Bibliographic record
Abstract
Introduction: Signet ring cell carcinoma (SRCC) is a poorly differentiated adenocarcinoma named after a histological resemblance to a signet ring. Ninety-six percent of all SRCC are located within the stomach, but may also be found in the breast, gallbladder, pancreas, urinary bladder, and large bowel. Duodenal SRCC is an extremely rare finding. A review of the literature reveals a number of cases of SRCC involving the ampulla of Vater, but only 2 reported cases of true duodenal SRCC. In this case report, we present a true duodenal SRCC in an 82-year-old female. Case Report: An 82-year-old female presented with melena off and on over a 5-month period. Past medical history included hypertension, hypothyroidism, chronic kidney disease, and previous hysterectomy. Medications included hydrochlorothiazide, synthroid, citalopram, metoprolol, candesartan, and ASA. Blood work demonstrated iron deficiency anemia with hemoglobin 86g/L, serum iron 11.3. The patient developed 2 episodes of pre-syncope after passing melena and was assessed in the ED. Her hemoglobin had dropped to 68. The patient was transfused 2 units of packed red blood cells and was sent home. An urgent outpatient gastroscopy was performed. It showed a deep, non-bleeding, clean-based ulcer (10 mm x 12 mm) in the duodenal bulb. Biopsies were taken from the ulcer edge. Pathology confirmed adenocarcinoma with signet ring pattern with vascular space invasion. Subsequent CT confirmed thickening of the duodenal wall with nodularity in the peritoneum suggestive of tumour deposit. The patient was assessed by general surgery, but given her age, comorbidities and possible peritoneal involvement surgery was not performed. She continued to pass melena and was assessed for palliative radiation therapy. The patient completed radiotherapy (3000 cGy in 10 fractions) and has remained relatively stable other than some intermittent rectal bleeding. Discussion: Small intestine tumours make up only 1-5 % of all bowel neoplasms, and of these, approximately 50% occur in the duodenum. Within the gastrointestinal tract, signet ring cell carcinoma (SRCC) are almost always located in the stomach and rarely seen in the small intestine. This illustrates that primary duodenal SRCC is exceedingly rare. Duodenal SRCC generally presents with advancedstage disease, and thus carries a poor prognosis. If caught in early stage disease, preferred treatment for those who are surgical candidates is a pancreaticoduodenectomy with dissection of regional lymph nodes. In the rare case of a suspected duodenal SRCC, the lesion may be located throughout the duodenum and should be considered even in the absence of symptoms of gastric outlet or hepatobiliary obstruction.
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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".