Diagnostic Approach to Congenital Cystic Masses of the Neck from a Clinical and Pathological Perspective
Round 1
Reviewer 1 Report
I really like the manuscript of Fanous A and coworkers reviewing the issue of congenital cystic neck masses in children. Overall, the work represents a nice and cooverview and therefore of interest for many clinicians of different specialities, such as pediatrics, surgeons, family doctors and ENTs as well.
However, some minor issues needs to be revised:
- Figures: i would recommend to add additional lettering and legends (e.g. arrow heads, asteriscs,....) to improve quality of figures and to make life easier for non-histopathologists. Secondly, histologic figures should be smaller but labelled.
- Line 109 - 110: "if the diagnosis of ectropic or lingual thyroid is suspected, a preoperative thyroid uptake scan should be performed". To be honest, I don't really see the clinical relevance for this additional imaging technique - if the decision was made to remove the suspected tissue due to certain complaints, a scintigraphy to detect thyroid tissue, would not change our initially made indication - except if no regular thyroid gland is present. I would revise this statement.
- Line 153: lesion would be more appropriate than defect
- Line 292: "Surgical resection is considered a last" - maybe considered "as" is missing
- (2.4.1. Clinical Findings - Dermoid cyst) - here it is crucial to point out that dermoid cysts are typically performed exactly in the midline. I think that it is a bit underestimated in the current version.
- The conclusion is unfortunately absolutely confusing. E.g. "the thyroglossal duct cyst is the most common congenital neck cyst, (...) second most common benign neck mass, after benign lymphadenopathy". So far, benign reactive lymphadenopathy has not be mentioned before and was just introduced in the conclusion. And so on.
- What about malignancies? Are the so uncommon? A section regarding malignancies would be great.
- An additional table (or maybe flow chart) dealing with the diagnostic algorithm would further improve the quality of the manuscript - what about fine needle aspiration, sonography, MRI depending on location of lesions. So, in particular, if a patient presents with a lesion of the lateral neck - what are the next required steps.
As already stated above, I really like the work of Fanous A et al, but I think that the histopathological part of the work is a bit overrepresented, while the diagnostic / clinical approach has been neglected. For a comprehensive review, this aspect should be also respected.
Author Response
We thank reviewer 1 for his/her valuable comments. All comments have been considered. We hope these changes have allowed to enrich and clarify this manuscript.
- Figures: i would recommend to add additional lettering and legends (e.g. arrow heads, asteriscs,....) to improve quality of figures and to make life easier for non-histopathologists. Secondly, histologic figures should be smaller but labelled.
Figures have been reduced and legends have been added for better comprehension.
- Line 109 - 110: "if the diagnosis of ectropic or lingual thyroid is suspected, a preoperative thyroid uptake scan should be performed". To be honest, I don't really see the clinical relevance for this additional imaging technique - if the decision was made to remove the suspected tissue due to certain complaints, a scintigraphy to detect thyroid tissue, would not change our initially made indication - except if no regular thyroid gland is present. I would revise this statement.
This sentence has been deleted.
- Line 153: lesion would be more appropriate than defect
This word has been changed.
- Line 292: "Surgical resection is considered a last" - maybe considered "as" is missing
This sentence has been corrected.
- (2.4.1. Clinical Findings - Dermoid cyst) - here it is crucial to point out that dermoid cysts are typically performed exactly in the midline. I think that it is a bit underestimated in the current version.
We put the stress on the importance of cyst localization in this paragraph and in other parts of the manuscript, especially in conclusion in order to deliver propoer messages.
- The conclusion is unfortunately absolutely confusing. E.g. "the thyroglossal duct cyst is the most common congenital neck cyst, (...) second most common benign neck mass, after benign lymphadenopathy". So far, benign reactive lymphadenopathy has not be mentioned before and was just introduced in the conclusion. And so on.
We have changed the conclusion in order to deliver comprehensive messages and underline important points.
- What about malignancies? Are the so uncommon? A section regarding malignancies would be great.
We create a dedicated section to detail in one hand malignancies originating from cystic mass and in other hand differential diagnosis between benign cystic mass and solid and cystic malignancies.
- An additional table (or maybe flow chart) dealing with the diagnostic algorithm would further improve the quality of the manuscript - what about fine needle aspiration, sonography, MRI depending on location of lesions. So, in particular, if a patient presents with a lesion of the lateral neck - what are the next required steps. As already stated above, I really like the work of Fanous A et al, but I think that the histopathological part of the work is a bit overrepresented, while the diagnostic / clinical approach has been neglected. For a comprehensive review, this aspect should be also respected.
An algorithm has been added. We have also tried to implement clinical part in the whole manuscript.
Reviewer 2 Report
This is an interesting review about diagnostic approach to congenital cystic masses of the neck.
The paper is well written. However, some issues remain.
The review analyzes also vascular malformations. This must be specified in the title.
Percentages related to frequency in Table 1 are not clear. What do they refer to?
Why did the authors report antibiotics as a treatment for lymphatic malformations?
Most of the sentences of the paper do not report a reference. Nineteen references for a review are too few.
Incidence of the lesions are not described.
Please report where the histological images were found (authors’ personal cases?).
Discussion and conclusion must be implemented. More data about differential diagnoses are needed.
Several grammatical errors are present.
Author Response
We thank reviewer 2 for excellent comments. We considered every comments and added appropriate changes.
The review analyzes also vascular malformations. This must be specified in the title.
Response: The manuscript deals with congenital cervical cystic masses which can indeed correspond to vascular lymphatic malformation. We think that the formulation of the title doesn’t exclude this diagnosis. Moreover, we chose not to promote a special diagnosis from another and we think that the title would be too long and confusing by adding different entities.
Percentages related to frequency in Table 1 are not clear. What do they refer to?
Response: We detailed percentages in table 1 for better comprehension.
Why did the authors report antibiotics as a treatment for lymphatic malformations?
Response: We added the indication of antibiotics in the text in order to clarify the message.
Most of the sentences of the paper do not report a reference. Nineteen references for a review are too few.
Response: We added and enriched the manuscript with additional references.
Incidence of the lesions are not described.
Response: We added frequencies of these different entities in the text from available data in literature.
Please report where the histological images were found (authors’ personal cases?).
Response: All images are from personal cases.
Discussion and conclusion must be implemented. More data about differential diagnoses are needed.
Response: We reorganized discussion and conclusion in order to clarify and enrich them.
Several grammatical errors are present.
Response: The whole manuscript has been reviewed for English language by J. Ciaran Hutchinson (Great Ormond Street Hospital for Children, London, UK) (Acknowledgment).
