Review for 10.1186/s12876-021-01744-2 (2021)

Reviewer’s report
Title: 
A case of intraductal tubulopapillary neoplasm of the pancreas in a branch
duct: a rare case report and literature review
Version: 
0 
Date: 
23 Jan 2021
Reviewer's report:
Authors reported a case of ITPN in a branch duct of the pancreas. There are
some concerns in this report.
1. What is a scientific benefit in this report? ITPNs in BD does not sound so rare.
Even differentiation between BD-origin and the main duct-origin does not seem
to be beneficial clinically. The authors need to make points clear to distinguish
BD-origin and MPD-origin in ITPNs.
2. Patients anonymity should be strictly warranted. Descriptions of exact time
like "November 2016" and "May 2014" should be avoided. 
3. "There are few case reports of ITPN in a branch of the pancreatic duct (BD)"
sounds inappropriate. As the authors described in discussion, ITPNs in BD
account for "9.4%", which does not sound "few" or "very rare". 
4. "known to have little invasion and good prognosis" in introduction; "a disease
with borderline malignancy and do not induce a poor prognosis" and "Most
cases, even with extraductal invasion, have a good prognosis" in discussion may
mislead readers. ITPN does claim patients lives as reported by Yamaguchi et al.
Basturk et al (PMID: 27984235) reported that 71% of their 33 experienced cases
reveled invasion and such invasive cases showed 71% in 5-year survival.
5. "pancreatic intraepitheral neoplasm" should be correctly "pancreatic
intraepithelial neoplasia."
6. "Fine needle biopsy was sent with suspicion of an intraductal lesion." The
biopsy is very critical for diagnosis of ITPN, therefore, it should have been
carefully examined. Is there any possibility that the biopsy could be accurately
diagnosed retrospectively?
7. In Figure 5a, what was indicated by arrows? The main pancreatic duct should
be indicated.
8. According to Figure 5c, the tumor mainly shows tubular pattern, which is not
consistent with descriptions as "the tumor had grown with a complicated
papillary structure, pseudopapillary structure, or cribriform pattern (Fig.5)."
9. A histological image of "an extraductal invasion" should be shown.
10. Regarding Figure 6, negative staining images should be shown with positive
controls.
11. "tubule-papillary pattern" should be replaced with "tubulopapillary pattern".
12. "ITPN is a very rare disease as 0.3% of intraductal tumors" is wrong. ITPNs
account for 3% of intraductal tumors of the pancreas.
13. Split of Table 1 is hard to read. 
14. Data of KI-67 in this case noted in Table 1 should be referred in the results
section.
15. Data in Table 2 should be examined statistically.
16. "Diagnosis of ITPN is difficult if localized in a branch duct" and
"Furthermore, the preoperative pathological diagnosis of ITPN in BD is very
difficult" seem to be redundant
17. "There is possibility" should be "there is a possibility".
18. "there are limitations in a histology from ITPNs in BD" is questionable. As
authours stated, an appropriate immunohistochemical examination may lead to
correct diagnosis.
19. "If tumors in a branch duct is certain to be ITPN, a course observation
without surgery might be one choice of therapy for patients with a poor general
condition" is very controversial; therefore, such description is strongly
discouraged. 
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