Reviewer’s report
Title: 
Multiple polypoid colonic metastases from rectal adenocarcinoma with
signet ring cells features: a case report
Version: 
1 
Date: 
10 Aug 2020
Reviewer's report:
"REVISION ASSESSMENT FROM THE ACADEMIC PEER REVIEWER: 
Has the author addressed your concerns sufficiently for you to now recommend
the work as a technically sound contribution? Yes
Reviewer comments: 
HAVE THE AUTHORS RESPONDED ADEQUATELY TO EACH OF THE
QUESTIONS YOU RAISED IN YOUR COMMENTS
Unfortunately I did not receive any comments from the authors to my last review
this I have looked at the changes they made and will comment on them
Having now read their report with the track changes yes they responded to all my
questions
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE
MANUSCRIPT 
Essentially yes I have made minor suggestions
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED
MANUSCRIPT 
I now think that with some grammatical help the case is interesting and adds to
the potential literature on treatment of Rectal SRCC
REQUESTED REVISIONS: 
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD
MAKE
1. Page 2 Line 9 and page 4 line 4 Round off the CEA levels to only a tenth of a
whole number 
no one talks about the hundredths of a point in CEA levels
2. Page 2 line 12 ad the word "contrast" before "enhanced"
3. Page 2 line 15 change the phrase " all over the large intestine" to one more
specific. Do you mean throughout the mucosal surface ?"
4. Page 2 Delete the word "scan" after CT 
is a tomographic imaging and the
word "scan" is redundant
5. Should you use the phrase "presumed colonic metastases" how do you know
that they are not multiple primary tumors?
6. Page 3 line 9 change to "from other distant gastrointestinal carcinomas"
7 page 3 line 6 change to "For Rectal cancers, metastases to the liver*****sites"
8. Page 3 line20-21 move this to page 5 line 20
9. Page 4 line 4 put the word "verge" back in
10. Page 4 line 5 change eliminates to "removed" also what did their pathologic
exam show? Benignity or SRCC?
11. Page 5 line 11 and 17 were the "mesenteric metastases" serosal Mets? 
I.e.
peritoneal spread?
12 page 6 lines 9 and 17 were you able to pathologically compare the genomic
footprint of the Rectal cancer and that of the Mets?
13. Page 7 line 1 change to previous 
cases were treated 
with a non-operative
approach using systemic chemotherapy"
14 page 7 line 2 start a new paragraph
CONFIDENTIAL COMMENTS TO THE EDITORS 
This manuscript will need some editorial help with word choices and grammar
but I think now will add to the literature of decay SRCC. 
"
Publons Reviewer Recognition
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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 
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No
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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
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: 
Multiple polypoid colonic metastases from rectal adenocarcinoma with
signet ring cells features: a case report
Version: 
1 
Date: 
10 Aug 2020
Reviewer's report:
"REVISION ASSESSMENT FROM THE ACADEMIC PEER REVIEWER: 
Has the author addressed your concerns sufficiently for you to now recommend
the work as a technically sound contribution? Yes
Reviewer comments: 
HAVE THE AUTHORS RESPONDED ADEQUATELY TO EACH OF THE
QUESTIONS YOU RAISED IN YOUR COMMENTS
Unfortunately I did not receive any comments from the authors to my last review
this I have looked at the changes they made and will comment on them
Having now read their report with the track changes yes they responded to all my
questions
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE
MANUSCRIPT 
Essentially yes I have made minor suggestions
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED
MANUSCRIPT 
I now think that with some grammatical help the case is interesting and adds to
the potential literature on treatment of Rectal SRCC
REQUESTED REVISIONS: 
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD
MAKE
1. Page 2 Line 9 and page 4 line 4 Round off the CEA levels to only a tenth of a
whole number 
no one talks about the hundredths of a point in CEA levels
2. Page 2 line 12 ad the word "contrast" before "enhanced"
3. Page 2 line 15 change the phrase " all over the large intestine" to one more
specific. Do you mean throughout the mucosal surface ?"
