A Case of Parathyroid Adenocarcinoma and Hyperparathyroidism, When “CRAB” Symptoms Are Not due to a Plasma Cell Myeloma
Bibliographic record
Abstract
A previously well 49-year-old patient presented to our hospital with symptomatic hypercalcaemia complaining of polyuria and polydipsia, as well as abdominal and lower back pain (serum/ionized calcium at 3.66 milli mole/l and 1.90 milli moles/l). At admission, he had a normocytic anemia (Hb, 99 g/L) and acute kidney injury (creatinine at 161 μ M). His parathyroid hormone (PTH) levels were at 67.6 pico moles/l. A plain X-ray of the lumbar spine showed the presence of a lytic lesion in the L4 vertebrae. CT and MRI confirmed this to be a destructive lesion. A subsequent pan CT scan showed a 2.8 cm complex nodule in the left lobe of the thyroid posteriorly. Excisional biopsy of the resected mass was associated with an infiltrative cellular parathyroid neoplasm with solid and nested architectural growth pattern admixed with hemorrhage and focal calcifications. The tumor showed lymphovascular and perineural invasion. At the time of workup and despite the absence of a positive SPEP/UPEP, a bone marrow biopsy was requested to rule out multiple myeloma. His normocellular bone marrow biopsy showed marked paratrabecular fibrosis and extensive bony remodelling but no metastatic invasion. The diagnosis of a metastatic parathyroid carcinoma was made. He is subsequently considered for palliative radiotherapy to the primary tumor bed and the lumbar spine. In addition, a role for immunotherapy with ipilimumab and nivolumab in context of clinical trials is envisioned and he is being considered for enrollment.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".