A Rapidly Developing Adenocarcinoma in Cronkite-Canada Syndrome
Bibliographic record
Abstract
A 68 yo male with 4 month history of nausea and loss of appetite. He also sustained a 30 pound weight loss with watery, nonbloody diarrhea. Previous colonoscopy showed diverticulosis. He appeared well developed with normal vitals. He had patchy alopecia over his scalp. Abdomen was benign and rectal revealed brown stool which was heme positive. Fingernails and toenails showed onchodystrophy. Pertinent laboratory revealed hypokalemia and zinc deficiency. EGD showed many polypoid lesions in the stomach and duodenum. Colonoscopy revealed multiple polypoid lesions in TI and colon (Figure 1,2). Pathology showed juvenile polypoid lesions throughout the GI tract consistent with Cronkite-Canada syndrome (CCS). He was started on Prednisone, Rifaximin, and antihistamines. Repeat colonoscopy completed 6 weeks after treatment showed improvement in polypoid lesions. Biopsies of a 2 cm rectal polyp confirmed a well-differentiated, adenocarcinoma with focus of submucosal invasion arising in juvenile polyp. He was referred to surgery and had a low anterior resection with margins of resection showing no residual invasive carcinoma. He was seen three weeks postop with improvement of all his symptoms. CCS is an extremely rare syndrome of unknown etiology. Cardinal manifestations are GI polyposis, skin hyperpigmentation, alopecia, and nail dystrophy as were seen in our patient. GI lesions are hamartomatous polyps. Adenomatous changes and carcinoma occur in, or in close proximity to, hamartomatous polyps in about 15% of affected patients. Our patient developed a colorectal carcinoma within 2 years of a prior negative colonoscopy. Histology showed the carcinoma immediately adjacent to a benign juvenile type polyp. The serrated adenoma-carcinoma sequence in CCS with microsatellite instability and p53 overexpression is a potential explanation for this rapidly developing cancer. [figure 1][figure 2]Figure 1Figure 2
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".