Reviewer’s report
Title: 
Epidermoid Cyst in an Intrapancreatic Accessory Spleen in the Pancreas
Head: A case report
Version: 
0 
Date: 
22 Sep 2020
Reviewer: 
Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
Yes, the description of the case is sufficient
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: This case report describes the presentation, treatment
and discussion of a patient diagnosed with a epidermoid cyst in an
intrapancreatic accessory spleen 
(ECIPAS) who was treated with surgical
excision for histologic confirmation of the diagnosis. 
The case is well written,
clear, concise and informative concerning the disease described. 
While the
subject matter is rare in its' prevalence, it remains clinically relevant as
pancreatic lesions are more commonly discovered with the increasing utilization
of body imaging for diagnosis. 
I feel that the authors presented the case
accurately and have discussed the majority of difficulties with the diagnosis and
management of patients with ECIPAS. 
I also believe that because of the rareness
of this diagnosis, publication of this subject material will help to increase the
awareness of the diagnosis for physicians in this area of practice.
REQUESTED REVISIONS: 
Overall the paper is well written and the case is described appropriately. 
In the
discussion, the utilization of EUS in the accurate diagnosis is briefly mentioned
but not discussed in depth. 
This is a minor point- I do believe the paper should be
published. However, I would like to know why EUS was not used as a
diagnostic tool in the evaluation of this patient (perhaps, the risk for pancreatitis,
or there was no window available for biopsy or perhaps, the institution does not
availability of EUS). 
In the United States, much of the diagnostic evaluation of
pancreatic tumor relies heavily on a combination of EUS and MRI for
determination. 
There are some clear contraindications to both techniques but for
the most part, EUS remains a relatively safe invasive technique for providing
histologic diagnosis to aid the physician in the determination of the treatment
pathway. 
The case report discusses the difficulty in making an accurate
diagnosis, which I agree. 
I think providing some information why EUS was not
used in this case would help readers understand the reasons for the author's
decision in treatment and a small discussion about the risks and benefits of EUS
in the histologic diagnosis of pancreatic tumors is warranted.
ADDITIONAL REQUESTS/SUGGESTIONS: 
no other suggestions
Publons Reviewer Recognition
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No
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 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
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 manuscript 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 must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. 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 publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Epidermoid Cyst in an Intrapancreatic Accessory Spleen in the Pancreas
Head: A case report
Version: 
0 
Date: 
22 Sep 2020
Reviewer: 
Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
Yes, the description of the case is sufficient
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: This case report describes the presentation, treatment
and discussion of a patient diagnosed with a epidermoid cyst in an
intrapancreatic accessory spleen 
(ECIPAS) who was treated with surgical
excision for histologic confirmation of the diagnosis. 
The case is well written,
clear, concise and informative concerning the disease described. 
While the
subject matter is rare in its' prevalence, it remains clinically relevant as
pancreatic lesions are more commonly discovered with the increasing utilization
of body imaging for diagnosis. 
I feel that the authors presented the case
accurately and have discussed the majority of difficulties with the diagnosis and
management of patients with ECIPAS. 
I also believe that because of the rareness
of this diagnosis, publication of this subject material will help to increase the
awareness of the diagnosis for physicians in this area of practice.
REQUESTED REVISIONS: 
Overall the paper is well written and the case is described appropriately. 
In the
discussion, the utilization of EUS in the accurate diagnosis is briefly mentioned
but not discussed in depth. 
This is a minor point- I do believe the paper should be
published. However, I would like to know why EUS was not used as a
diagnostic tool in the evaluation of this patient (perhaps, the risk for pancreatitis,
or there was no window available for biopsy or perhaps, the institution does not
availability of EUS). 
In the United States, much of the diagnostic evaluation of
pancreatic tumor relies heavily on a combination of EUS and MRI for
determination. 
There are some clear contraindications to both techniques but for
the most part, EUS remains a relatively safe invasive technique for providing
histologic diagnosis to aid the physician in the determination of the treatment
pathway. 
The case report discusses the difficulty in making an accurate
diagnosis, which I agree. 
I think providing some information why EUS was not
used in this case would help readers understand the reasons for the author's
decision in treatment and a small discussion about the risks and benefits of EUS
in the histologic diagnosis of pancreatic tumors is warranted.
ADDITIONAL REQUESTS/SUGGESTIONS: 
no other suggestions
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 registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings 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 of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice 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
No
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 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
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 manuscript 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 must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. 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 publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Epidermoid Cyst in an Intrapancreatic Accessory Spleen in the Pancreas
Head: A case report
Version: 
0 
Date: 
22 Sep 2020
Reviewer: 
Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
Yes, the description of the case is sufficient
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: This case report describes the presentation, treatment
and discussion of a patient diagnosed with a epidermoid cyst in an
intrapancreatic accessory spleen 
(ECIPAS) who was treated with surgical
excision for histologic confirmation of the diagnosis. 
The case is well written,
clear, concise and informative concerning the disease described. 
While the
subject matter is rare in its' prevalence, it remains clinically relevant as
pancreatic lesions are more commonly discovered with the increasing utilization
of body imaging for diagnosis. 
I feel that the authors presented the case
accurately and have discussed the majority of difficulties with the diagnosis and
management of patients with ECIPAS. 
I also believe that because of the rareness
of this diagnosis, publication of this subject material will help to increase the
awareness of the diagnosis for physicians in this area of practice.
REQUESTED REVISIONS: 
Overall the paper is well written and the case is described appropriately. 
In the
discussion, the utilization of EUS in the accurate diagnosis is briefly mentioned
but not discussed in depth. 
This is a minor point- I do believe the paper should be
published. However, I would like to know why EUS was not used as a
diagnostic tool in the evaluation of this patient (perhaps, the risk for pancreatitis,
or there was no window available for biopsy or perhaps, the institution does not
availability of EUS). 
In the United States, much of the diagnostic evaluation of
pancreatic tumor relies heavily on a combination of EUS and MRI for
determination. 
There are some clear contraindications to both techniques but for
the most part, EUS remains a relatively safe invasive technique for providing
histologic diagnosis to aid the physician in the determination of the treatment
pathway. 
The case report discusses the difficulty in making an accurate
diagnosis, which I agree. 
I think providing some information why EUS was not
used in this case would help readers understand the reasons for the author's
decision in treatment and a small discussion about the risks and benefits of EUS
in the histologic diagnosis of pancreatic tumors is warranted.
ADDITIONAL REQUESTS/SUGGESTIONS: 
no other suggestions
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 registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings 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 of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice 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
No
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 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
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 manuscript 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 must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. 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 publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant