Reviewer’ s report
Title: A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary
mucinous neoplasm
Version: 1Date: 23 Jun 2020
Reviewer's report:
I congratulate the authors for their astute clinical acumen in diagnosing and successfully managing
this case. Based on their report, such findings are certainly unique and worthy of widerdissemination to benefit the medical community. However, before fulfilling this obligation, itwould be beneficial for authors to clarify and gather their thoughts, analyze them, and translatethem based on the critical message they seek to deliver. Currently, the manuscript appears ratherhastily assembled and I feel as though certain aspects are rushed. I believe the authors have aninteresting point but in its current form is unsuitably delivered and will require some moderatelevel of revision that I hope will elevate the quality of this work. Please find my comments below.1.Reviewing the CARE checklist provided, the title does not include the "Case report"requirement that is mandated. I would suggest a revision of the title if the editors wish to followthe checklist entirely.2.The authors have pointed out in their introduction how pancreatic panniculitis commonly afflictsthe lower limbs and state the uniqueness of their case where truncal involvement occurred. Ifpossible, this point should be reinforced and highlighted by presenting numerical evidence (e.gonly X number of prior reports have been found in the literature. Or by presenting numbers fromprior case series (if available).)3.The authors state in their introduction how the recognition of cutaneous lesions is importantbecause they can precede abdominal symptoms. This point appears to be a central message of this
article given that it is highlighted later in the discussion as well as in the conclusion. However, in
this case, abdominal symptoms appear to have occurred prior to the onset of the patient's nodules.The authors should reconsider how this is framed and carefully formulate their messageconsistently.4.Given the importance of the cutaneous lesion, I believe it would merit further description thanwhat is provided in the report. At a minimum, its size, location with respect to other surfacelandmarks, consistency, and a description of the surrounding skin should be presented.5.Are the authors certain that this was acute pancreatitis secondary to IPMN? Given the history ofalcohol consumption, I am not certain based on the information provided. It could be that thealcohol was responsible for the acute pancreatitis and the IPMN was an incidental finding.6.There is no reported Lipase level. Given that lipase is primarily considered responsible for thesemanifestations, some justification should be provided as to why the level was not obtained. If theauthors routinely do not obtain lipase levels in such cases, brief mention should be made of thisfact. Reviewing the cases provided, Lipase elevation appears consistent in all/most cases.7.Given the patients reported improvement on day 3 in response to conservative treatment, I amnot certain why he was hospitalized for a total of 12 days and what care was taken in thisintervening period. This should be elaborated.8. The long term follow up of this case would be helpful. Did the nodule recur? Were additional
nodules noted later? How long has the patient been free of complaints? How was the IPMN
managed? Did the occurrence of these painful nodules factor in treating the IPMN differently to
how the authors would approach an incidental IPMN.9.I feel as though the authors have presented a well-rounded discussion that will be useful to futurereaders. They have reviewed commonly described skin manifestations, histologic findings. Theyfollow this with a proposed mechanism for the findings and apply this to their presentation. This isfollowed by a review of the documented causes of pancreatic panniculitis. This suitably fulfills therequirements of the provided checklist.10.As previously noted, point 11d should be revised accordingly given how this was not evident inthis case.
11.With regards to table 2. I am pleased by the authors' commitment to finding prior relevant
cases, however, I am concerned about the methodology employed in assembling this table. This isclearly not exhaustive. In reference 3 provided by the authors, Zundler and colleagues noted 130cases of pancreatic panniculitis in a 20-year time frame. This table has 21. I feel this may bemisleading to our readers, who may erroneously draw conclusions regarding the incidence of thisdisease simply based on this table. The authors should provide justifications and clarify this.a.What databases were searchedb.Was a period cut off used (e.g 2000-2020)c.What other inclusion/exclusion criteria were used to distinguish cases.
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
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profile page. Publons may use the Review Data to generate derivative metadata for the benefit ofPublons and you as a reviewer, carefully considering the sensitivity of such information. Forexample, Publons may verify your record as a reviewer by updating your profile published on itswebservice 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
NoAre the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes 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.
NoAre 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 furtherassessment 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 publishedDeclaration 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 thismanuscript, 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.
