Chemotherapy-induced small bowel perforation in a patient with extrapulmonary small-cell carcinoma of the small bowel.
Bibliographic record
Abstract
Extrapulmonary small cell carcinoma (epsmcc) is rare and represents a clinicopathologic entity distinct from pulmonary small-cell carcinoma. It has been described in all anatomic sites outside the central nervous system1, but most commonly involves the gastrointestinal tract (git), the genitourinary and reproductive systems, the salivary glands and sinuses, and lymph nodes1,2. Overall, epsmcc represents 0.1%–1% of git malignancies3. Within the git, most tumours occur within the large bowel (39%), esophagus (30%), and stomach (8%); only about 3% involve the small bowel4. In a review of epsmcc of the duodenum in 2004, only 9 cases had been reported in the literature5. Clinical presentation often involves weight loss and anorexia, or site-specific symptoms such as abdominal pain, obstruction, bleeding, or mass. Staging workup depends on the site of the primary, but often involves computed tomography (ct) imaging of the chest, abdomen, and pelvis, and git endoscopy. Diagnosis is confirmed when biopsy shows small cells with scanty cytoplasm and round nuclei combined with histologic features typical of high-grade neuroendocrine tumours. Staging can be defined by the tumour–node–metastasis (tnm) system, but more commonly uses the Veterans Administration Lung Study Group (valsg) system which identifies two distinct stages: limited stage (ls) or extensive stage (es), based on whether the disease is confined to a locoregional anatomic location or whether it is not. The treatment approach has evolved from being primarily surgical to being centered on chemotherapy, particularly platinum-based regimens. The precise role of surgery in ls disease is not well defined, nor have any studies examined the role of surgery as prophylaxis for potential chemotherapy-induced complications such as perforation or hemorrhage.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".