Reviewer ’s report  
 
Title: A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid 
FDG uptake mimicking a malignant pan creatic tumor: a systematic case review  
 
Version: 0 Date: 31 Aug 2016  
 
Revie wer: Stuart Amateau  
 
Reviewer's report:  
 
Major comment:  
The authors present a well written case report of a pancreatic hamartoma concerning for a 
malignant lesion prompting evaluation by PET scan which demonstrated avid uptake mimicking 
cancer. The patient t hen underwent pylorus sparring Whipple. The manuscript is also 
supplemented with a brief review of the literature. The avid FDG uptake is the acknowledged 
novel aspect of the manuscript. Indeed, a review of the literature demonstrates that while rare, 
similar reports of hamartoma mimicking adenocarcinoma is now a well appreciated topic. What 
remains unclear, in this and in several of the published reports, is why EUS was not utilized for 
fine needle aspiration. In fact, this is the exact reason that oncolog ists will not treat imaging only 
tissue diagnoses. This topic has to be directly addressed as this patient may have well been 
spared an unnecessary major surgery as she was asymptomatic.  
 
Minor comment:  
Figures 1 -4 should be culled and compressed into 1 or perhaps 2 figures  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 o f 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 receive d 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 ga in 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 com peting 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 I have no competing interests  
 
I agree to the  open peer 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 that any comments  
which I do not wish to be included in my named report can b e 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: A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid 
FDG uptake mimicking a malignant pan creatic tumor: a systematic case review  
 
Version: 0 Date: 31 Aug 2016  
 
Revie wer: Stuart Amateau  
 
Reviewer's report:  
 
Major comment:  
The authors present a well written case report of a pancreatic hamartoma concerning for a 
malignant lesion prompting evaluation by PET scan which demonstrated avid uptake mimicking 
cancer. The patient t hen underwent pylorus sparring Whipple. The manuscript is also 
supplemented with a brief review of the literature. The avid FDG uptake is the acknowledged 
novel aspect of the manuscript. Indeed, a review of the literature demonstrates that while rare, 
similar reports of hamartoma mimicking adenocarcinoma is now a well appreciated topic. What 
remains unclear, in this and in several of the published reports, is why EUS was not utilized for 
fine needle aspiration. In fact, this is the exact reason that oncolog ists will not treat imaging only 
tissue diagnoses. This topic has to be directly addressed as this patient may have well been 
spared an unnecessary major surgery as she was asymptomatic.  
 
Minor comment:  
Figures 1 -4 should be culled and compressed into 1 or perhaps 2 figures  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 o f 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 receive d 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 ga in 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 com peting 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 I have no competing interests  
 
I agree to the  open peer 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 that any comments  
which I do not wish to be included in my named report can b e 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: A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid 
FDG uptake mimicking a malignant pan creatic tumor: a systematic case review  
 
Version: 0 Date: 31 Aug 2016  
 
Revie wer: Stuart Amateau  
 
Reviewer's report:  
 
Major comment:  
The authors present a well written case report of a pancreatic hamartoma concerning for a 
malignant lesion prompting evaluation by PET scan which demonstrated avid uptake mimicking 
cancer. The patient t hen underwent pylorus sparring Whipple. The manuscript is also 
supplemented with a brief review of the literature. The avid FDG uptake is the acknowledged 
novel aspect of the manuscript. Indeed, a review of the literature demonstrates that while rare, 
similar reports of hamartoma mimicking adenocarcinoma is now a well appreciated topic. What 
remains unclear, in this and in several of the published reports, is why EUS was not utilized for 
fine needle aspiration. In fact, this is the exact reason that oncolog ists will not treat imaging only 
tissue diagnoses. This topic has to be directly addressed as this patient may have well been 
spared an unnecessary major surgery as she was asymptomatic.  
 
Minor comment:  
Figures 1 -4 should be culled and compressed into 1 or perhaps 2 figures  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 o f 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 receive d 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 ga in 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 com peting 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 I have no competing interests  
 
I agree to the  open peer 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 that any comments  
which I do not wish to be included in my named report can b e included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant