Reviewer ’s report  
 
Title:  Primary pancreatic plasmacytoma: a rare case report  
 
Version: 0 Date: 07 Sep 2016 
 
Reviewer:  Ben Lawrence  
 
Reviewer’s report:  
 
This is a potentially interesting case of a very rare primary pancreatic plasmacytoma, but needs 
additional description before it can be considered for publication. In general, as well as 
addressing the itemized list below, I suggest the authors shift the focus in the discussion from 
radiological description (which will never be definitive enough in such a rare tumour to guide 
management) to include the more interesting aspect of what this case contributes to our 
understanding of tumourigenesis and clinical  management.  
 
1. This case is interesting because it is apparently a primary pancreatic plasmacytoma. But 
to confirm this is not a 'secondary' plasmacytoma in context of myeloma, it needs careful 
description of myeloma work up so the reader feels comfortable with this c onclusion. 
This detail is missing, e.g. Blood results not given. "Routine blood tests suggested 
infection" - needs explanation in setting of plasmacytoma because differential of multiple 
myeloma. Which "tumour markers were within normal limits"? Morphology  and IHC 
staining results need to be explicitly stated (and shown in figure).  
 
1. The clinical description of the case is limited and so reduces the learnings for clinicians 
eg. Why did "electrocardiogram reveal myocardial ischaemia." Was the presentation due 
to myocardial infarction? This is important because would suggest true incidental 
findings and so more benign course. Given MRI findings, was this an R2 resection? If so 
what is happening in follow up. There is a significant and unexpected difference b etween 
size on MRI and operative findings but no explanation. If truly primary in pancreas, then 
length of follow up should be stated to allow reader to determine whether this true (ie 
Myeloma has not become apparent in followup. Discussion paragraph 5 - differential 
diagnosis is incomplete. The MRI features are interesting but description of other tumour 
appearance is oversimplified and so limits impact.  
 
2. The novelty of the case relies on accurate literature review, but review appears to be 
incomplete. A quick pubmed search found additional cases of primary pancreatic 
plasmacytoma not referenced in the current paper (e.g., one of the 6 cases described by 
Wizzane etal 2013). Also the comment of 20 previous cases of secondary plasmacytoma 
does not match pr evious descriptions of "50 cases" described by other authors (eg. Lopes 
da Silva, 2012)  
 
3. Inconsistency within the document - is this the 4th case (as stated in abstract) or the 3rd 
case (as stated in discussion)? (noting that both are incorrect as in po int 3 above).  
 
4. The writing needs some attention. e.g. grammar in sentence 1 and 2 of background. 
Spelling mistakes eg. Bence jones proteins line 44, extramedullary line 52, 
plasmacytomas line 54, etc. Discussion paragraph 3 is a bit confusing because m ixes 
primary and secondary pancreatic plasmacytoma. Discussion paragraph 4 is banal and 
does not contribute to the learning from this case.  
 
I wish the authors well in reformulating this short paper, and hope these comments are 
constructive and help lead t o eventual publication.  
 
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.  
 
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 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 com peting 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, e ither 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 re port 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 Crea tive 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:  Primary pancreatic plasmacytoma: a rare case report  
 
Version: 0 Date: 07 Sep 2016 
 
Reviewer:  Ben Lawrence  
 
Reviewer’s report:  
 
This is a potentially interesting case of a very rare primary pancreatic plasmacytoma, but needs 
additional description before it can be considered for publication. In general, as well as 
addressing the itemized list below, I suggest the authors shift the focus in the discussion from 
radiological description (which will never be definitive enough in such a rare tumour to guide 
management) to include the more interesting aspect of what this case contributes to our 
understanding of tumourigenesis and clinical  management.  
 
1. This case is interesting because it is apparently a primary pancreatic plasmacytoma. But 
to confirm this is not a 'secondary' plasmacytoma in context of myeloma, it needs careful 
description of myeloma work up so the reader feels comfortable with this c onclusion. 
This detail is missing, e.g. Blood results not given. "Routine blood tests suggested 
infection" - needs explanation in setting of plasmacytoma because differential of multiple 
myeloma. Which "tumour markers were within normal limits"? Morphology  and IHC 
staining results need to be explicitly stated (and shown in figure).  
 
1. The clinical description of the case is limited and so reduces the learnings for clinicians 
eg. Why did "electrocardiogram reveal myocardial ischaemia." Was the presentation due 
to myocardial infarction? This is important because would suggest true incidental 
findings and so more benign course. Given MRI findings, was this an R2 resection? If so 
what is happening in follow up. There is a significant and unexpected difference b etween 
size on MRI and operative findings but no explanation. If truly primary in pancreas, then 
length of follow up should be stated to allow reader to determine whether this true (ie 
Myeloma has not become apparent in followup. Discussion paragraph 5 - differential 
diagnosis is incomplete. The MRI features are interesting but description of other tumour 
appearance is oversimplified and so limits impact.  
 
