E-082 Venous Vascular Malformation of the Floor of Mouth Masquerading as Dermoid Tumor
Bibliographic record
Abstract
Introduction Venous vascular malformations (VVMs) are described as abnormal post-capillary lesions which exhibit low flow. These are typically malleable and may grow with endocrine fluctuations. These irregular conduits are often characterized by a soft, compressible, nonpulsatile tissue mass that may exhibit a blue tinge due to the collection of ectatic venous channels underneath the dermis. Further findings upon physical examination may include expansion of the malformation with the Valsalva maneuver, and flattening of the protrusion with applied pressure. A VVM that mimics the classic appearance of dermoid tumor on imaging has never been reported. Case presentation We encountered a 43 year-old woman with intermittent dysphagia relating to a firm submandibular mass. Physical exam and cross-sectional imaging revealed features consistent with variant dermoid cyst. Gadolinium-enhanced MRI of the mass in T1 and T2 weighted imaging (Figure 1) revealed a lesion with T1 hypersensitivity and variable T2 signal. These results were followed-up with CT angiography which showed internal enhancement (Figure 1) possibly attributable to saponification, calcification, or rupture of the presumed dermoid cyst. However this pattern of enhancement was felt to be unusual, and digital subtraction angiography was performed to exclude a primarily vascular lesion. Catheter angiography eventually demonstrated a VVM which possessed vessels of variable size and partial thrombosis. Discussion This case presented a significant diagnostic challenge to our team as the VVM possessed numerous idiosyncratic features prevalent in cases of dermoid cysts, with simultaneous findings that are contraindicative of most venous malformations. The regression of the VVM during the patient’s pregnancy was counterintuitive to expectation, as endocrine fluctuations would be expected to precipitate rapid enlargement of the lesion. Similarly, the abnormal firmness of the mass discouraged the diagnosis of a VVM which is characteristically soft on palpation, but this may be explained by the presence of partially thrombosed vessels. We report the case and propose that catheter angiography remains important in cases where vascular malformation is considered. Disclosures A. Dmytriw: None. J. Song: None. P. Gullane: None. K. terBrugge: None. E. Yu: None.
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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) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.026 | 0.005 |
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".