Bibliographic record
Abstract
Primary adenocarcinoma of the duodenum is implicated in less than 0.5% of all gastrointestinal cancers. Although rare, benign looking duodenal ulcers at time of endoscopy may represent more sinister pathology, particularly in the absence of H. pylori or NSAID use. We report a case of an elderly man with a benign appearing duodenal ulcer at endoscopy who ultimately developed metastatic carcinoma from a primary adenocarcinoma of the duodenum. Case report A 72 year old male presented for a routine screening colonoscopy. At time of endoscopy, the patient gave a history of vague epigastric discomfort and melena stools over the past two days. He denied ASA or non-steroidal drug use and was a non-smoker. A gastroscopy and colonoscopy were pursued. Upon examination of the duodenal bulb, a small, benign appearing ulcer was noted on the anterior wall with no active bleeding. Antral biopsies for H.pylori were negative. No intestinal metaplasia was seen. He was prescribed proton pump inhibitor and instructed to seek follow up care with his family doctor. Approximately 8 months later, the patient began experiencing epigastric pain, nausea, early satiety and weight loss. He presented to the emergency room 11 months after the original endoscopy. A CT scan of the abdomen showed multiple hepatic metastases and lymphadenopathy at the porta-hepatis. A repeat gastroscopy revealed an ulcerated, stenotic mass at the pylorus, extending from the duodenal bulb. Biopsies of the pylorus revealed invasive adenocarcinoma, intestinal type. The patient was subsequently referred for palliative care. This case highlights that not all duodenal ulcers are benign. It may be worthwhile to ensure patients follow up with their endoscopist should they develop a recurrence of symptoms, at which time biopsy of the actual ulcer, if not healed, could be performed. 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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.006 | 0.004 |
| Science and technology studies | 0.006 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.009 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
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".