Reviewer ’s report  
 
Title:  Malignant transformation of a gastric hyperplastic polyp in a context of Helicobacter 
pylori -negative autoimmune gastritis: a case report  
 
Version: 0 Date: 23 May 2016 
 
Reviewer:  Francesca  Galuppini  
 
Reviewer’s report:  
 
GENERAL COMMENTS  
 
This manuscript presents the case of a 55 -year-old female patient with malignant transformation 
of gastric hyperplastic polyp arising in a background of autoimmu ne gastritis. The Authors 
described the clinical -radiological and pathological features of the cases and briefly evaluated the 
Literature.  
 
The manuscript is potentially attractive but there are too many concerns.  
 
  
SPECIFIC COMMENTS  
 
MAJOR POINTS  
 
1- Hyperplastic polyps are frequent findings in autoimmune gastritis, not also in H.Pylori 
related gastritis (Coati et al. Autoimmune gastritis: Pathologist's viewpoint. World J 
Gastroenterol. 2015 Nov 14; 21(42): 12179 -12189). The Authors could specify th is point 
in the Background.  
 
2- It is not clear whether in 2005, at the time of the first diagnosis of the hyperplastic lesion, 
the endoscopy and the pathologists had make also the diagnosis of autoimmune gastritis. 
The Authors could specify this point.  
 
3- The patient underwent PET -CT to evaluating the treatment effect on a previous breast 
cancer. Did the Author exclude a possible, even rare, breast cancer metastasis in the 
stomach?  
 
4- In autoimmune gastritis diagnosis, it's relevant the pepsinogens I and II  ratio. Did the 
Authors obtain this data?  
 
5- Autoimmune gastritis is characterized also by neuroendocrine cells hyperplasia 
(enterochromaffine cells -like hyperplasia). Did the Authors find this feature in their case 
biopsy?  
 
6- Vannella L, et al reported t hat the most important risk factors of malignant transformation 
in autoimmune gastritis include clinical evidence of pernicious anemia, severity of 
atrophy, the presence of intestinal metaplasia, the duration of the disease, and age over 50 
years (Vannella  L, et al. Risk for gastric neoplasias in patients with chronic atrophic 
gastritis: a critical reappraisal. World J Gastroenterol. 2012;18:1279 -1285). In particular, 
many studies underline the importance of atrophy staging. In the manuscript the Authors 
didn't report any staging of atrophy as OLGA or OLGIM (Rugge M, et al. Autoimmune 
gastritis: histology phenotype and OLGA staging. Aliment Pharmacol Ther. 2012 
Jun;35(12):1460 -6). 
 
 
MINOR POINTS  
 
1- The sentence at line 113 "The final histological diagnosis w as adenocarcinoma of 112 the 
stomach, tub>pap, φ20mm, submucosal invasion 0.3 mm, v( -), ly(+)" could be re -editing, 
without abbreviations.  
 
2- The quality of the Figure 4 could be improved.  
 
3- The Authors could improve the reviewed Literature about autoimm une gastritis and risk 
of malignant progression.  
 
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 necessary 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 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 relevan t 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 c ontent 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  
 
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 website 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 publis hed. 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Malignant transformation of a gastric hyperplastic polyp in a context of Helicobacter 
pylori -negative autoimmune gastritis: a case report  
 
Version: 0 Date: 23 May 2016 
 
Reviewer:  Francesca  Galuppini  
 
Reviewer’s report:  
 
GENERAL COMMENTS  
 
This manuscript presents the case of a 55 -year-old female patient with malignant transformation 
of gastric hyperplastic polyp arising in a background of autoimmu ne gastritis. The Authors 
described the clinical -radiological and pathological features of the cases and briefly evaluated the 
Literature.  
 
The manuscript is potentially attractive but there are too many concerns.  
 
  
SPECIFIC COMMENTS  
 
MAJOR POINTS  
 
1- Hyperplastic polyps are frequent findings in autoimmune gastritis, not also in H.Pylori 
related gastritis (Coati et al. Autoimmune gastritis: Pathologist's viewpoint. World J 
Gastroenterol. 2015 Nov 14; 21(42): 12179 -12189). The Authors could specify th is point 
in the Background.  
 
2- It is not clear whether in 2005, at the time of the first diagnosis of the hyperplastic lesion, 
the endoscopy and the pathologists had make also the diagnosis of autoimmune gastritis. 
The Authors could specify this point.  
 
3- The patient underwent PET -CT to evaluating the treatment effect on a previous breast 
cancer. Did the Author exclude a possible, even rare, breast cancer metastasis in the 
stomach?  
 
4- In autoimmune gastritis diagnosis, it's relevant the pepsinogens I and II  ratio. Did the 
Authors obtain this data?  
 
