Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know
, Luca Barresi 2,*, Francesco Paolo Zito 1, Michele Amata 3, Roberto Fiorentino 4, Severo Campione 5, Alessandro Iacobelli 5, Enrico Crolla 6, Roberto Di Mitri 3, Carlo Molino 6, Marco Di Serafino 7 and Giovanni Lombardi 1Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsA review of the pathognominic signs in pancreatic cysts is important and this paper lists some of those, but not all. Needle confocal laser endomicroscopy findings are pathognomic and should be included in a paper like this. I am not sure of the usefulness of chylous cyst fluid for lymphangiomas. I have never obtained a TG level on cyst fluid.
The figures are great. I would consider adding a CT Abdomen to show the central scar since it is seen better on CT.
Comments on the Quality of English Language
Fair. Incorrect usage of some words. For example, line 36, instead of "differential diagnosis" I would only use diagnosis. We are able to make a differential diagnosis for pancreatic cysts, but making an more precise diagnosis is difficult. Also I would use "premalignant" instead of "borderline" (line 25). I do not see a reason for Figure 3B as it is not related to fish mouth papilla.
Line 149 "degenerated IPMN"- I do not know what that means.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsDespite the not-so-tremendous level of novelty of the study, I recognize the usefulness of the material and its good preparation. Readers of this review can feel the interest and professionalism of the authors when reading this manuscript.
I want to note the multidisciplinary approach to the actual problem of pancreatic neoplasia (since this is one of the oncological diseases, the morbidity and mortality of which continues to grow in recent years).
As improvements to the manuscript, I would like to suggest the following:
- to expand the radiological-pathological comparisons, for example, microphotographs of a stellate scar or chylous cysts can be given;
- to expand the pathomorphological description of IPMN and MSN, to show the pathohistological changes behind the fish mouth/eye papilla;
- add information about calcification of the pancreas in other diseases to enrich the differential diagnosis.
I believe this manuscript is valuable to doctors from a practical point of view, so I support the possibility of publication.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThank you for the revisions on the paper. I believe that the information added has significantly enrched this manusceript.
