Squamous cell carcinoma in enterocutaneous fistula associated with Crohn's disease: First case report: Figure 1
Bibliographic record
Abstract
Dear Sir, Malignant transformation of fistulas in Crohn's disease (CD) patients is rare. Prior studies mainly focused on perianal fistulas as a complication of CD, and little is known about carcinoma in enterocutaneous fistulas. There are increasing concerns that chronic immunosuppression with azathioprine, widely used for remission maintenance and post-operative recurrence prevention in CD, could increase the risk of cancer in this patients. A 38-year-old female, non-smoker was referred to our outpatient clinic in 2011, with penetrating ileocolic CD diagnosed at 16 (A1L3B3, Montreal classification). At age 19, she underwent a total colectomy with ileo-rectal anastomosis in the referring institution, which was complicated with ileorectal anastomotic stricture and later development of enterocutaneous fistulous tract to umbilical area. She was on azathioprine since then, maintaining poor general condition and a high-output fistula, with intermittent bleeding. The patient was started on infliximab (5 mg/kg/8w) but twelve weeks after, she was hospitalized with abdominal pain and fever. Computed tomography scan disclosed a large mass involving a large enterocutaneous fistula. Microscopic analysis of ultrasonography-guided-biopsy specimen yielded the diagnosis of squamous cell carcinoma (SCC) (Fig. 1). In multidisciplinary team meeting, the patient was deemed not suitable for surgical resection, due to the tumor size and overall health status, and was referred to palliative care. She died three months later.
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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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.009 | 0.005 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
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".