Poikilodermatous Plaque-like Hemangioma: Case Presentation and Literature Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is a case report of a recently-described and as yet poorly known entity called ‘poikilodermatous plaque-pike hemangioma’ (PPH). Only 18 such cases have been previously published, therefore this case merits publication. However, the article should be improved:

 

As there are few similar cases in the literature, the case merits to be better studied. In the ‘discussion’ (line 94) mention is made on the cell infiltrate present in the lesion, but in the ‘Case Report’ nothing relevant is mentioned. Please describe the presence of a cell infiltrate and, ideally, perform immunohistochemistry to study the composition of the cells (CD3, CD4, CD20, CD79a,….). I also suggest to perform histochemical stains for elastic fibers (these seem to be reduced in the other cases so far published) and for would also hemosiderin (Perls’ staining). I also suggest to perform additional immunohistochemical stains relevant to vascular proliferations (such as CD34, GLUT1, ERG, SMA, Ki67). Line 40 and legend of fig. 2: the description of ‘proliferation of microvasculature’ is somewhat vague; please describe better the aspect of the proliferating vessels.

 

The literature review could be more accurate and complete. For example, (line 79) ‘The most frequently described sites…’: I suggest to provide the precise numbers (or percentages) of the different localizations. Line 70: the mean age of patients (72.9 years) could be completed by the standard deviation. Did the previously-reported patients have any comorbidities (such as immunosuppressive conditions) or history of drug intake?

Additionally, some discussion should be provided on the clinical and histological differential diagnosis of PPH.

 

Comments on the Quality of English Language

The English needs thorough editing as it often reads awkward. For instance (line69): In the sentence “Male involvement predominates (17/19, 89.4%) in all cases”, “in all cases” is awkward/redundant and should be deleted.

Lines 31 & 33: the terms ‘buttock’ and ‘gluteus’ are used. It would be preferable to use one single term to descrine the same body zone. Lines 41-42: correct ‘confirm’ to ‘confirmed’…. etc

Author Response

Dear Reviewers,

We extend our sincere gratitude for dedicating your time to review our manuscript titled "Poikilodermatous Plaque-like Hemangioma: Case Presentation and Literature Review", Manuscript ID: dermatopathology-2995761. Your insightful comments and suggestions have been invaluable in enhancing the quality of our work. Below, we address each of your specific recommendations and provide corresponding responses:

Response to Reviewer 1:

1. Cell infiltrate and immunohistochemistry: We have duly noted the importance of describing the cell infiltrate in the lesion and have included a detailed description in the Case Report section and Figure 2a. Case Report, lines 43-44; Figure 2a.
2. Additional stains: Thank you for the suggestion. Verhoeff-van Gieson staining for elastic fibers has been included as suggested and the results have been incorporated into our report. Case Report, lines 44-46; Figure 2b.
3. Description of proliferating vessels: We have provided a more detailed description of the proliferating vessels as requested. Case Report, line 42; Figure 2a.
4. Completeness of literature review: We have thoroughly revised the literature review, providing precise numbers and percentages of lesion localizations and addressing relevant comorbidities in previously-reported patients. Discussion, lines 109-115; 141-144.
5. Mean age of patients: The standard deviation has been provided along with the mean age of patients, as suggested. Discussion, line 80.
6. Differential diagnosis: We have included a discussion on the clinical and histological differential diagnosis of PHH to enrich the understanding of the condition. Discussion, lines 110-132.

Reviewer 2 Report

Comments and Suggestions for Authors

The case report is interesting. Has been made the V.Gieson to see  elastic fibers? The direction of new vessels is always orizontal or perpendicular to epidermis or both, taking in consideration the other reports? In my opinion you must to underline in a wider way the clinical and histological differential diagnosis. What about a demoscopy very useful to discover a vascular lesio?

Author Response

Dear Reviewers,

We extend our sincere gratitude for dedicating your time to review our manuscript titled "Poikilodermatous Plaque-like Hemangioma: Case Presentation and Literature Review", Manuscript ID: dermatopathology-2995761. Your insightful comments and suggestions have been invaluable in enhancing the quality of our work. Below, we address each of your specific recommendations and provide corresponding responses:

Response to Reviewer 2:

1. Elastic fibers: Van Gieson staining has been performed to visualize elastic fibers in the lesion, and the results have been incorporated into our report. Case Report, lines 44-46; Figure 2b.
2. Direction of new vessels: There is no mention of vessel direction in other reports and no predilected direction was described in previous reports.
3. Clinical and histological differential diagnosis: We have expanded on the clinical and histological differential diagnosis to provide a more comprehensive understanding of the condition. Discussion, lines 116-138.
4. Dermoscopy: A description of the dermoscopic features and a discussion of other cases' dermoscopic findings have been added to the manuscript. Case report, lines 38-40; Discussion, lines 99-104.