Primary hepatic perivascular epithelioid tumor (PEComa)
Bibliographic record
Abstract
A 49 year-old woman was found to have a 2.9 cm hepatic lesion in segment 8, initially identified on an abdominal ultrasound performed for chronic abdominal pain and new onset diabetes mellitus, type 2. On computed tomography study the lesion was arterial enhancing with washout on portal venous and delayed phase and was classified as a LI-RADS category 4 (LR-4), suggestive but not diagnostic of hepatocellular carcinoma (HCC); the remainder of the exam was normal with no evidence of metastatic deposits. Of note, the background liver did not show any features of advanced fibrosis, but the patient had a past medical history of non-alcoholic fatty liver disease (NAFLD). The patient subsequently underwent a partial hepatectomy and on gross examination a well circumscribed grey tan lesion was identified. Histologically, the lesion showed a nested architecture, composed of epithelioid cells with round to oval nuclei, variable nucleoli and prominent granular eosinophilic cytoplasm (Figures 1A and 1B; * denotes background normal hepatic parenchyma). In areas the tumoral cells condensed around blood vessels (Figure 1B). The lesion also showed prominent fibrous trabeculae and pericellular fibrosis, raising the morphological differential diagnosis of a scirrhous or fibrolamellar subtype of hepatocellular carcinoma. By immunohistochemistry the tumour cells were positive with antibodies to gp100 protein (HMB-45; Figure 1C), melanA but negative for hepatocyte specific antigen (HSA) and S-100 protein. The perivascular epithelioid group of tumors (PEComas) is characterized by their co-expression of melanocytic and muscle markers and includes angiomyolipoma, lymphangioleiomyoma, and clear cell (‘sugar’) tumors of the lung, pancreas, and uterus.1-4 Primary hepatic PEComas are rare, but usually present in non-cirrhotic younger patients and on imaging studies often are suggestive of hepatocellular carcinoma. Although renal angiomyolipoThe Official Journal of the Mexican Association of Hepatology, the Latin-American Association for Study of the Liver and the Canadian Association for the Study of the Liver
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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) | 0.001 | 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) | 0.001 | 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".