4. Page 2 Delete the word "scan" after CT 
is a tomographic imaging and the
word "scan" is redundant
5. Should you use the phrase "presumed colonic metastases" how do you know
that they are not multiple primary tumors?
6. Page 3 line 9 change to "from other distant gastrointestinal carcinomas"
7 page 3 line 6 change to "For Rectal cancers, metastases to the liver*****sites"
8. Page 3 line20-21 move this to page 5 line 20
9. Page 4 line 4 put the word "verge" back in
10. Page 4 line 5 change eliminates to "removed" also what did their pathologic
exam show? Benignity or SRCC?
11. Page 5 line 11 and 17 were the "mesenteric metastases" serosal Mets? 
I.e.
peritoneal spread?
12 page 6 lines 9 and 17 were you able to pathologically compare the genomic
footprint of the Rectal cancer and that of the Mets?
13. Page 7 line 1 change to previous 
cases were treated 
with a non-operative
approach using systemic chemotherapy"
14 page 7 line 2 start a new paragraph
CONFIDENTIAL COMMENTS TO THE EDITORS 
This manuscript will need some editorial help with word choices and grammar
but I think now will add to the literature of decay SRCC. 
"
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 upon publication of the manuscript. 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
No
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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
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: 
Multiple polypoid colonic metastases from rectal adenocarcinoma with
signet ring cells features: a case report
Version: 
1 
Date: 
10 Aug 2020
Reviewer's report:
"REVISION ASSESSMENT FROM THE ACADEMIC PEER REVIEWER: 
Has the author addressed your concerns sufficiently for you to now recommend
the work as a technically sound contribution? Yes
Reviewer comments: 
HAVE THE AUTHORS RESPONDED ADEQUATELY TO EACH OF THE
QUESTIONS YOU RAISED IN YOUR COMMENTS
Unfortunately I did not receive any comments from the authors to my last review
this I have looked at the changes they made and will comment on them
Having now read their report with the track changes yes they responded to all my
questions
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE
MANUSCRIPT 
Essentially yes I have made minor suggestions
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED
MANUSCRIPT 
I now think that with some grammatical help the case is interesting and adds to
the potential literature on treatment of Rectal SRCC
REQUESTED REVISIONS: 
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD
MAKE
1. Page 2 Line 9 and page 4 line 4 Round off the CEA levels to only a tenth of a
whole number 
no one talks about the hundredths of a point in CEA levels
2. Page 2 line 12 ad the word "contrast" before "enhanced"
3. Page 2 line 15 change the phrase " all over the large intestine" to one more
specific. Do you mean throughout the mucosal surface ?"
4. Page 2 Delete the word "scan" after CT 
is a tomographic imaging and the
word "scan" is redundant
5. Should you use the phrase "presumed colonic metastases" how do you know
that they are not multiple primary tumors?
6. Page 3 line 9 change to "from other distant gastrointestinal carcinomas"
7 page 3 line 6 change to "For Rectal cancers, metastases to the liver*****sites"
8. Page 3 line20-21 move this to page 5 line 20
9. Page 4 line 4 put the word "verge" back in
10. Page 4 line 5 change eliminates to "removed" also what did their pathologic
exam show? Benignity or SRCC?
11. Page 5 line 11 and 17 were the "mesenteric metastases" serosal Mets? 
I.e.
peritoneal spread?
12 page 6 lines 9 and 17 were you able to pathologically compare the genomic
footprint of the Rectal cancer and that of the Mets?
13. Page 7 line 1 change to previous 
cases were treated 
with a non-operative
approach using systemic chemotherapy"
14 page 7 line 2 start a new paragraph
CONFIDENTIAL COMMENTS TO THE EDITORS 
This manuscript will need some editorial help with word choices and grammar
but I think now will add to the literature of decay SRCC. 
"
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 upon publication of the manuscript. 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
No
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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
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