Recently, studies are being performed for targeted drug therapy in patients with pathologies caused by somatic mosaicism within the PROS spectrum. However, they have focused more on CLOVES, and no endpoints have been established for MCAP. In this work, the authors aim to make a clinical and radiological review of 33 PIK3CA positive patients (MRI in 21) with MCAP and suggest clinical endpoints for targeted drug therapy trials.

The study confirms the main clinical characteristics already described for MCAP. The authors propose an approach in which patients are evaluated individually according to their phenotypic expression and provides quantitative data that can be used in future trials.

This is a well written, complete, and methodical descriptive work. I have no specific comments that could help improve the document.

The authors have included a significant amount of data in this version, mainly in the Supporting Tables, making the reported data more specific and complete. I also consider that the authors have responded adequately to the main comments made by all the reviewers (when space limitations allowed). Therefore, I consider that this improved version of the paper offers valuable information on the pathology studied by suggesting clinical endpoints for targeted drug therapy trials.

I have only one comment on including a list with all the disorders within PROS on this R1. I think that it does not represent an improvement to this particular paper. In a pathology as complex as this one runs the risk (as it has happened) of not including a complete list, probably because the scientific community, in general, has not agreed to suggest an official list, at least not recently after the detection of PIK3CA in other syndromes, or the detection of other genes in syndromes previously considered within PROS. Should CLAPO syndrome be included? Is it correct to include the KlippelTrenaunay-Weber here? That said, the list included by the authors seems imperfect but acceptable to me.