I declare that I have no competing interests.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 manu-script 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 mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. 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: A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary
mucinous neoplasm
Version: 1Date: 23 Jun 2020
Reviewer's report:
I congratulate the authors for their astute clinical acumen in diagnosing and successfully managing
this case. Based on their report, such findings are certainly unique and worthy of widerdissemination to benefit the medical community. However, before fulfilling this obligation, itwould be beneficial for authors to clarify and gather their thoughts, analyze them, and translatethem based on the critical message they seek to deliver. Currently, the manuscript appears ratherhastily assembled and I feel as though certain aspects are rushed. I believe the authors have aninteresting point but in its current form is unsuitably delivered and will require some moderatelevel of revision that I hope will elevate the quality of this work. Please find my comments below.1.Reviewing the CARE checklist provided, the title does not include the "Case report"requirement that is mandated. I would suggest a revision of the title if the editors wish to followthe checklist entirely.2.The authors have pointed out in their introduction how pancreatic panniculitis commonly afflictsthe lower limbs and state the uniqueness of their case where truncal involvement occurred. Ifpossible, this point should be reinforced and highlighted by presenting numerical evidence (e.gonly X number of prior reports have been found in the literature. Or by presenting numbers fromprior case series (if available).)3.The authors state in their introduction how the recognition of cutaneous lesions is importantbecause they can precede abdominal symptoms. This point appears to be a central message of this
article given that it is highlighted later in the discussion as well as in the conclusion. However, in
this case, abdominal symptoms appear to have occurred prior to the onset of the patient's nodules.The authors should reconsider how this is framed and carefully formulate their messageconsistently.4.Given the importance of the cutaneous lesion, I believe it would merit further description thanwhat is provided in the report. At a minimum, its size, location with respect to other surfacelandmarks, consistency, and a description of the surrounding skin should be presented.5.Are the authors certain that this was acute pancreatitis secondary to IPMN? Given the history ofalcohol consumption, I am not certain based on the information provided. It could be that thealcohol was responsible for the acute pancreatitis and the IPMN was an incidental finding.6.There is no reported Lipase level. Given that lipase is primarily considered responsible for thesemanifestations, some justification should be provided as to why the level was not obtained. If theauthors routinely do not obtain lipase levels in such cases, brief mention should be made of thisfact. Reviewing the cases provided, Lipase elevation appears consistent in all/most cases.7.Given the patients reported improvement on day 3 in response to conservative treatment, I amnot certain why he was hospitalized for a total of 12 days and what care was taken in thisintervening period. This should be elaborated.8. The long term follow up of this case would be helpful. Did the nodule recur? Were additional
nodules noted later? How long has the patient been free of complaints? How was the IPMN
managed? Did the occurrence of these painful nodules factor in treating the IPMN differently to
how the authors would approach an incidental IPMN.9.I feel as though the authors have presented a well-rounded discussion that will be useful to futurereaders. They have reviewed commonly described skin manifestations, histologic findings. Theyfollow this with a proposed mechanism for the findings and apply this to their presentation. This isfollowed by a review of the documented causes of pancreatic panniculitis. This suitably fulfills therequirements of the provided checklist.10.As previously noted, point 11d should be revised accordingly given how this was not evident inthis case.
11.With regards to table 2. I am pleased by the authors' commitment to finding prior relevant
cases, however, I am concerned about the methodology employed in assembling this table. This isclearly not exhaustive. In reference 3 provided by the authors, Zundler and colleagues noted 130cases of pancreatic panniculitis in a 20-year time frame. This table has 21. I feel this may bemisleading to our readers, who may erroneously draw conclusions regarding the incidence of thisdisease simply based on this table. The authors should provide justifications and clarify this.a.What databases were searchedb.Was a period cut off used (e.g 2000-2020)c.What other inclusion/exclusion criteria were used to distinguish cases.
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 registeredat Publons, they will notify you of the receipt of this review and update your profile as per yoursettings 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 ofPublons and you as a reviewer, carefully considering the sensitivity of such information. Forexample, Publons may verify your record as a reviewer by updating your profile published on itswebservice 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
NoAre the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes 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.
NoAre 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 furtherassessment 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 publishedDeclaration 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 thismanuscript, 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.