5- Autoimmune gastritis is characterized also by neuroendocrine cells hyperplasia 
(enterochromaffine cells -like hyperplasia). Did the Authors find this feature in their case 
biopsy?  
 
6- Vannella L, et al reported t hat the most important risk factors of malignant transformation 
in autoimmune gastritis include clinical evidence of pernicious anemia, severity of 
atrophy, the presence of intestinal metaplasia, the duration of the disease, and age over 50 
years (Vannella  L, et al. Risk for gastric neoplasias in patients with chronic atrophic 
gastritis: a critical reappraisal. World J Gastroenterol. 2012;18:1279 -1285). In particular, 
many studies underline the importance of atrophy staging. In the manuscript the Authors 
didn't report any staging of atrophy as OLGA or OLGIM (Rugge M, et al. Autoimmune 
gastritis: histology phenotype and OLGA staging. Aliment Pharmacol Ther. 2012 
Jun;35(12):1460 -6). 
 
 
MINOR POINTS  
 
1- The sentence at line 113 "The final histological diagnosis w as adenocarcinoma of 112 the 
stomach, tub>pap, φ20mm, submucosal invasion 0.3 mm, v( -), ly(+)" could be re -editing, 
without abbreviations.  
 
2- The quality of the Figure 4 could be improved.  
 
3- The Authors could improve the reviewed Literature about autoimm une gastritis and risk 
of malignant progression.  
 
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 necessary 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 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 relevan t 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 c ontent 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  
 
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 website 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 publis hed. 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Malignant transformation of a gastric hyperplastic polyp in a context of Helicobacter 
pylori -negative autoimmune gastritis: a case report  
 
Version: 0 Date: 23 May 2016 
 
Reviewer:  Francesca  Galuppini  
 
Reviewer’s report:  
 
GENERAL COMMENTS  
 
This manuscript presents the case of a 55 -year-old female patient with malignant transformation 
of gastric hyperplastic polyp arising in a background of autoimmu ne gastritis. The Authors 
described the clinical -radiological and pathological features of the cases and briefly evaluated the 
Literature.  
 
The manuscript is potentially attractive but there are too many concerns.  
 
  
SPECIFIC COMMENTS  
 
MAJOR POINTS  
 
1- Hyperplastic polyps are frequent findings in autoimmune gastritis, not also in H.Pylori 
related gastritis (Coati et al. Autoimmune gastritis: Pathologist's viewpoint. World J 
Gastroenterol. 2015 Nov 14; 21(42): 12179 -12189). The Authors could specify th is point 
in the Background.  
 
2- It is not clear whether in 2005, at the time of the first diagnosis of the hyperplastic lesion, 
the endoscopy and the pathologists had make also the diagnosis of autoimmune gastritis. 
The Authors could specify this point.  
 
3- The patient underwent PET -CT to evaluating the treatment effect on a previous breast 
cancer. Did the Author exclude a possible, even rare, breast cancer metastasis in the 
stomach?  
 
4- In autoimmune gastritis diagnosis, it's relevant the pepsinogens I and II  ratio. Did the 
Authors obtain this data?  
 
5- Autoimmune gastritis is characterized also by neuroendocrine cells hyperplasia 
(enterochromaffine cells -like hyperplasia). Did the Authors find this feature in their case 
biopsy?  
 
6- Vannella L, et al reported t hat the most important risk factors of malignant transformation 
in autoimmune gastritis include clinical evidence of pernicious anemia, severity of 
atrophy, the presence of intestinal metaplasia, the duration of the disease, and age over 50 
years (Vannella  L, et al. Risk for gastric neoplasias in patients with chronic atrophic 
gastritis: a critical reappraisal. World J Gastroenterol. 2012;18:1279 -1285). In particular, 
many studies underline the importance of atrophy staging. In the manuscript the Authors 
didn't report any staging of atrophy as OLGA or OLGIM (Rugge M, et al. Autoimmune 
gastritis: histology phenotype and OLGA staging. Aliment Pharmacol Ther. 2012 
Jun;35(12):1460 -6). 
 
 
MINOR POINTS  
 
1- The sentence at line 113 "The final histological diagnosis w as adenocarcinoma of 112 the 
stomach, tub>pap, φ20mm, submucosal invasion 0.3 mm, v( -), ly(+)" could be re -editing, 
without abbreviations.  
 
2- The quality of the Figure 4 could be improved.  
 
3- The Authors could improve the reviewed Literature about autoimm une gastritis and risk 
of malignant progression.  
 
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 necessary 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 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 relevan t 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 c ontent 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  
 
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 website 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 publis hed. 
 
I agree to the open peer review policy of the journal  
assistant