2. The novelty of the case relies on accurate literature review, but review appears to be 
incomplete. A quick pubmed search found additional cases of primary pancreatic 
plasmacytoma not referenced in the current paper (e.g., one of the 6 cases described by 
Wizzane etal 2013). Also the comment of 20 previous cases of secondary plasmacytoma 
does not match pr evious descriptions of "50 cases" described by other authors (eg. Lopes 
da Silva, 2012)  
 
3. Inconsistency within the document - is this the 4th case (as stated in abstract) or the 3rd 
case (as stated in discussion)? (noting that both are incorrect as in po int 3 above).  
 
4. The writing needs some attention. e.g. grammar in sentence 1 and 2 of background. 
Spelling mistakes eg. Bence jones proteins line 44, extramedullary line 52, 
plasmacytomas line 54, etc. Discussion paragraph 3 is a bit confusing because m ixes 
primary and secondary pancreatic plasmacytoma. Discussion paragraph 4 is banal and 
does not contribute to the learning from this case.  
 
I wish the authors well in reformulating this short paper, and hope these comments are 
constructive and help lead t o eventual publication.  
 
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.  
 
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 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 com peting 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, e ither 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 re port 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 Crea tive 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:  Primary pancreatic plasmacytoma: a rare case report  
 
Version: 0 Date: 07 Sep 2016 
 
Reviewer:  Ben Lawrence  
 
Reviewer’s report:  
 
This is a potentially interesting case of a very rare primary pancreatic plasmacytoma, but needs 
additional description before it can be considered for publication. In general, as well as 
addressing the itemized list below, I suggest the authors shift the focus in the discussion from 
radiological description (which will never be definitive enough in such a rare tumour to guide 
management) to include the more interesting aspect of what this case contributes to our 
understanding of tumourigenesis and clinical  management.  
 
1. This case is interesting because it is apparently a primary pancreatic plasmacytoma. But 
to confirm this is not a 'secondary' plasmacytoma in context of myeloma, it needs careful 
description of myeloma work up so the reader feels comfortable with this c onclusion. 
This detail is missing, e.g. Blood results not given. "Routine blood tests suggested 
infection" - needs explanation in setting of plasmacytoma because differential of multiple 
myeloma. Which "tumour markers were within normal limits"? Morphology  and IHC 
staining results need to be explicitly stated (and shown in figure).  
 
1. The clinical description of the case is limited and so reduces the learnings for clinicians 
eg. Why did "electrocardiogram reveal myocardial ischaemia." Was the presentation due 
to myocardial infarction? This is important because would suggest true incidental 
findings and so more benign course. Given MRI findings, was this an R2 resection? If so 
what is happening in follow up. There is a significant and unexpected difference b etween 
size on MRI and operative findings but no explanation. If truly primary in pancreas, then 
length of follow up should be stated to allow reader to determine whether this true (ie 
Myeloma has not become apparent in followup. Discussion paragraph 5 - differential 
diagnosis is incomplete. The MRI features are interesting but description of other tumour 
appearance is oversimplified and so limits impact.  
 
2. The novelty of the case relies on accurate literature review, but review appears to be 
incomplete. A quick pubmed search found additional cases of primary pancreatic 
plasmacytoma not referenced in the current paper (e.g., one of the 6 cases described by 
Wizzane etal 2013). Also the comment of 20 previous cases of secondary plasmacytoma 
does not match pr evious descriptions of "50 cases" described by other authors (eg. Lopes 
da Silva, 2012)  
 
3. Inconsistency within the document - is this the 4th case (as stated in abstract) or the 3rd 
case (as stated in discussion)? (noting that both are incorrect as in po int 3 above).  
 
4. The writing needs some attention. e.g. grammar in sentence 1 and 2 of background. 
Spelling mistakes eg. Bence jones proteins line 44, extramedullary line 52, 
plasmacytomas line 54, etc. Discussion paragraph 3 is a bit confusing because m ixes 
primary and secondary pancreatic plasmacytoma. Discussion paragraph 4 is banal and 
does not contribute to the learning from this case.  
 
I wish the authors well in reformulating this short paper, and hope these comments are 
constructive and help lead t o eventual publication.  
 
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.  
 
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 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 com peting 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, e ither 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 re port 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 Crea tive 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