A mobile yellow nodule under the foreskin of a toddler
Bibliographic record
Abstract
A previously healthy uncircumcised 2-year-old boy presented with a 1-year history of an asymptomatic mobile yellow nodule near the base of the glans penis. He was otherwise healthy. On examination, there was a 1.5 × 1.0 cm mobile yellow nodule between the glans and the foreskin on the penis (Figures 1 and 2). Lateral view of a mobile yellow nodule between the glans and the foreskin on the penis of an uncircumcised 2-year-old male. Anterior view of a mobile yellow nodule between the glans and the foreskin on the penis of an uncircumcised 2-year-old male. Based on the morphology and location of the lesion, the nodule was diagnosed as a smegma pearl. Smegma is a collection of desquamated epithelial cell debris produced within the subprepucial space. As physiological phimosis resolves, foreskin adhesions begin to break down and the inner foreskin detaches from the glans penis. Smegma can become entrapped during this process, forming smooth palpable pearls (1). Although children are frequently referred to paediatric dermatologists with smegma pearls, given the paucity of published reports, they can pose a diagnostic challenge for clinicians unfamiliar with this entity. The differential diagnosis for smegma pearls includes preputial cyst, prepucial Epstein pearl, median raphe cyst, smegmalith and foreign body (1). The location and age of onset help differentiate these from smegma pearls. Preputial cysts are located under the glans while prepucial Epstein pearls are located at the tip of the foreskin and fade by 1 week of life. Median raphe cysts present on the ventral surface of the penis near the glans and smegmaliths typically present in the adult population as hard stony structures. Smegma pearls are a benign entity with anticipated spontaneous resolution. Treatment should include monitoring for resolution with parental reassurance. Bimanual retraction and manual expression of smegma is possible but poses a theoretical risk for paraphimosis, a urological emergency. This procedure can lead to possible irritation of the foreskin, recurrence of phimosis, and ultimately recurrence of the smegma pearl (2). Proper counseling regarding the natural history of this entity can alleviate parental anxiety and prevent unnecessary investigations or interventions. Funding sources: None. The authors have no conflict of interest to disclose; this paper has not previously been published or presented.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".