Reviewer ’s report  
 
Title: Case report: Acute abdominal pain in a 37 -year-old patient and the consequences for 
his family  
 
Version: 2 Date: 15 Jan 2020  
 
Reviewer: Joji Kitayama  
 
Reviewer's report:  
 
This case and family with hereditary diffuse gastric cancer （HDGC）is not so rare and the 
MS need more information.  
 
Major points.  
 
1. There are various patterns in germline mutation of CDH1. How often is this type 
(1137G &gt;A) of point mutation among the HDGC case, and what is the effects on protein E -
cadherin protein?  Since immunostaining showed positive expression in gastric cancer of 
index case, it looks like to induce functional change of E -cadherin.  
 
2. In one of the aunt who underwent gastrectomy, a diffuse GC (T1a) was found in 
pathology. The detail information should be described, such as size, location, macroscopic 
appearance and microscopic findings.  In addition, retrospective evaluation of endoscopic 
features fo cused on corresponding part should be carefully performed to find any changes 
such as unevenness, color or surface structure to suggest the lesion.  If it cannot be really 
detected in retrospective analysis, it is OK, but should be pointed out in photos in  Fig2 A/B.  
Fig2 C/D is not necessary.  
 
3. There are still objections against prophylactic gastrectomy. This should be at least 
mentioned in text.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the neces sary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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.  
 
None  
 
I agree to the open peer review policy of the journal. I understand that my name will be 
included  on my report to the authors and, if the manuscript is accepted for publication, my 
named report  including any attachments I upload will be posted on the w ebsite along with the 
authors'  responses. 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/ ). I understand that 
any comments  which I do not wish to be included in my named report can be included as 
confidential comments  to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Case report: Acute abdominal pain in a 37 -year-old patient and the consequences for 
his family  
 
Version: 2 Date: 15 Jan 2020  
 
Reviewer: Joji Kitayama  
 
Reviewer's report:  
 
This case and family with hereditary diffuse gastric cancer （HDGC）is not so rare and the 
MS need more information.  
 
Major points.  
 
1. There are various patterns in germline mutation of CDH1. How often is this type 
(1137G &gt;A) of point mutation among the HDGC case, and what is the effects on protein E -
cadherin protein?  Since immunostaining showed positive expression in gastric cancer of 
index case, it looks like to induce functional change of E -cadherin.  
 
2. In one of the aunt who underwent gastrectomy, a diffuse GC (T1a) was found in 
pathology. The detail information should be described, such as size, location, macroscopic 
appearance and microscopic findings.  In addition, retrospective evaluation of endoscopic 
features fo cused on corresponding part should be carefully performed to find any changes 
such as unevenness, color or surface structure to suggest the lesion.  If it cannot be really 
detected in retrospective analysis, it is OK, but should be pointed out in photos in  Fig2 A/B.  
Fig2 C/D is not necessary.  
 
3. There are still objections against prophylactic gastrectomy. This should be at least 
mentioned in text.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the neces sary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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.  
 
None  
 
I agree to the open peer review policy of the journal. I understand that my name will be 
included  on my report to the authors and, if the manuscript is accepted for publication, my 
named report  including any attachments I upload will be posted on the w ebsite along with the 
authors'  responses. 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/ ). I understand that 
any comments  which I do not wish to be included in my named report can be included as 
confidential comments  to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Case report: Acute abdominal pain in a 37 -year-old patient and the consequences for 
his family  
 
Version: 2 Date: 15 Jan 2020  
 
Reviewer: Joji Kitayama  
 
Reviewer's report:  
 
This case and family with hereditary diffuse gastric cancer （HDGC）is not so rare and the 
MS need more information.  
 
Major points.  
 
1. There are various patterns in germline mutation of CDH1. How often is this type 
(1137G &gt;A) of point mutation among the HDGC case, and what is the effects on protein E -
cadherin protein?  Since immunostaining showed positive expression in gastric cancer of 
index case, it looks like to induce functional change of E -cadherin.  
 
2. In one of the aunt who underwent gastrectomy, a diffuse GC (T1a) was found in 
pathology. The detail information should be described, such as size, location, macroscopic 
appearance and microscopic findings.  In addition, retrospective evaluation of endoscopic 
features fo cused on corresponding part should be carefully performed to find any changes 
such as unevenness, color or surface structure to suggest the lesion.  If it cannot be really 
detected in retrospective analysis, it is OK, but should be pointed out in photos in  Fig2 A/B.  
Fig2 C/D is not necessary.  
 
3. There are still objections against prophylactic gastrectomy. This should be at least 
mentioned in text.  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the neces sary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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.  
 
None  
 
I agree to the open peer review policy of the journal. I understand that my name will be 
included  on my report to the authors and, if the manuscript is accepted for publication, my 
named report  including any attachments I upload will be posted on the w ebsite along with the 
authors'  responses. 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/ ). I understand that 
any comments  which I do not wish to be included in my named report can be included as 
confidential comments  to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant