank you for you comment. The introduction has been modified, including adding a reference, to describe somatic transformation of GCT.

2、Discussion: Strengthen the discussion by incorporating more comparative analysis between cases and emphasizing the significance of the multidisciplinary approach in managing this transition.

Thank you for your comment. A paragraph discussing surgical approach has been added to the discussion. Two case reports describing resection of similar large GCT have also been included.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Accepted with the current form

Author Response

Thank you for your comments and suggestions.