Reviewer ’s report  
 
Title: A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid 
FDG uptake mimicking a malignant pancreatic tumor: a systematic case review  
 
Version: 1 Date: 28 Mar 2017  
 
Reviewer: Stuart Amateau  
 
Reviewer's report:  
 
I appreciate the response of the authors to my major concern, however I do not believe it directly 
satisfies the issue at hand. They note that EUS demonstrated a hyperechoic lesion not a 
hypoechoic lesion. Hyperechoic lesions are solid and therefore very, very unlikely to be a 
mucinous lesion; one could imaging complete transformation to malign ancy from a solid lesion, 
however all the more reason for sampling. Moreover, they explain in Japan that FNA is not 
recommended for mucinous lesions (which I also appreciate), however as its a hyperchoic lesion, 
mucinous type lesions would not have been on  a typical differential. Therefore, FNA should 
have been performed for definitive diagnosis and to avoid a major surgery.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the auth ors. 
 
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 revi ew? 
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 manusc ript: 
 
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 ma y 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.  
 
None  
 
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 manus cript 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://cr eativecommons.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 jo urnal  
Reviewer ’s report  
 
Title: A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid 
FDG uptake mimicking a malignant pancreatic tumor: a systematic case review  
 
Version: 1 Date: 28 Mar 2017  
 
Reviewer: Stuart Amateau  
 
Reviewer's report:  
 
I appreciate the response of the authors to my major concern, however I do not believe it directly 
satisfies the issue at hand. They note that EUS demonstrated a hyperechoic lesion not a 
hypoechoic lesion. Hyperechoic lesions are solid and therefore very, very unlikely to be a 
mucinous lesion; one could imaging complete transformation to malign ancy from a solid lesion, 
however all the more reason for sampling. Moreover, they explain in Japan that FNA is not 
recommended for mucinous lesions (which I also appreciate), however as its a hyperchoic lesion, 
mucinous type lesions would not have been on  a typical differential. Therefore, FNA should 
have been performed for definitive diagnosis and to avoid a major surgery.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the auth ors. 
 
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 revi ew? 
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 manusc ript: 
 
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 ma y 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.  
 
None  
 
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 manus cript 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://cr eativecommons.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 jo urnal  
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 pancreatic tumor: a systematic case review  
 
Version: 1 Date: 28 Mar 2017  
 
Reviewer: Stuart Amateau  
 
Reviewer's report:  
 
I appreciate the response of the authors to my major concern, however I do not believe it directly 
satisfies the issue at hand. They note that EUS demonstrated a hyperechoic lesion not a 
hypoechoic lesion. Hyperechoic lesions are solid and therefore very, very unlikely to be a 
mucinous lesion; one could imaging complete transformation to malign ancy from a solid lesion, 
however all the more reason for sampling. Moreover, they explain in Japan that FNA is not 
recommended for mucinous lesions (which I also appreciate), however as its a hyperchoic lesion, 
mucinous type lesions would not have been on  a typical differential. Therefore, FNA should 
have been performed for definitive diagnosis and to avoid a major surgery.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the auth ors. 
 
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 revi ew? 
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 manusc ript: 
 
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 ma y 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.  
 
None  
 
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 manus cript 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://cr eativecommons.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 jo urnal  
assistant