Images – Atypical presentation of pearly penile papules
Bibliographic record
Abstract
Case presentationA male in his early 30s presented for evaluation of papules on the ventral penis that had been present since adolescence.He noted that since being discovered, the papules have caused significant psychosocial distress.He was sexually active with one female partner and was concerned about transmitting the lesions to his partner.He was previously seen by his primary care physician and diagnosed with genital warts and was treated with topical podophyllin which he had used for several months prior to his referral.The podophyllin use precipitated significant irritation and ulceration of the lesions without overall improvement.Physical examination revealed a 4mm pink to white papule on the ventral aspect of the left glans penis, and a 1mm skin colored papule overlying the medial portion of corona on the contralateral side (Figure 1).He was circumcised and two additional minute white papules were noted on the corona.Shave biopsies of the ventral papules were performed both for diagnostic and therapeutic purposes (Figures 234).Scanning magnification of the larger pink papule revealed a projectileshaped architecture with acanthosis and hyperkeratosis.The dermis featured an increase in small caliber vessels with perivascular fibroplasia and increased dermal fibroblastic cells with spindled to triangular shaped nuclei.The smaller papule displayed similar histologic features.There was no evidence of koilocytic changes or dysplasia to suggest human papillomavirus-mediated warts or Bowenoid papulosis which usually present as pink to skin-colored papules on the shaft of the penis.Features of molluscum contagiosum, such as molluscum (Henderson-Patterson) bodies, were not seen.Clinically, the lesions also lacked creamy white cores and umbilications and did not undergo spontaneous resolution.The patient was diagnosed with pearly penile papules (PPP) and reassurance of the benign and non-contagious nature was provided to the patient.Angiofibromas are common, benign fibroblastic proliferations that take on several clinical forms.They are a common feature of tuberous sclerosis and may appear as multiple
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.014 | 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".