Urinary Bladder Metastasis from Gastric Cancer: A Case Report and Review of the Literature

Round 1

Reviewer 1 Report

Case report regarding urinary bladder metastasis in gastric cancer.

The authors should include some figures and a timeline summarizing this interesting case.

In addition, although some important studies have been cited in the introduction, we suggest to include other reports, just for a matter of consistency (doi: 10.2217/fon-2019-0429.).

Major changes are required, including a linguistic correction.

Author Response

Unfortunately, there are no other figures available.

Concerning the linguistic corrections, the manuscript was revised and checked by a native speaker teacher of English literature.

We made some changes in the section of the manuscript in lines 141-151.

Author Response File: Author Response.docx

Reviewer 2 Report

Please be consistent and choose urothelial cancer instead of bladder cancer.
As the manuscript is dealing with metastatic bladder lesion there is no need to discuss about urothelial cancer. Besides mentioning that most of the bladder lesions are urothelial and the minority is secondary all the data concerning primary urothelial cancer is redundant. Including references.
Cystoscopy can be done with either flexible or rigid instruments. This is redundant the case is not dealing with urology training. 
Cystoscopy can be done with either flexible or rigid instruments. Cystoscopic find139 ings include obvious tumors, papillary or solid, nonspecific inflammation, and a thick140 ened bladder wall covered with normal mucosa. The presence of changes in the bladder 141 mucosa is useful in distinguishing a primary bladder tumor from a metastatic bladder 142 tumor. A submucosal tumor is suggestive of a secondary bladder tumor, but ulcerative 143 lesions can be seen in some cases. Solid tumors are more suspicious of metastatic lesions. 144 Superficial, low-grade tumors appear as single or multiple papillary lesions, usually of 145 urothelial pathology. Higher grade lesions are larger and sessile. Prostate metastatic can146 cer to the bladder usually is recognized by extensive oedema and inflammation appear147 ance of the mucosa. In our study several endoscopic findings were described like exten148 sive vegetative session, protuberant mass, extensive bullous oedema of the bladder mu149 cosa and diffuse papillary nodular lesion

This section is based on personal impression. For scientific evidence, please shorten and backup with references.

Author Response

We use bladder cancer in order to include all cancer types that can be revealed in the bladder (there are not only urothelial carcinomas)

We stressed out also that most of the cancers that appeared in the bladder are urothelial carcinomas in order to highlight the uniqueness of our study (metastatic gastric cancer to the urinary bladder).

We corrected the sections of the manuscript between lines 141-151 and we supported it with references. You can find it in the revised manuscript.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Case report regarding urinary bladder metastasis in gastric cancer.

The authors addressed most of our concerns.

In addition, although some important studies have been cited in the introduction, we suggest including other reports, just for a matter of consistency (doi: 10.2217/fon-2019-0429.).

Minor changes are required.

Author Response

I believe no further changes are required

Author Response File: Author Response.docx

Reviewer 2 Report

Revisions done according to my remarks

Author Response

No further changes are required

Author Response File: Author Response.docx