Soft Tissue Metastasis of Parathyroid Carcinoma: Description of a Difficult Case
Bibliographic record
Abstract
Parathyroid carcinoma is an extremely rare cause of hyperparathyroidism. Histologic diagnosis may be challenging. DAB, male aged 66 was submitted to subtotal gastrectomy because of a localized gastric adenocarcinoma (intestinal type). A mild primary hyperparathyroidism was simultaneously found. Calcium oxalate nephrolithiasis was diagnosed 16 years before. Sonography revealed a nodular lesion in the right lower thyroid pole, while NMR showed a nodular lesion at the left lower thyroid pole. The sestamibi scan found a late image hyperfixation at the right lower pole. Bilateral inferior parathy roidectomy was performed and revealed on both sides adenoma and moderate nuclear polymorphism and no mitotic figures; on the left side a central cystic area was found. Clinical and biochemical cure apparently followed. Six months later a presumed unrelated nodular lesion in the right thigh muscular mass was removed and found to have numerous mitotic figures and immunoreactivity for PTH. A sestamibi scan showed marked hyperfixation in the right leg and PET-FDG-F 18 hyperfixated the right quadricipital area. There is evidence for a long standing disease since nephrolithiasis was found some years before. Long standing hyperparathyroidism and increased gastric acid secretion can lead to chronic gastritis, intestinal metaplasia and gastric adenocarcinoma. There is evidence for evolution along bilateral hyperplasia, adenoma and carcinoma since bilateral disease was present and left cystic nonfunctioning lesion was found. Most surprisingly a single metastatic lesion was later found in a very unusual location and this lesion was highly undifferentiated in sharp contrast with the primitive lesion.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.011 | 0.005 |
| Insufficient payload (model declined to judge) | 0.006 | 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".