Reviewer’s report
Title: 
A Case of Primary Intestinal Lymphangiectasia with non-Hodgkin
Lymphoma
Version: 
0 
Date: 
18 May 2021
Reviewer's report:
The authors present an interesting case of a patient with intestinal large cell B-
cell lymphoma and preceding protein loss and thickened small bowel loops. The
authors make a diagnosis of primary intestinal lymphangiectasia. A review on
literature on lymphoma in patients with primary intestinal lymphangiectasia is
further included.
This paper is well written with relevant images.
However, the images 
of terminal iluem show a nodular mucosa, presumably of
lymphatic origin. Histology shows dilated lymphatic vessels. This seems rather
due to secondary lymphangiectasia associated with lymphoma. The typical
endoscopic feature of whittish, dilated villi is missing. In my opinion, this case
cannot support the hypothesis of primary lymphangiectasia being a risk factor
for development of lymphoma.
In summary, an interesting case of presumably secondary lymphangiectasia in
small bowel lymphoma is reported. The discussion and literature research should
be on the wide field of differential diagnoses to secondary lymphangiectasia. The
discussion could also include feature of both, primary and secondary
lymphangiectasia.
However, this case cannot be the trigger for a systematic review and not an
additional case to support the hypothesis of primary intestinal lymphangiectasia
being a potential cause of lymphoma insteaad of just being a epiphenomen of
lymphoma. To do so, endoscopic diagnosis in the upper small bowel with dilated
lymphatic vessels in enlarged whittish villi and the absence of lymphoma in total
enteroscopy, either by capsule endoscopy or device assisted enteroscopy would
be mandotory in the early state of disease.
In 2021 the authors claimd that since the first description of primary intestinal
lymphangiectasia only 200 cases have been published. However, this evidence is
from a report published in 2010. This number is not supposed to be still correct
today, especially when considering the massive improvement of small bowel
endoscopy in the last years.
Publons Reviewer Recognition
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find the details of processing in Publons’ privacy policy
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Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
A Case of Primary Intestinal Lymphangiectasia with non-Hodgkin
Lymphoma
Version: 
0 
Date: 
18 May 2021
Reviewer's report:
The authors present an interesting case of a patient with intestinal large cell B-
cell lymphoma and preceding protein loss and thickened small bowel loops. The
authors make a diagnosis of primary intestinal lymphangiectasia. A review on
literature on lymphoma in patients with primary intestinal lymphangiectasia is
further included.
This paper is well written with relevant images.
However, the images 
of terminal iluem show a nodular mucosa, presumably of
lymphatic origin. Histology shows dilated lymphatic vessels. This seems rather
due to secondary lymphangiectasia associated with lymphoma. The typical
endoscopic feature of whittish, dilated villi is missing. In my opinion, this case
cannot support the hypothesis of primary lymphangiectasia being a risk factor
for development of lymphoma.
In summary, an interesting case of presumably secondary lymphangiectasia in
small bowel lymphoma is reported. The discussion and literature research should
be on the wide field of differential diagnoses to secondary lymphangiectasia. The
discussion could also include feature of both, primary and secondary
lymphangiectasia.
However, this case cannot be the trigger for a systematic review and not an
additional case to support the hypothesis of primary intestinal lymphangiectasia
being a potential cause of lymphoma insteaad of just being a epiphenomen of
lymphoma. To do so, endoscopic diagnosis in the upper small bowel with dilated
lymphatic vessels in enlarged whittish villi and the absence of lymphoma in total
enteroscopy, either by capsule endoscopy or device assisted enteroscopy would
be mandotory in the early state of disease.
In 2021 the authors claimd that since the first description of primary intestinal
lymphangiectasia only 200 cases have been published. However, this evidence is
from a report published in 2010. This number is not supposed to be still correct
today, especially when considering the massive improvement of small bowel
endoscopy in the last years.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
A Case of Primary Intestinal Lymphangiectasia with non-Hodgkin
Lymphoma
Version: 
0 
Date: 
18 May 2021
Reviewer's report:
The authors present an interesting case of a patient with intestinal large cell B-
cell lymphoma and preceding protein loss and thickened small bowel loops. The
authors make a diagnosis of primary intestinal lymphangiectasia. A review on
literature on lymphoma in patients with primary intestinal lymphangiectasia is
further included.
This paper is well written with relevant images.
However, the images 
of terminal iluem show a nodular mucosa, presumably of
lymphatic origin. Histology shows dilated lymphatic vessels. This seems rather
due to secondary lymphangiectasia associated with lymphoma. The typical
endoscopic feature of whittish, dilated villi is missing. In my opinion, this case
cannot support the hypothesis of primary lymphangiectasia being a risk factor
for development of lymphoma.
In summary, an interesting case of presumably secondary lymphangiectasia in
small bowel lymphoma is reported. The discussion and literature research should
be on the wide field of differential diagnoses to secondary lymphangiectasia. The
discussion could also include feature of both, primary and secondary
lymphangiectasia.
However, this case cannot be the trigger for a systematic review and not an
additional case to support the hypothesis of primary intestinal lymphangiectasia
being a potential cause of lymphoma insteaad of just being a epiphenomen of
lymphoma. To do so, endoscopic diagnosis in the upper small bowel with dilated
lymphatic vessels in enlarged whittish villi and the absence of lymphoma in total
enteroscopy, either by capsule endoscopy or device assisted enteroscopy would
be mandotory in the early state of disease.
In 2021 the authors claimd that since the first description of primary intestinal
lymphangiectasia only 200 cases have been published. However, this evidence is
from a report published in 2010. This number is not supposed to be still correct
today, especially when considering the massive improvement of small bowel
endoscopy in the last years.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant