Reviewer ’s report  
 
Title: A case of multicentric pancreatic mixed acinar -ductal carcinoma diagnosed by a yogurt -
like cell clump flowing from the papilla of Vater  
 
Version: 1 Date: 17 Oct 2016 
 
Reviewer:  Takashi  Muraki  
 
Reviewer’s report:  
 
This is an interesting  case report. There is one critique as mentioned in comments to the author.  
 
As I mentioned and also authors indicated, this case contained acinar -like stricture, ductal -like, 
and NET components. The HE -stain showed relatively typical ACC features, but neg ative for 
trypsin Bcl -10 and lipase. I can understand it was difficult to diagnose as ACC. But at least these 
lesions had differentiations to acinar -like and ductal -like, which means no "poorly differentiated" 
PDAC. If this case is reported as "poorly diff erentiated" PDAC in the literature, it may be 
confused. It may be fine to change/describe more about your final pathological diagnosis and its 
differential diagnosis, such as ITPN, NEC, medullary carcinoma, and so on.  
 
It will be suitable for the aim and t he scope of BMC Gastroenterology, if the authors resolve that 
critique.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
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 expl ain in your comments to the authors.  
 
No 
 
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 furthe r 
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:  
 
Acceptabl e 
 
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 a n 
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.  
 
'I declare that 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 be 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 case of multicentric pancreatic mixed acinar -ductal carcinoma diagnosed by a yogurt -
like cell clump flowing from the papilla of Vater  
 
Version: 1 Date: 17 Oct 2016 
 
Reviewer:  Takashi  Muraki  
 
Reviewer’s report:  
 
This is an interesting  case report. There is one critique as mentioned in comments to the author.  
 
As I mentioned and also authors indicated, this case contained acinar -like stricture, ductal -like, 
and NET components. The HE -stain showed relatively typical ACC features, but neg ative for 
trypsin Bcl -10 and lipase. I can understand it was difficult to diagnose as ACC. But at least these 
lesions had differentiations to acinar -like and ductal -like, which means no "poorly differentiated" 
PDAC. If this case is reported as "poorly diff erentiated" PDAC in the literature, it may be 
confused. It may be fine to change/describe more about your final pathological diagnosis and its 
differential diagnosis, such as ITPN, NEC, medullary carcinoma, and so on.  
 
It will be suitable for the aim and t he scope of BMC Gastroenterology, if the authors resolve that 
critique.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
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 expl ain in your comments to the authors.  
 
No 
 
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 furthe r 
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:  
 
Acceptabl e 
 
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 a n 
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.  
 
'I declare that 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 be 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 case of multicentric pancreatic mixed acinar -ductal carcinoma diagnosed by a yogurt -
like cell clump flowing from the papilla of Vater  
 
Version: 1 Date: 17 Oct 2016 
 
Reviewer:  Takashi  Muraki  
 
Reviewer’s report:  
 
This is an interesting  case report. There is one critique as mentioned in comments to the author.  
 
As I mentioned and also authors indicated, this case contained acinar -like stricture, ductal -like, 
and NET components. The HE -stain showed relatively typical ACC features, but neg ative for 
trypsin Bcl -10 and lipase. I can understand it was difficult to diagnose as ACC. But at least these 
lesions had differentiations to acinar -like and ductal -like, which means no "poorly differentiated" 
PDAC. If this case is reported as "poorly diff erentiated" PDAC in the literature, it may be 
confused. It may be fine to change/describe more about your final pathological diagnosis and its 
differential diagnosis, such as ITPN, NEC, medullary carcinoma, and so on.  
 
It will be suitable for the aim and t he scope of BMC Gastroenterology, if the authors resolve that 
critique.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
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 expl ain in your comments to the authors.  
 
No 
 
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 furthe r 
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:  
 
Acceptabl e 
 
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 a n 
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.  
 
'I declare that 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 be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
assistant