Reviewer’s report
Title: 
Multiple polypoid colonic metastases from rectal adenocarcinoma with
signet ring cells features: a case report
Version: 
0 
Date: 
23 Jun 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
No, the findings of this report are well known and/or similar reports have already
been published
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are major issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
Yes, the case is discussed fully in the context of the literature
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
I am not a fan of case reports that have been reported before unless the case
illustrates a common treatment advantage not reported before or opens the door
for 
insight k to pathogens is or new treatment. While this case is interesting, it is
so unusual that I am uncertain what the clinician will learn from this for their
practice - sorry. 
Are you confident in the authors' description and interpretation of the report? 
Yes I think the authors have described the patient and clinical situation well there
are several other important points they shoul describe see. Points # 2 and 7
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
I am not convinced that there is a message that is both realistic or will aid the
average clinician. This is a weirdo case, and although it may be the first patient
with multiple polyploid lesions in the he colon after resection and it is interesting
, I doubt that any clinician will say that they learned something 
useful or
important for clinical practice
REQUESTED REVISIONS: 
Suggested changes 
1. Page 1 line 2. What do you mean about "doubtable ". Do you mean no other
abnormality was seen 
2. Page 3 lines 47-33. How did the patient respond to the neoadjuvant
chemotherapy in terms of imaging or CEA level ? What did the pathology show
after the resection in terms of response to the neoadjuvant therapy? If no obvious
response why the same chemotherapeutic agent as adjuvant therapy?
3. Page 4 line 31 were the "mesenteric" Mets on the serosa? 
Was any
consideration given 
to doing HIPEC since there was no evidence of
hematogenous metastases? 
4. Figure 1 why 4 panels. One should suffice. Similarly for Figure 2 I would
suggest that you only show panels C and 
D and add figure 3 as the third panel.
Saves redundancy
5. Page 4 line 51 delete " consists" and replace with "account for" 
6. Page 5 lines 31-34. I doubt that spread through the submucosal lymphatic
vascular network would account for such distant Mets in the proximal colon,
leaving either intraluminal spread or hematogenous spread as the most likely
pathogenesis.
7. Page 5 line 45 what chemotherapy was used? This is why I asked about the
pathologic effects of the NEOadjuvant therapy
8. Page 5 line 51 are you discussing the Rectal primary or the metastatic disease-
if the latter radiotherapy would not be an option on this patient with such diffuse
Mets
9. In retrospect, I do not think that a total colectomy was warranted with this
type of diffuse spread; although you touch on this in the last paragraph I would
make your suggestion much stronger
ADDITIONAL REQUESTS/SUGGESTIONS: 
see above
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
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to 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:
Needs some language corrections before being published
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)
Reviewer’s report
Title: 
Multiple polypoid colonic metastases from rectal adenocarcinoma with
signet ring cells features: a case report
Version: 
0 
Date: 
23 Jun 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
No, the findings of this report are well known and/or similar reports have already
been published
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are major issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
Yes, the case is discussed fully in the context of the literature
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
I am not a fan of case reports that have been reported before unless the case
illustrates a common treatment advantage not reported before or opens the door
for 
insight k to pathogens is or new treatment. While this case is interesting, it is
so unusual that I am uncertain what the clinician will learn from this for their
practice - sorry. 
Are you confident in the authors' description and interpretation of the report? 
Yes I think the authors have described the patient and clinical situation well there
are several other important points they shoul describe see. Points # 2 and 7
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
I am not convinced that there is a message that is both realistic or will aid the
average clinician. This is a weirdo case, and although it may be the first patient
with multiple polyploid lesions in the he colon after resection and it is interesting
, I doubt that any clinician will say that they learned something 
useful or
important for clinical practice
REQUESTED REVISIONS: 
Suggested changes 
1. Page 1 line 2. What do you mean about "doubtable ". Do you mean no other
abnormality was seen 
2. Page 3 lines 47-33. How did the patient respond to the neoadjuvant
chemotherapy in terms of imaging or CEA level ? What did the pathology show
after the resection in terms of response to the neoadjuvant therapy? If no obvious
response why the same chemotherapeutic agent as adjuvant therapy?
