An Intramucosal Large Cell Neuroendocrine Carcinoma Arising Within a Tubulovillous Adenoma With High- Grade Dysplasia of the Rectosigmoid Colon Treated With Polypectomy
Bibliographic record
Abstract
High-grade neuroendocrine carcinoma (NEC) has been previously reported to arise within preexisting adenoma but is usually at an advanced stage and carries a dismal prognosis and is almost always treated with surgical resection. Intramucosal NECs treated with polypectomy have not been reported. Herein, we report the first case of intramucosal NEC treated by polypectomy. An 87-year-old white male was referred to the Cleveland Clinic for a polyp detected in an outside hospital. A 40 mm sessile polyp was visualized in the recto-sigmoid colon using flexible sigmoidoscopy. Polypectomy was performed and histopathology revealed multiple fragments of tubulovillous adenoma (TVA) with extensive high-grade dysplasia (HGD). Notably, there was a focus (1 mm) of NEC confined to lamina propria and intimately related to the adenomatous component. This focus of intramucosal NEC was confirmed by its strong and diffuse synaptophysin and chromogranin A immunoreactivity and near 100% Ki-67 labeling index. Immunohistochemistry using a panel of antibodies against mismatch repair proteins was performed and both the adenomatous and NEC components had normal staining for MLH1, PMS2, MSH2, and MSH6. This, to the best of our knowledge, is the first case of intramucosal NEC treated with polypectomy reported to date. Patient was alive 1 year after polypectomy. Clinical behavior remains to be seen with long-term follow-ups. J Med Cases. 2016;7(5):174-177 doi: http://dx.doi.org/10.14740/jmc1996w
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| 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 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".