I declare that I have no competing interests.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 manu-script 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 mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. 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: A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary
mucinous neoplasm
Version: 1Date: 23 Jun 2020
Reviewer's report:
I congratulate the authors for their astute clinical acumen in diagnosing and successfully managing
this case. Based on their report, such findings are certainly unique and worthy of widerdissemination to benefit the medical community. However, before fulfilling this obligation, itwould be beneficial for authors to clarify and gather their thoughts, analyze them, and translatethem based on the critical message they seek to deliver. Currently, the manuscript appears ratherhastily assembled and I feel as though certain aspects are rushed. I believe the authors have aninteresting point but in its current form is unsuitably delivered and will require some moderatelevel of revision that I hope will elevate the quality of this work. Please find my comments below.1.Reviewing the CARE checklist provided, the title does not include the "Case report"requirement that is mandated. I would suggest a revision of the title if the editors wish to followthe checklist entirely.2.The authors have pointed out in their introduction how pancreatic panniculitis commonly afflictsthe lower limbs and state the uniqueness of their case where truncal involvement occurred. Ifpossible, this point should be reinforced and highlighted by presenting numerical evidence (e.gonly X number of prior reports have been found in the literature. Or by presenting numbers fromprior case series (if available).)3.The authors state in their introduction how the recognition of cutaneous lesions is importantbecause they can precede abdominal symptoms. This point appears to be a central message of this
article given that it is highlighted later in the discussion as well as in the conclusion. However, in
this case, abdominal symptoms appear to have occurred prior to the onset of the patient's nodules.The authors should reconsider how this is framed and carefully formulate their messageconsistently.4.Given the importance of the cutaneous lesion, I believe it would merit further description thanwhat is provided in the report. At a minimum, its size, location with respect to other surfacelandmarks, consistency, and a description of the surrounding skin should be presented.5.Are the authors certain that this was acute pancreatitis secondary to IPMN? Given the history ofalcohol consumption, I am not certain based on the information provided. It could be that thealcohol was responsible for the acute pancreatitis and the IPMN was an incidental finding.6.There is no reported Lipase level. Given that lipase is primarily considered responsible for thesemanifestations, some justification should be provided as to why the level was not obtained. If theauthors routinely do not obtain lipase levels in such cases, brief mention should be made of thisfact. Reviewing the cases provided, Lipase elevation appears consistent in all/most cases.7.Given the patients reported improvement on day 3 in response to conservative treatment, I amnot certain why he was hospitalized for a total of 12 days and what care was taken in thisintervening period. This should be elaborated.8. The long term follow up of this case would be helpful. Did the nodule recur? Were additional
nodules noted later? How long has the patient been free of complaints? How was the IPMN
managed? Did the occurrence of these painful nodules factor in treating the IPMN differently to
how the authors would approach an incidental IPMN.9.I feel as though the authors have presented a well-rounded discussion that will be useful to futurereaders. They have reviewed commonly described skin manifestations, histologic findings. Theyfollow this with a proposed mechanism for the findings and apply this to their presentation. This isfollowed by a review of the documented causes of pancreatic panniculitis. This suitably fulfills therequirements of the provided checklist.10.As previously noted, point 11d should be revised accordingly given how this was not evident inthis case.
11.With regards to table 2. I am pleased by the authors' commitment to finding prior relevant
cases, however, I am concerned about the methodology employed in assembling this table. This isclearly not exhaustive. In reference 3 provided by the authors, Zundler and colleagues noted 130cases of pancreatic panniculitis in a 20-year time frame. This table has 21. I feel this may bemisleading to our readers, who may erroneously draw conclusions regarding the incidence of thisdisease simply based on this table. The authors should provide justifications and clarify this.a.What databases were searchedb.Was a period cut off used (e.g 2000-2020)c.What other inclusion/exclusion criteria were used to distinguish cases.
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 registeredat Publons, they will notify you of the receipt of this review and update your profile as per yoursettings 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 ofPublons and you as a reviewer, carefully considering the sensitivity of such information. Forexample, Publons may verify your record as a reviewer by updating your profile published on itswebservice 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
NoAre the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes 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.
NoAre 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 furtherassessment 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 publishedDeclaration 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 thismanuscript, 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.
I declare that I have no competing interests.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 manu-script 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 mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. 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