Obliterated Appendiceal Orifice with Sessile Serrated Lesion
Bibliographic record
Abstract
A 68-year-old female presented for surveillance colonoscopy. Her last colonoscopy was 5 years prior, during which two subcentimeter sessile serrated lesions (SSLs) were removed. During the current procedure, a polyp involving the appendiceal orifice was identified. This lesion measured approximately 1 cm, with an asymmetric shape and clouded surface. It was categorized as a Paris IIa and JNET 1 lesion consistent with SSL (fig. 1a–d). Interestingly, the appendiceal orifice appeared completely obliterated (fig. 1d). (a) White light exam. (b) Linked colour imaging exam. (c) Blue light imaging demonstrating JNET 1. (d) Obliterated appendiceal orifice. (e) Hematoxylin phloxine saffron stain: cross-section of appendix demonstrating fibrous obliteration. (f) Hematoxylin phloxine saffron stain: sessile serrated adenoma within the appendiceal lumen. Due to the uncertainty of ensuring clear deep margins, the patient underwent a laparoscopic appendectomy and cecectomy, which was successfully completed on an outpatient basis without complication. Final pathology indicated a completely excised non-dysplastic SSL (fig. 1f). Notably, on histologic examination, the appendiceal orifice was completely obliterated by fibrous tissue (fig. 1e). Although less common, polyps involving the appendiceal orifice have been previously described. However, this SSL involving the appendiceal orifice, which was also completely obliterated, is an exceptionally rare finding that, to the best of our knowledge, has not been described in the literature. Careful visualization of the appendiceal orifice on colonoscopy may lead to improved detection of appendiceal lesions, however, the significance of these lesions with regards to their malignant potential is uncertain. In a cohort of patients with serrated polyposis syndrome having undergone appendectomy, van Toledo et al. reported a 41.2 percent prevalence of appendiceal lesions with only 7.1 percent having been detected on previous colonoscopy.1 There was no funding associated with this manuscript. Robert Bechara is a consultant for Medtronic, Olympus, Pentax, Vantage, and Pendopharm. There are no data associated with this manuscript.
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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 | 0.002 |
| 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 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".