Reviewer ’s report  
 
Title:  WIRSUNG ATRAUMATIC RUPTURE IN PATIENT WITH PANCREATIC 
PSEUDOCYSTS. A CASE PR ESENTATION  
 
Version: 0 Date: 24 Jan 2018 
 
Reviewer:  Hiroyuki  Matsubayashi  
 
Reviewer’s report:  
 
General comment  
 
This report documented a case of multiple pancreatic pseudocysts presenting jaundice 
accompanied with Wirsung duct rupture without traumatic history.  
 
The reviewer wondered if the conclusion written in the Abstract can be drawn fro m this case 
presentation.  
 
 
Specific comments  
 
1) P3, L60 -63. The authors described EUS allows a sample of cyst fluid for testing amylase 
and cytology, essential to differentiate inflammatory pseudocysts from cystic neoplasms. 
However, they also stated in th e text that "IPMN could be considered because of the 
location of the mass in pancreas head….. Consequently pseudocyst diagnosis was 
hypothesized." The reviewer also feel the effect of EUS -FNA cyst fluid analysis can only 
"suggest" but not "conclude", as yo u finally concluded by laparotomy, not by EUS -FNA .  
 
2) P5, L85 -89. There are several tumor markers descriptions (CEA, CA19 -9, CA125, CgA, 
NSE). Please, add the normal range.  
 
3) P6, L101 -102. EUS confirmed the multiple pancreatic cystic lesions and fine n eedle 
aspiration ruled out the presence of neoplastic cells (Fig. 3).  
 
Do authors want to say cytology by EUS -FNA? or biopsy? Also, why you can say rule out? How 
accurate are the aspiration cytology or cyst fluid analysis for the diagnosis of pathological 
diagnosis. Authors should quote the literatures describing the sensitivity, specificity, accuracy…. 
of the cytology/fluid analysis of the pancreatic cystic lesions.  
 
4) P6, L105. What was the pathological diagnosis of "A large mass"?  
 
5) P8, L155. Managemen t of PFCs is  ….. to duct disruption. Current case also showed duct 
disruption, a cause of these pseudocysts suggested by authors. What caused the 
disruption?  
 
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 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 addi tional 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:  
 
Acceptable  
 
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 cont ent 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 compet ing 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 n ot be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  WIRSUNG ATRAUMATIC RUPTURE IN PATIENT WITH PANCREATIC 
PSEUDOCYSTS. A CASE PR ESENTATION  
 
Version: 0 Date: 24 Jan 2018 
 
Reviewer:  Hiroyuki  Matsubayashi  
 
Reviewer’s report:  
 
General comment  
 
This report documented a case of multiple pancreatic pseudocysts presenting jaundice 
accompanied with Wirsung duct rupture without traumatic history.  
 
The reviewer wondered if the conclusion written in the Abstract can be drawn fro m this case 
presentation.  
 
 
Specific comments  
 
1) P3, L60 -63. The authors described EUS allows a sample of cyst fluid for testing amylase 
and cytology, essential to differentiate inflammatory pseudocysts from cystic neoplasms. 
However, they also stated in th e text that "IPMN could be considered because of the 
location of the mass in pancreas head….. Consequently pseudocyst diagnosis was 
hypothesized." The reviewer also feel the effect of EUS -FNA cyst fluid analysis can only 
"suggest" but not "conclude", as yo u finally concluded by laparotomy, not by EUS -FNA .  
 
2) P5, L85 -89. There are several tumor markers descriptions (CEA, CA19 -9, CA125, CgA, 
NSE). Please, add the normal range.  
 
3) P6, L101 -102. EUS confirmed the multiple pancreatic cystic lesions and fine n eedle 
aspiration ruled out the presence of neoplastic cells (Fig. 3).  
 
Do authors want to say cytology by EUS -FNA? or biopsy? Also, why you can say rule out? How 
accurate are the aspiration cytology or cyst fluid analysis for the diagnosis of pathological 
diagnosis. Authors should quote the literatures describing the sensitivity, specificity, accuracy…. 
of the cytology/fluid analysis of the pancreatic cystic lesions.  
 
4) P6, L105. What was the pathological diagnosis of "A large mass"?  
 
5) P8, L155. Managemen t of PFCs is  ….. to duct disruption. Current case also showed duct 
disruption, a cause of these pseudocysts suggested by authors. What caused the 
disruption?  
 
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 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 addi tional 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:  
 
Acceptable  
 
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 cont ent 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 compet ing 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 n ot be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  WIRSUNG ATRAUMATIC RUPTURE IN PATIENT WITH PANCREATIC 
PSEUDOCYSTS. A CASE PR ESENTATION  
 
Version: 0 Date: 24 Jan 2018 
 
Reviewer:  Hiroyuki  Matsubayashi  
 
Reviewer’s report:  
 
General comment  
 
This report documented a case of multiple pancreatic pseudocysts presenting jaundice 
accompanied with Wirsung duct rupture without traumatic history.  
 
The reviewer wondered if the conclusion written in the Abstract can be drawn fro m this case 
presentation.  
 
 
Specific comments  
 
1) P3, L60 -63. The authors described EUS allows a sample of cyst fluid for testing amylase 
and cytology, essential to differentiate inflammatory pseudocysts from cystic neoplasms. 
However, they also stated in th e text that "IPMN could be considered because of the 
location of the mass in pancreas head….. Consequently pseudocyst diagnosis was 
hypothesized." The reviewer also feel the effect of EUS -FNA cyst fluid analysis can only 
"suggest" but not "conclude", as yo u finally concluded by laparotomy, not by EUS -FNA .  
 
2) P5, L85 -89. There are several tumor markers descriptions (CEA, CA19 -9, CA125, CgA, 
NSE). Please, add the normal range.  
 
3) P6, L101 -102. EUS confirmed the multiple pancreatic cystic lesions and fine n eedle 
aspiration ruled out the presence of neoplastic cells (Fig. 3).  
 
Do authors want to say cytology by EUS -FNA? or biopsy? Also, why you can say rule out? How 
accurate are the aspiration cytology or cyst fluid analysis for the diagnosis of pathological 
diagnosis. Authors should quote the literatures describing the sensitivity, specificity, accuracy…. 
of the cytology/fluid analysis of the pancreatic cystic lesions.  
 
4) P6, L105. What was the pathological diagnosis of "A large mass"?  
 
5) P8, L155. Managemen t of PFCs is  ….. to duct disruption. Current case also showed duct 
disruption, a cause of these pseudocysts suggested by authors. What caused the 
disruption?  
 
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 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 addi tional 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:  
 
Acceptable  
 
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 cont ent 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 compet ing 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 n ot be published.  
 
I agree to the open peer review policy of the journal  
assistant