3. Page 4 line 31 were the "mesenteric" Mets on the serosa? 
Was any
consideration given 
to doing HIPEC since there was no evidence of
hematogenous metastases? 
4. Figure 1 why 4 panels. One should suffice. Similarly for Figure 2 I would
suggest that you only show panels C and 
D and add figure 3 as the third panel.
Saves redundancy
5. Page 4 line 51 delete " consists" and replace with "account for" 
6. Page 5 lines 31-34. I doubt that spread through the submucosal lymphatic
vascular network would account for such distant Mets in the proximal colon,
leaving either intraluminal spread or hematogenous spread as the most likely
pathogenesis.
7. Page 5 line 45 what chemotherapy was used? This is why I asked about the
pathologic effects of the NEOadjuvant therapy
8. Page 5 line 51 are you discussing the Rectal primary or the metastatic disease-
if the latter radiotherapy would not be an option on this patient with such diffuse
Mets
9. In retrospect, I do not think that a total colectomy was warranted with this
type of diffuse spread; although you touch on this in the last paragraph I would
make your suggestion much stronger
ADDITIONAL REQUESTS/SUGGESTIONS: 
see above
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
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to 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:
Needs some language corrections before being published
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)
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: 
0 
Date: 
23 Jun 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
No, the findings of this report are well known and/or similar reports have already
been published
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are major issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
Yes, the case is discussed fully in the context of the literature
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
I am not a fan of case reports that have been reported before unless the case
illustrates a common treatment advantage not reported before or opens the door
for 
insight k to pathogens is or new treatment. While this case is interesting, it is
so unusual that I am uncertain what the clinician will learn from this for their
practice - sorry. 
Are you confident in the authors' description and interpretation of the report? 
Yes I think the authors have described the patient and clinical situation well there
are several other important points they shoul describe see. Points # 2 and 7
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
I am not convinced that there is a message that is both realistic or will aid the
average clinician. This is a weirdo case, and although it may be the first patient
with multiple polyploid lesions in the he colon after resection and it is interesting
, I doubt that any clinician will say that they learned something 
useful or
important for clinical practice
REQUESTED REVISIONS: 
Suggested changes 
1. Page 1 line 2. What do you mean about "doubtable ". Do you mean no other
abnormality was seen 
2. Page 3 lines 47-33. How did the patient respond to the neoadjuvant
chemotherapy in terms of imaging or CEA level ? What did the pathology show
after the resection in terms of response to the neoadjuvant therapy? If no obvious
response why the same chemotherapeutic agent as adjuvant therapy?
3. Page 4 line 31 were the "mesenteric" Mets on the serosa? 
Was any
consideration given 
to doing HIPEC since there was no evidence of
hematogenous metastases? 
4. Figure 1 why 4 panels. One should suffice. Similarly for Figure 2 I would
suggest that you only show panels C and 
D and add figure 3 as the third panel.
Saves redundancy
5. Page 4 line 51 delete " consists" and replace with "account for" 
6. Page 5 lines 31-34. I doubt that spread through the submucosal lymphatic
vascular network would account for such distant Mets in the proximal colon,
leaving either intraluminal spread or hematogenous spread as the most likely
pathogenesis.
7. Page 5 line 45 what chemotherapy was used? This is why I asked about the
pathologic effects of the NEOadjuvant therapy
8. Page 5 line 51 are you discussing the Rectal primary or the metastatic disease-
if the latter radiotherapy would not be an option on this patient with such diffuse
Mets
9. In retrospect, I do not think that a total colectomy was warranted with this
type of diffuse spread; although you touch on this in the last paragraph I would
make your suggestion much stronger
ADDITIONAL REQUESTS/SUGGESTIONS: 
see above
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
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to 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:
Needs some language corrections before being published
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)
assistant