A Multiple Myeloma Patient Presenting with Multiple Hepatic Masses
Bibliographic record
Abstract
A 47-year-old male with Multiple Myeloma (MM) presented with a history of worsening jaundice and intermittent abdominal discomfort for one month. Physical examination was unremarkable except for the icterus and palpable, nontender liver extending 2 cm below the right costal margin. The liver function test was more consistent with an obstructive pathology. MRCP showed at least six hepatic masses- largest of which measured 16.4 × 11.2 cm, severe upper abdominal and retroperitoneal adenopathy and moderate to severe intrahepatic biliary duct dilatation due to extrinsic compression of Common Bile Duct (CBD) by a 6.0 × 5.7 cm porta-hepatis mass. A CAT-scan guided hepatic-mass-biopsy showed plasmacytoma. Endoscopic Retrograde Cholangiopancreatography with stent placement in CBD was done and the patient was discharged upon clinical improvement. Multiple Myeloma is a monoclonal, plasma-cell neoplasm that usually produces large amount of a specific immunoglobulin. Though Extramedullary plasmacytoma (EMP) is not uncommon feature of MM, it is rarely considered as a specific part of the clinical picture of MM. Though the most common mechanism for development of EMP is local growth of the malignant tissue outside the bone, it can also be formed in various distant organs via hematogenous spread of the malignant plasma cells. Hepatic plasmacytoma is considered a rare entity and literature is limited to few case notes. Out of two distinct pathologic variants of hepatic plasmacytoma, infiltrative plasma-cell lesion are more common that macroscopic-nodular form. There are reports of nodular-hepatic plasma cell tumor being diagnosed incidentally or presenting with clinical features of hepatocellular injury and/or cholestasis. We have presented a rare case of hepatic plasmacytoma in MM with intrahepatic and porta-hepatis macroscopic nodules occurring simultaneously. This clinical picture of obstructive jaundice with multiple liver masses, a porta-hepatis mass and severe abdominal adenopathy usually generates differential diagnoses of primary liver tumor, metastases, gall bladder carcinoma, cholangiocarcinoma or abscesses. If a patient has pre-existing multiple myeloma, plasmacytoma should invariably be added to the differential diagnosis. doi: http://dx.doi.org/10.4021/jmc1470w
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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 | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 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".