Clinically Malignant Breast Lesion in an Adolescent Girl: A Case Report

Round 1

Reviewer 1 Report

The authors presented an interesting case of differential diagnosis between abscess and malignant breast lesion. It would have been of great interest to see images. Although an abscess was suspected no culture of the material from breast biopsy was obtained. Additionally, once the MRI showed a cystic lesion why a fine-needle aspiration was not attempted? All these alternative treatment should be discussed and eventually treated as limitations.

Author Response

Dear Editor and Reviewers,

I wish to resubmit the corrected manuscript entitled “Clinically malignant breast lesion in an adolescent girl: a case report” for re-evaluation. We would be very grateful if your journal reconsidered evaluation of our efforts and potential publication of the manuscript in the revised form.

The answer to the Reviewer Comments:

1. It would have been of great interest to see images.

Re: Thank you very much for the comment. We managed to get the results of imaging examinations (USG, MRI) from the parents. Unfortunately, these are the only images available and I hope their quality will be sufficient.

Figure 2 and 3.

All figures have been renumbered.

2. Although an abscess was suspected no culture of the material from breast biopsy was obtained.

Thank you very much for the comment. The entire management of a breast tumor was consulted with an oncologist. Due to the ambiguous picture of the breast lesion on physical examination and ultrasound, it was not decided to drain it due to the risk of dissemination if the lesion was malignant. Until the abscess evacuated spontaneously, there was no decision to make a biopsy or drain it.

It was only when the pus was released that it became clear that the lesion was an abscess and the content was submitted for microbiological examination. Methicillin-sensitive (MSSA) Staphylococcus aureus strains were isolated [Line 74-78].

3. Additionally, once the MRI showed a cystic lesion why a fine-needle aspiration was not attempted?

Thank you very much for the comment. Yes, of course, after performing the MRI examination, another oncological consultation was performed, and it was decided that a fine-needle breast biopsy was needed. Unfortunately, the result of fine-needle aspiration biopsy was undiagnosed [Line 65-66]. Although we knew that the biopsy should be repeated, we were preparing the girl for the transfer within two days, and we did not want to repeat the test anymore.

4. All these alternative treatment should be discussed and eventually treated as limitations.

Thank you very much for the comment and valuable clue. In the discussion, we described the value of MRI [Line 146-149] and fine-needle breast biopsy [Line 150-154]. We also indicated the standard methods of treatment: antibiotic therapy and drainage [Line 160-162].

One more time I want to thank for all advices. We introduce corrections into the manuscript.

I hope the manuscript now meets all the requirements.

Yours faithfully,

Patrycja Sosnowska-Sienkiewicz

Author Response File: Author Response.docx

Reviewer 2 Report

The authors report a case of breast abscess exhibiting malignant features in a teenage girl. They identified the methicillin-sensitive Staphylococcus aureus as a likely cause, and the antibiotic treatment was not working until the spontaneous evacuation of pus.

Major points:

1. Please provide the ultrasound and MRI images that support the descriptions in line 47 and line 55, respectively.
2. Too much repetitive information in Discussion and Conclusion sections. Please combine these two sections.
3. Line 69 and line 133/134: if incision and drainage were not performed in this case, then please replace the word “drainage” in line 134 with “a spontaneous evacuation of pus” or other appropriate words.
4. In Discussion, the flow of ideas could be better organized and connected to the Case Report section. For example, in line 118, please elaborate the sentence “Thus, disturbing features were observed in our patient” by providing more specific details on the observed features. Similarly, from line 119 to line 122, the authors described the MRI results- then, how would that connect to the description referenced from the ref. 8? In the case of breast abscess, a more appropriate and specific comparison would be to the inflammatory breast cancer (please elaborate this part).

Minor points:

1. Line 19: Please use the format of 84x66x50 mm³ or 84 mm x 66 mm x 50 mm. There is a similar issue in line 48, 57, and 58.
2. Line 34: “15-year-old”
3. Line 45: Please describe in a bit more details about the “necessary laboratory tests.” For example, blood examinations.
4. Please define CRP in line 45.
5. Line 46: Please replace “16x103/μl” with “16 x 10⁹/L”
6. Line 47: USG stands for “ultrasonography.” US stands for “ultrasound.”
7. Line 53: “MRI” is mentioned for the first time here.
8. Line 125: “…decided to consult her outside our medical center.” Is it better to write like “…decided to consult with experts outside our medical center.”

Author Response

Dear Editor and Reviewers,

I wish to resubmit the corrected manuscript entitled “Clinically malignant breast lesion in an adolescent girl: a case report” for re-evaluation. We would be very grateful if your journal reconsidered evaluation of our efforts and potential publication of the manuscript in the revised form.

The answer to the Reviewer Comments:

Major points:

1. Please provide the ultrasound and MRI images that support the descriptions in line 47 and line 55, respectively.

Re: Re: Thank you very much for the comment. We managed to get the results of imaging examinations (USG, MRI) from the parents. Unfortunately, these are the only images available and I hope their quality will be sufficient.

Figure 2 and 3.

All figures have been renumbered.

2. Too much repetitive information in Discussion and Conclusion sections. Please combine these two sections.

Re: Thank you very much for your valuable comment. Some of the conclusions were unnecessarily information from the discussion. Recurring conclusions in the discussion have been removed or modified [Line 165-171].

3. Line 69 and line 133/134: if incision and drainage were not performed in this case, then please replace the word “drainage” in line 134 with “a spontaneous evacuation of pus” or other appropriate words.

Re: Thank you very much for this comment. The word “drainage” was changed on “a spontaneous evacuation of pus”.

4. In Discussion, the flow of ideas could be better organized and connected to the Case Report section. For example, in line 118, please elaborate the sentence “Thus, disturbing features were observed in our patient” by providing more specific details on the observed features.

Re: Thank you very much for this comment. This part was completed. [Line 142-144] Discussion was modified.

Similarly, from line 119 to line 122, the authors described the MRI results- then, how would that connect to the description referenced from the ref. 8?

Re: This part also was modified and completed. [Line 145-148]

In the case of breast abscess, a more appropriate and specific comparison would be to the inflammatory breast cancer (please elaborate this part).

Re: Thank you very much for this comment. Fragment of the text about inflammatory breast cancer in children was added to the manuscript. The described symptoms were compared to our patient [Line 98-115]. I also completed the references.

Minor points:

1. Line 19: Please use the format of 84x66x50 mm3 or 84 mm x 66 mm x 50 mm. There is a similar issue in line 48, 57, and 58.

Re: It was corrected.

2. Line 34: “15-year-old”

Re: It was corrected.

3. Line 45: Please describe in a bit more details about the “necessary laboratory tests.” For example, blood examinations.

Re: It was corrected.

4. Please define CRP in line 45.

Re: It was completed.

5. Line 46: Please replace “16x103/μl” with “16 x 109/L”

Re: It was corrected.

6. Line 47: USG stands for “ultrasonography.” US stands for “ultrasound.”

Re: Thank you for this comment. It was corrected.

7. Line 53: “MRI” is mentioned for the first time here.

Re: It was corrected.

8. Line 125: “…decided to consult her outside our medical center.” Is it better to write like “…decided to consult with experts outside our medical center.”

Re: It was corrected.

Thank you very much for the valuable comments. All hints of "minor points" were introduced to the text.

One more time I want to thank for all advices. We introduce corrections into the manuscript.

I hope the manuscript now meets all the requirements.

Yours faithfully,

Patrycja Sosnowska-Sienkiewicz

Author Response File: Author Response.docx