Gastrointestinal: A sheep in wolf's clothing
Bibliographic record
Abstract
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
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.020 | 0.007 |
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".