Bibliographic record
Abstract
Verrucal hyperplasia of the esophagus (VHE), a precursor to verrucous carcinoma of the esophagus (VCE), thought to be associated with Human Papilloma Virus (HPV), smoking or alcohol use. Since its discovery, less than 25 cases of VCE have been reported. The diagnosis can be very challenging due to a high prevalence of superimposed candida infection. We present a 67 year old woman with a 3 month history of progressive dysphagia and 10 pound weight loss, who had two esophagogastroduodenoscopies (EGD) preformed at an outside facility demonstrating thick, white exudates in the proximal esophagus with biopsies consistent with esophageal candidiasis and treated with antifungals, with no improvement. She denied any other symptoms, no other past medical history, no smoking, or alcohol use, no risk factors for immunosuppression and was on no medications. We performed an EGD, revealing white, verrucous plaques throughtout the esophagus. Multiple biopsies demonstrated hyperplasia but unable to rule out carcinoma, and HPV testing was negative. An endoscopic ultrasound (EUS) found a thickened esophagus, with no evidence of invasive disease or lymph node involvement, hence deep biopsies were not obtained. The patient was referred to surgery for possible esophagectomy. We are unable to label this as VCE due to the lack of deep and conclusive biopsies. Verrucal hyperplasia of the Esophagus is misdiagnosed due to lack of familiarity and candida overgrowth. EUS may be used to evaluate for penetrating disease, however the role of EUS and fine needle aspiration (FNA) for verruccal hyperplasia/carinoma is unknown. Studies have shown that esophagectomy is curative in the absence of metastatic disease. In our patient the lack of risk factors led to multiple EGDs with a misdiagnosis of Candidiasis. Our biopsies demonstrated hyperplastic changes with questionable dysplasia. This may have been due to an early diagnosis in the disease process or limited tissue on biopsy. Hence, we cannot conclusively say that she has verrucal carcinoma. However, hyperplastic changes are a know precursor to VCE and squamous cell carcinoma of the esophagus. Although very rare, and difficult to recognize due to concomitant esophageal candidiasis in most cases, it is imperative that gastroenterologists are familiar with this disease presentation even in patients with no risk factors, since early recognition is essential due to its high curative potential when recognized early in the disease process.Figure 1Figure 2Figure 3
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 | 0.001 | 0.007 |
| 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 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.025 | 0.014 |
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".