Review for 10.1186/s12876-020-01587-3 (2021)

Reviewer’s report
Title: 
Simultaneous brain and lung metastases of pancreatic ductal
adenocarcinoma after curative pancreatectomy: A case report and literature
review
Version: 
0 
Date: 
21 Oct 2020
Reviewer's report:
The authors have described a patient who underwent distal pancreatectomy and
splenectomy for pancreatic adenocarcinoma with post operative adjuvant
chemotherapy but went on to develop simultaneous lung and brain metastases 8
months after index surgery.
This report illustrates the fact that we are still at a loss when it comes to
predicting tumor biology pre-operatively and why some tumors behave so
aggressively. It is also surprising that two patients reported by Lemke et al. (Ref
21; labelled as 22 in the Table; kindly check) survived for more than 6, 10 years
The CT scan suggests presence of polycystic kidney as well as polycystic liver
disease. These are known to be associated with pancreatic tumors as well as
brain tumors. Do the authors think that this may have some relevance to the
present case? 
Was a CA 19-9 level done at the time of metastatic presentation? CEA was
elevated but a rise in CA 19-9 after fall in response to Gemcitabine might
suggest recurrence of the pancreatic tumor more strongly
In the literature reviewed by the authors, in what percentage of patients was the
brain metastases from pancreatic adenocarinoma cystic?
Although the clinical course suggests metastatic pancreatic cancer, is it correct
there was no biopsy confirmation of the brain lesion; similar
immunohistochemical markers as the primary tumor would make it irrefutable;
understandably, clinical treatment is based on various considerations and a
biopsy may always not be warranted
The authors could discuss the above points
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