Review for 10.1186/s12876-020-01540-4 (2020)

Reviewer’s report
Title: 
Epidermoid Cyst in an Intrapancreatic Accessory Spleen in the Pancreas
Head: A case report
Version: 
0 
Date: 
22 Sep 2020
Reviewer: 
Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
Yes, the description of the case is sufficient
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: This case report describes the presentation, treatment
and discussion of a patient diagnosed with a epidermoid cyst in an
intrapancreatic accessory spleen 
(ECIPAS) who was treated with surgical
excision for histologic confirmation of the diagnosis. 
The case is well written,
clear, concise and informative concerning the disease described. 
While the
subject matter is rare in its' prevalence, it remains clinically relevant as
pancreatic lesions are more commonly discovered with the increasing utilization
of body imaging for diagnosis. 
I feel that the authors presented the case
accurately and have discussed the majority of difficulties with the diagnosis and
management of patients with ECIPAS. 
I also believe that because of the rareness
of this diagnosis, publication of this subject material will help to increase the
awareness of the diagnosis for physicians in this area of practice.
REQUESTED REVISIONS: 
Overall the paper is well written and the case is described appropriately. 
In the
discussion, the utilization of EUS in the accurate diagnosis is briefly mentioned
but not discussed in depth. 
This is a minor point- I do believe the paper should be
published. However, I would like to know why EUS was not used as a
diagnostic tool in the evaluation of this patient (perhaps, the risk for pancreatitis,
or there was no window available for biopsy or perhaps, the institution does not
availability of EUS). 
In the United States, much of the diagnostic evaluation of
pancreatic tumor relies heavily on a combination of EUS and MRI for
determination. 
There are some clear contraindications to both techniques but for
the most part, EUS remains a relatively safe invasive technique for providing
histologic diagnosis to aid the physician in the determination of the treatment
pathway. 
The case report discusses the difficulty in making an accurate
diagnosis, which I agree. 
I think providing some information why EUS was not
used in this case would help readers understand the reasons for the author's
decision in treatment and a small discussion about the risks and benefits of EUS
in the histologic diagnosis of pancreatic tumors is warranted.
ADDITIONAL REQUESTS/SUGGESTIONS: 
no other suggestions
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