Gastrointestinal: A sheep in wolf's clothing
Notice bibliographique
Résumé
About 1% of oesophageal neoplasms are benign—in general, they are not difficult histologic diagnoses with tissue obtained through traditional sampling techniques at oesophagogastroduodenoscopy (OGD). This case report highlights a rare benign neoplasm of the oesophagus with the potential to be misdiagnosed as a malignant epithelial or mesenchymal tumor. A 70 year-old man underwent OGD for evaluation of dysphagia. He was found to have a 5mm nodule at the gastroesophageal junction. Biopsies were reported as a poorly differentiated malignant neoplasm, favoring an undifferentiated sarcoma. This was reviewed by three independent gastrointestinal (GI) pathologists, including an expert pathologist in sarcomas, who all concurred with the original diagnosis. Staging investigations were normal. The patient was referred for consideration of endoscopic mucosal resection (EMR). At OGD he was observed to have a benign-appearing 4mm sessile polyp at the gastroesophageal junction. This was removed en-bloc using the Duette endoscopic mucosal resection system (Cook Medical, Winston-Salem, NC) (Figure 1). Review of current and previous pathology by our expert GI pathologists revealed markedly inflamed and reactive squamous epithelium along the surface, with local thinning (Figure 2). In the most superficial portion of the lamina propria, there were large cells with high nuclear-cytoplasmic ratio and marked nuclear atypia, the features that had lead to the initial diagnosis of cancer, however in contrast to true sarcomas, the lesion was predominantly inflammatory, with only scattered atypical cells found in the superficial portions. These findings were consistent with an inflammatory pseudotumor (IPT) of the oesophagus. The patient has remained well more than 15 months later. White light endoscopy revealing a 4mm nodule at the gastroesophageal junction (Arrow). Inflammation with atypical stromal cells showing markedly atypical nuclei (H&E x 200). IPTs are benign lesions which have been described in several organs. In the gastrointestinal tract, they most commonly occur in the stomach and distal ileum and only rarely in the oesophagus. Oesophageal IPTs are usually located in the mid to distal oesophagus, usually appear as nodules or circumscribed masses, are rarely pedunculated, and are frequently associated with mucosal ulceration. The natural history is variable with a number of cases reporting spontaneous resolution. Their importance lies in the high misdiagnosis as either squamous cell carcinomas or carcinosarcomas with several case reports in the literature where the benign diagnosis was made only in oesophagectomy specimens. Resection has been advocated in cases where patients are symptomatic, however in view of some cases of spontaneous resolution, unless easily removed by endoscopic resection techniques, we would advocate an initial period of observation. Contributed by
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,004 | 0,002 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,007 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».