Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript presents an uncommon and clinically relevant scenario in which an umbilical lesion initially presumed to be an umbilical hernia was ultimately diagnosed as a Sister Mary Joseph nodule associated with cholangiocarcinoma. The topic is appropriate for a case report and the central message (maintaining suspicion for malignancy in atypical “hernia-like” umbilical lesions) is valuable. The manuscript is generally well organized (Introduction, Case Presentation, Discussion, Conclusions). The following points would strengthen the manuscript:

1. The term “distal intrahepatic cholangiocarcinoma” is potentially confusing. Please clarify the anatomic classification and use consistent terminology throughout (intrahepatic vs perihilar vs distal extrahepatic) in a way that matches the imaging description.
2. The umbilical lesion is described as metastatic carcinoma, while the primary diagnosis appears largely imaging-based (CT/MRCP). Please clarify whether there was tissue confirmation of the primary tumor (biopsy/brushings/cytology) and, if performed, briefly report any IHC from the umbilical lesion to support the likely origin.
3. The abstract/discussion mention “cholestatic symptoms,” but the case presentation provides limited symptom detail (mainly fatigue/lethargy and direct bilirubin elevation). Please add a brief symptom/laboratory summary (e.g., jaundice/pruritus, dark urine/pale stool, ALP/GGT/AST/ALT, total/direct bilirubin), or revise wording for consistency if typical cholestatic symptoms were not present.
4. The consent statement reads as if multiple subjects were included; please confirm written informed consent for publication (or waiver, per policy).
5. Please expand the figure legends to be self-contained and correct minor punctuation/spacing issues. For the histology figure, add stain and magnification (and scale bar if available). For imaging figures, consider arrows/labels indicating the key findings.
6. The Author Contributions section includes an isolated name fragment; please correct formatting and clearly assign roles to all listed authors.
7. “Supporting research found on ClinicalKey” is unusual for a case report. Please revise to a standard statement (e.g., “Not applicable” or “Data available upon request,” depending on journal requirements). If ClinicalKey content is essential to the manuscript, please specify exactly what is available there and how it can be accessed (e.g., identifier/code), if applicable.

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have documented a rare case of cholangiocarcinoma presenting with SMJN.

Some suggestions are as under:

1. Figure legend for Figure 2 needs rephrasing.
2. Figure legend for Figure 4 needs mentioning of the magnification used instead of moderate power.
3. A clinical photograph of lesion may be added if available.
4. A few lines on histotypes of tumors seen as SMJN should be added to the discussion. Like mostly these are adenocarcinoma but rare tumors include squamous cell carcinoma, neuroendocrine tumors, GIST, etc.
5. A line on mean survival of these cases may be added.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Hello, dear colleagues!

This clinical case focuses on an interesting patient with the primary manifestation of metastatic intrahepatic cholangiocarcinoma.

Nevertheless, I would like to make a few comments.
1. For completeness, it would be advisable to add the following to the description:
indicate reference values ​​for direct bilirubin, as well as information on ALP, GGT, ALT, and AST levels.
2. Figure legends should be more detailed, indicating the affected side, examination type, section type, etc.
3. 5 references (4, 6, 8, 9, 11) are older than 10 years (2010, 2020, 2014, 2006, 2006). References #4 (2010) and #11 (2006) are particularly critical for the quality of the introduction data. This section needs updating.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Dear authors and editors, an interesting clinical example of late-stage cholangiocellular cancer is presented. With an atypical manifestation. The optimal diagnostic algorithm that was possible in this situation is described. Sufficient illustrative material. As a comment: It is necessary to supplement the description with laboratory data (oncological markers). A photo of the umbilical region is also necessary. As an example of assessing the prognosis of this disease, we can use the system described in the article "Kovalenko Y, Olifir A, Glotov A, Popov A, Trifonov S, Blagovestnov D, Shevchenko T, Gurmikov B, Loginova N, Zharikov Y. Tumor invasion loci in respected margins of perihilar cholangiocarcinoma and their impact on survival: a retrospective 13-year longitudinal cohort study. World J Surg Oncol. 2025 Oct 21;23(1):386. doi: 10.1186/s12957-025-04006-7. PMID: 41121241; PMCID: PMC12538948" (but this is at the discretion of the authors). In general, the manuscript meets the standard for this type of article. I recommend taking it after minimal correction of the content.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Hello, dear colleagues!

I am satisfied with the authors' responses and have no other comments.