 
Reviewer ’s report  
 
Title: Pancreatic undifferentiated carcinoma with osteoclast -like giant cells curatively resected 
after pembrolizumab therapy for lung metastases: A case report  
 
Version: 0 Date: 31 Mar 2020  
 
Reviewer: Seung -Mo Mo Hong  
 
Reviewer's report:  
 
The authors presented interesting case report of pemprolizumab response of metastatic anaplastic 
pancreatic carcinoma. The reviewer has several points that the authors addressed.  
 
1. Based on WHO classification of digestive system tumors, it is recommended to use 
"undifferentiated carcinoma" rather than "anaplastic carcinoma". The reviewer recommends to 
change the terminology throughout the manuscript.  
 
2. The authors used some abbreviations without explain them. The reviewer recommends to use 
full term of th e abbreviations that the authors used in the manuscript. For example, CK -WSS in 
page 5 line 88.  
 
3. What PD -L1 clone did the authors used for PD -L1 immunohistochemical staining? Since 
difference expression patterns exist based on usage of different PD -L1 cl ones. The reviewer 
recommends to reveal the exact clone name, company, and dilution.  
 
4. The explanation of Figure 3 and main text were not matching. The authors should correct the 
explanation in main text about Figure 3 in page 6. For example, lines 104 -105 seemed to explain 
gross figures of the distal pancreatectomy specimen, but Figure 3H is figure of PL -D1 
immunohistochemical staining. The same in Figure 3e, 3f in page 6.  
 
5. Different with the results of Luchini et al.'s study (ref #14), the outcome in t he study was 
acceptable. The reviewer recommends to the authors explain why the results between 2 studies 
were different.  
 
6. Page 8, line 152. The authors described that "lymphocytic infiltration was stronger in the lung 
metastatic lesion than primary panc reatic lesion (Figure 3a and d). But it is difficult to recognize 
lymphocytes in H &amp; E image with this resolution. The reviewer recommends to authors to 
demonstrate lymphocytic infiltration both pancreatic and metastatic lesion using 
immunohistochemical staining.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to t he authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments t o the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publicati on of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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 currentl y 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 oth er 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or 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 th at any comments 
which I do not wish to be included in my named report can be in cluded 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: Pancreatic undifferentiated carcinoma with osteoclast -like giant cells curatively resected 
after pembrolizumab therapy for lung metastases: A case report  
 
Version: 0 Date: 31 Mar 2020  
 
Reviewer: Seung -Mo Mo Hong  
 
Reviewer's report:  
 
The authors presented interesting case report of pemprolizumab response of metastatic anaplastic 
pancreatic carcinoma. The reviewer has several points that the authors addressed.  
 
1. Based on WHO classification of digestive system tumors, it is recommended to use 
"undifferentiated carcinoma" rather than "anaplastic carcinoma". The reviewer recommends to 
change the terminology throughout the manuscript.  
 
2. The authors used some abbreviations without explain them. The reviewer recommends to use 
full term of th e abbreviations that the authors used in the manuscript. For example, CK -WSS in 
page 5 line 88.  
 
3. What PD -L1 clone did the authors used for PD -L1 immunohistochemical staining? Since 
difference expression patterns exist based on usage of different PD -L1 cl ones. The reviewer 
recommends to reveal the exact clone name, company, and dilution.  
 
4. The explanation of Figure 3 and main text were not matching. The authors should correct the 
explanation in main text about Figure 3 in page 6. For example, lines 104 -105 seemed to explain 
gross figures of the distal pancreatectomy specimen, but Figure 3H is figure of PL -D1 
immunohistochemical staining. The same in Figure 3e, 3f in page 6.  
 
5. Different with the results of Luchini et al.'s study (ref #14), the outcome in t he study was 
acceptable. The reviewer recommends to the authors explain why the results between 2 studies 
were different.  
 
6. Page 8, line 152. The authors described that "lymphocytic infiltration was stronger in the lung 
metastatic lesion than primary panc reatic lesion (Figure 3a and d). But it is difficult to recognize 
lymphocytes in H &amp; E image with this resolution. The reviewer recommends to authors to 
demonstrate lymphocytic infiltration both pancreatic and metastatic lesion using 
immunohistochemical staining.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to t he authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments t o the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publicati on of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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 currentl y 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 oth er 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or 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 th at any comments 
which I do not wish to be included in my named report can be in cluded 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: Pancreatic undifferentiated carcinoma with osteoclast -like giant cells curatively resected 
after pembrolizumab therapy for lung metastases: A case report  
 
Version: 0 Date: 31 Mar 2020  
 
Reviewer: Seung -Mo Mo Hong  
 
Reviewer's report:  
 
The authors presented interesting case report of pemprolizumab response of metastatic anaplastic 
pancreatic carcinoma. The reviewer has several points that the authors addressed.  
 
1. Based on WHO classification of digestive system tumors, it is recommended to use 
"undifferentiated carcinoma" rather than "anaplastic carcinoma". The reviewer recommends to 
change the terminology throughout the manuscript.  
 
2. The authors used some abbreviations without explain them. The reviewer recommends to use 
full term of th e abbreviations that the authors used in the manuscript. For example, CK -WSS in 
page 5 line 88.  
 
3. What PD -L1 clone did the authors used for PD -L1 immunohistochemical staining? Since 
difference expression patterns exist based on usage of different PD -L1 cl ones. The reviewer 
recommends to reveal the exact clone name, company, and dilution.  
 
4. The explanation of Figure 3 and main text were not matching. The authors should correct the 
explanation in main text about Figure 3 in page 6. For example, lines 104 -105 seemed to explain 
gross figures of the distal pancreatectomy specimen, but Figure 3H is figure of PL -D1 
immunohistochemical staining. The same in Figure 3e, 3f in page 6.  
 
5. Different with the results of Luchini et al.'s study (ref #14), the outcome in t he study was 
acceptable. The reviewer recommends to the authors explain why the results between 2 studies 
were different.  
 
6. Page 8, line 152. The authors described that "lymphocytic infiltration was stronger in the lung 
metastatic lesion than primary panc reatic lesion (Figure 3a and d). But it is difficult to recognize 
lymphocytes in H &amp; E image with this resolution. The reviewer recommends to authors to 
demonstrate lymphocytic infiltration both pancreatic and metastatic lesion using 
immunohistochemical staining.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to t he authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments t o the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publicati on of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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 currentl y 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 oth er 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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or 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 th at any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant