A 16‐Year‐Old Boy With Colonic Adenocarcinoma
Bibliographic record
Abstract
A 16-year-old boy presented with vomiting, diarrhea, and fever after traveling to Vietnam. He also reported a 6-month history of vague abdominal pain and anorexia. Abdominal computed tomography (CT) scan showed luminal narrowing owing to an inflammatory stricture versus mass lesion at the distal transverse colon. Colonoscopy could only be performed to the splenic flexure (Fig. 1). Preliminary biopsy reports suggested adenocarcinoma. Magnetic resonance enterography showed a 10-cm dilatation of the transverse colon secondary to a distal occlusive mass (Fig. 2), warranting urgent surgical resection. Histopathologic examination revealed a moderately differentiated colonic adenocarcinoma with node-positive disease, stage IIIC.FIGURE 1: Endoscopic image of colonic mass lesion at the splenic flexure.FIGURE 2: A, Coronal T1W1 fat saturation shows severe dilatation of the transverse and ascending colon and the terminal ileum (thick arrow). At the splenic flexure, there is a nonenhancing mass originating from the lumen of the colon producing severe intestinal obstruction (arrow head). The walls of the terminal ileum and the cecum show significant postcontrast mucosal enhancement and mild wall thickening (thin arrows), representing inflammatory changes related to long-standing intestinal obstruction. B, Coronal apparent diffusion coefficients map shows positive diffusion restriction in the walls of the cecum and terminal ileum (thin arrows), which correlates with the inflammatory changes related to long-standing intestinal obstruction. The mass in the splenic flexure shows marked diffusion restriction denoting the increased cellularity of the tumor (arrow head).Colorectal cancer is rarely encountered in pediatrics, with an incidence of <2 cases per million people <20 years in the United States (1,2), the majority of which are sporadic. In contrast to adults, youth often present with acute bowel obstruction after months of insidious symptomatology (3,4). With obstruction, bowel wall thickening and diffusion restriction may develop proximal to the lesion, which can mimic inflammatory bowel disease. Adenocarcinoma, however, is not typically associated with mucosal enhancement or transmural edema (5). CT scan and lesional biopsy are recommended for tumor staging. Unfortunately, many pediatric cases have mucinous histology and poor differentiation, conferring a poor prognosis (3,4). Surgical resection with adjuvant chemotherapy can be curative (6).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".