Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript presents an unusual and clinically important case of thyroid-presenting plasmablastic lymphoma (PBL) in an immunocompetent patient with life-threatening airway obstruction. The case is rare, well documented, and supported by an appropriate combination of morphology, immunophenotyping, flow cytometry, and MYC cytogenetic analysis. The manuscript is generally well written, the literature review is up to date.

However, several issues should be addressed before publication. You can find the items for revision in the attachment

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Comments:
   The manuscript entitled “ Thyroid-Presenting Plasmablastic Lymphoma Mimicking Anaplastic Thyroid Carcinoma”. Plasmablastic lymphoma (PBL) is an aggressive large B-cell tumor often accompanied by the loss of conventional B-cell markers. This article reports a case of an immunocompetent patient with thyroid PBL presenting as an acute surgical airway emergency, highlighting the pitfalls associated with differential diagnosis and treatment of undifferentiated thyroid carcinoma. In this case, the loss of conventional B-cell markers, CD138 negativity, and abnormal cytoplasmic CD3 expression could have presented clinically very similarly to undifferentiated thyroid carcinoma. The case involved a complex diagnostic process but was successfully treated, making it of high clinical educational value.

Comments:
1. Clearly indicate the peak time point of LDH (e.g., before treatment, after the first cycle of chemotherapy, after the sixth cycle).

2. EBV DNA "low-level positivity" has no specific value.

3. If chemotherapy has been administered, it is recommended to supplement baseline BUN/Cr and liver function to corroborate the patient's tolerance to the safety of the treatment.

4. Figure 2 Immunohistochemical image: The caption text is inconsistent with the image label.

5. The caption reads: "(a) CD3 with dim cytoplasmic staining (b)", but Section 2.3 of the text describes it as "weak cytoplasmic CD3 expression", and the first half of the caption states "positive for CD45 with dim membranous staining (a)".

6. Clearly label the biomarkers corresponding to each figure.

7. The figure caption mentions "bright CD38 and variable CD19 expression." It is recommended to mark the abnormal population with arrows or circles on the figures and add antibody markers (e.g., CD38-FITC vs CD19-PE) to the x and y axes.

8. "EPOCH-based regimens alone have historically yielded CR rates of 40–65%"—this data comes from reference 21 (Hamby et al. 2026), but the sample size and patient population are not specified. Since the 40-65% range is relevant to the discussion but the source lacks sample size and demographic details, I prefer that the authors retain the figure but add a clear caveat to address this limitation. A suitable phrasing would be: "Reference 21 reports a range of 40-65%, although the original paper does not disclose the specific sample size or detailed patient demographics, which constitutes a limitation of the cited data."

9. Add the patient's diagnosis date, chemotherapy completion date, and last follow-up date, and calculate the specific follow-up months. Clearly define the assessment method for complete remission (PET-CT Deauville score or CT size standard) and the assessment time point.

10. Add the occurrence of ≥ grade 3 adverse events (such as neutropenia, infection, etc.) during chemotherapy.

11. Figures 1 and 2 must be Quantitative. This will ensure the charts meet the standard quantitative rigor expected for publication.

Comments for author File: Comments.pdf

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Accept in present form

Author Response

Comment 1: Accept in present form

Response 1: We sincerely thank the reviewer for their favorable assessment of the revised manuscript and for recommending acceptance in its present form. We appreciate their careful review and constructive feedback throughout the revision process.