Not Captured on Camera: A Case of Appendiceal Cancer and Ascites
Bibliographic record
Abstract
Introduction Appendiceal cancers are rare GI malignancies with less than 1000 Americans diagnosed each year (total of 0.5% of GI cancers). About half of cases are discovered while undergoing surgery for acute appendicitis. Unfortunately, even screening colonoscopies can sometimes miss these cancers. In patients with concomitant ascites, the serum ascites albumin gradient (SAAG) and cytology can play a crucial complementary role in uncovering this malignancy. Case description: A 60 year old female with recently diagnostic decompensated “idiopathic” cirrhosis with ascites for 2 months presented to the ER with nausea and early satiety for 1 month. CT abdomen with IV and oral contrast and Liver Ultrasound was concerning for cirrhosis, with lab workup unrevealing of a discrete etiology at that time. Liver biopsy showed early cirrhosis .The SAAG was less than 1.1.On Transjugular Liver Biopsy HVPG was 14mmHg consistent with portal hypertension. A repeat CT with contrast was performed concerning for peritoneal carcinomatosis,appendix was not clearly visualised. Ascitic fluid Cytology analysis showed “adenocarcinoma with primary colorectal”. Of note, the patient had a colonoscopy by her primary gastroenterologist less than 1 year ago which was normal but the appendix was not clearly visualized or photodocumented. A repeat colonoscopy was performed and again the appendix was poorly visualized. Surgical oncology was consulted who recommended open laparotomy and debulking surgery with peritonectomy. The appendix was felt to be “firm to the touch” in the retrocecum and resected. Final pathology demonstrated poorly differentiated adenocarcinoma of appendix measuring 5.1cm with lymphovascular invasion. The patient was subsequently started on chemotherapy. Discussion This case underscores the subtle clinical features of appendiceal cancer as well as the importance of clear photodocumentation of the appendix during colonoscopy. In the case of poor appendiceal visualization, CT imaging such as CT colonography may have diagnosed the lesion. Further, in patients with ascites the SAAG and cytology analysis can be helpful in picking up this rare GI diagnosis.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.007 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.006 | 0.004 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.009 | 0.006 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
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".