Reviewer ’s report  
 
Title: Isolated Gastric Varices Secondary to Abdomina l Tuberculosis Mimicking Lymphoma: A 
Case Report  
 
Version: 0 Date: 09 Apr 2019  
 
Reviewer: Shinichi Morita  
 
Reviewer's report:  
 
This report is a relatively rare disease of abdominal tuberculosis, in which the lesion infiltrated 
and occluded the splenic vein, resulting in rupture of gastric varices(GV) from left portal 
hypertension.  
The necessary information is lacking in both the presentation and the discussion of case, and I 
think a major revision is needed.  
1. It is obvious that the cause of the gastric varices is the TB lesion at the splenic hilar.  
However, when the splenic vein is  occluded, similar conditions can occur in cancer or malignant 
lymphoma. So, I think it is strange to think that intra -abdominal tuberculosis should be suspected 
if you find sporadic GV.  
2. Please mention the patient medical history and family history of p ulmonary tuberculosis.  
3. Please describe the result of Mycobacterium tuberculosis culture and PCR analysis.  
4. Please discuss why EUS -FNA could not diagnose but percutaneous needle biopsy could.  
5. What did you treat for GV?  In addition, it is expected  that GV remains because the splenic 
hilar tumor remains after TB treatment. It is necessary to describe the course of GV.  
6. There is not enough description for tuberculosis treatment. Is the treatment for abdominal 
tuberculosis the same as treatment for  pulmonary tuberculosis? Why did you treat with three 
drugs, not four?  How long has she been taking her medication? Although the lesion remains on 
CT image, what will you do with post treatment? Please describe the strategy of treatment for 
abdominal tube rculosis more detail.  
7. Please delete the scale because the tumor is hard to recognize in figure 1b and 2d.  
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 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 r elation 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' below.  
 
I agree to the open pe er 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 t hat 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: Isolated Gastric Varices Secondary to Abdomina l Tuberculosis Mimicking Lymphoma: A 
Case Report  
 
Version: 0 Date: 09 Apr 2019  
 
Reviewer: Shinichi Morita  
 
Reviewer's report:  
 
This report is a relatively rare disease of abdominal tuberculosis, in which the lesion infiltrated 
and occluded the splenic vein, resulting in rupture of gastric varices(GV) from left portal 
hypertension.  
The necessary information is lacking in both the presentation and the discussion of case, and I 
think a major revision is needed.  
1. It is obvious that the cause of the gastric varices is the TB lesion at the splenic hilar.  
However, when the splenic vein is  occluded, similar conditions can occur in cancer or malignant 
lymphoma. So, I think it is strange to think that intra -abdominal tuberculosis should be suspected 
if you find sporadic GV.  
2. Please mention the patient medical history and family history of p ulmonary tuberculosis.  
3. Please describe the result of Mycobacterium tuberculosis culture and PCR analysis.  
4. Please discuss why EUS -FNA could not diagnose but percutaneous needle biopsy could.  
5. What did you treat for GV?  In addition, it is expected  that GV remains because the splenic 
hilar tumor remains after TB treatment. It is necessary to describe the course of GV.  
6. There is not enough description for tuberculosis treatment. Is the treatment for abdominal 
tuberculosis the same as treatment for  pulmonary tuberculosis? Why did you treat with three 
drugs, not four?  How long has she been taking her medication? Although the lesion remains on 
CT image, what will you do with post treatment? Please describe the strategy of treatment for 
abdominal tube rculosis more detail.  
7. Please delete the scale because the tumor is hard to recognize in figure 1b and 2d.  
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 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 r elation 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' below.  
 
I agree to the open pe er 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 t hat 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: Isolated Gastric Varices Secondary to Abdomina l Tuberculosis Mimicking Lymphoma: A 
Case Report  
 
Version: 0 Date: 09 Apr 2019  
 
Reviewer: Shinichi Morita  
 
Reviewer's report:  
 
This report is a relatively rare disease of abdominal tuberculosis, in which the lesion infiltrated 
and occluded the splenic vein, resulting in rupture of gastric varices(GV) from left portal 
hypertension.  
The necessary information is lacking in both the presentation and the discussion of case, and I 
think a major revision is needed.  
1. It is obvious that the cause of the gastric varices is the TB lesion at the splenic hilar.  
However, when the splenic vein is  occluded, similar conditions can occur in cancer or malignant 
lymphoma. So, I think it is strange to think that intra -abdominal tuberculosis should be suspected 
if you find sporadic GV.  
2. Please mention the patient medical history and family history of p ulmonary tuberculosis.  
3. Please describe the result of Mycobacterium tuberculosis culture and PCR analysis.  
4. Please discuss why EUS -FNA could not diagnose but percutaneous needle biopsy could.  
5. What did you treat for GV?  In addition, it is expected  that GV remains because the splenic 
hilar tumor remains after TB treatment. It is necessary to describe the course of GV.  
6. There is not enough description for tuberculosis treatment. Is the treatment for abdominal 
tuberculosis the same as treatment for  pulmonary tuberculosis? Why did you treat with three 
drugs, not four?  How long has she been taking her medication? Although the lesion remains on 
CT image, what will you do with post treatment? Please describe the strategy of treatment for 
abdominal tube rculosis more detail.  
7. Please delete the scale because the tumor is hard to recognize in figure 1b and 2d.  
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 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 r elation 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' below.  
 
I agree to the open pe er 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 t hat 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