Hepatobiliary and pancreatic: Alveolar echinococcosis mimicking hepatocellular carcinoma
Bibliographic record
Abstract
Human alveolar echinococcosis is a rare disease caused by Echinococcus multilocularis. The disease is restricted to the northern hemisphere and most cases have been described in central Europe, Canada, China and Japan. The most common definitive and intermediate hosts are foxes and voles, respectively. Human infections can be acquired by exposure to parasite ova in the feces of infected foxes or dogs. In the liver, the larval mass remains in the proliferative phase indefinitely with invasion and destruction of normal tissue. There are also reports of metastatic spread, occasionally to the lungs or brain. Macroscopically, larger lesions have a central cavity containing turbid, brown fluid surrounded by pale tissue that lacks a clearly-defined border. The diagnosis of alveolar echinococcosis is usually made by imaging and serological studies. One helpful imaging feature is that of marginal calcification. However, the differential diagnosis can include various hepatic tumors including hepatocellular carcinoma. Suspicion of alveolar echinococcosis is normally considered a relative or absolute contraindication for liver biopsy. However, in the case illustrated below, a biopsy was performed as the clinical setting seemed to favour the diagnosis of hepatocellular carcinoma. A 27-year-old man was admitted to hospital with jaundice, dark urine and pruritis. He did not describe significant abdominal pain but had noted weight loss of 4 kg over the preceding 4 months. He was known to have hepatitis C, presumably acquired by use of intravenous drugs. On physical examination, he was tender over the right upper quadrant of his abdomen. Blood tests revealed an elevated serum bilirubin and liver enzymes but his alpha-fetoprotein level was within the reference range. An abdominal computed tomography (CT) scan showed a large mass, 16 × 13 × 14 cm in size, that occupied most of the right lobe of the liver. The mass showed central necrosis, irregular margins and patchy calcification in peripheral areas (Figure 1). Two liver biopsies were taken under CT guidance; the first only showed necrotic tissue but the second showed laminated membrane with vesiculo-tubular structures that were highlighted by a periodic acid-Schiff stain (Figure 2, original magnification ×100). The diagnosis of E. multilocularis infection was supported by strongly positive serological tests using crude and recombinant parasite antigens. 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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
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".