Surgical images: musculoskeletal Synchronous multifocal osteosarcoma.
Bibliographic record
Abstract
A 19-year-old white man presented with left knee pain and radiographs (Fig. 1). Open biopsy revealed high-grade osteogenic sarcoma. Bone scan showed another lesion involving the pedicle and transverse process of L1 (Fig. 2). CT and MRI were suggestive of osteosarcoma (Fig. 3). Biopsy revealed multicentric osteosarcoma. FIG. 1. Preoperative knee. Plain x-ray films revealing a blastic malignant lesion in distal femur that open biopsy verified to be high-grade osteogenic sarcoma. FIG. 2. Bone scan demonstrating additional lesion involving the pedicle and transverse process of L1. FIG. 3. Preoperative advanced spine. Axial CT and MRI scan of suspicious area of increased uptake on bone scan; additional biopsy confirmed the diagnosis of multicentric osteosarcoma. After preoperative multidrug chemotherapy, the patient underwent resection of his distal femur with replacement with a massive prosthesis (Fig. 4). Tumor necrosis was found to be 99%. FIG. 4. Postoperative femur. After preoperative chemotherapy, the patient underwent resection of his distal femur with replacement with a massive prosthesis. He underwent 2 more cycles of chemotherapy followed by en bloc resection of his L1 tumour (Fig. 5). Tumor necrosis was found to be 100%. Anterior and posterior instrumentation was successful (Fig. 6). FIG. 5. Path specimen. Pathology specimen after en bloc resection, including part of the vertebral body as well as entire pedicle, transverse process and spinous process. FIG. 6. Postoperative spine. Three months later, the patient had en bloc resection of his spinal lesion, followed by posterior instrumentation and anterior cage reconstruction. The most recent follow-up, at 2 years, demonstrates excellent outcome with full extension of his left knee and flexion to 105°. He has very minimal functional limitation. Synchronous multifocal osteosarcoma is most often thought to represent the phenomenon of bony metastasis, but in some patients, aggressive management leads to cure.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.036 | 0.006 |
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".