White Globe Appearance in Autoimmune Atrophic Gastritis
Bibliographic record
Abstract
An 84-year-old female with iron-deficiency anemia underwent upper endoscopy, which revealed diffuse loss of gastric folds and marked vascular appearance (Fig. 1a). Using magnifying Blue-light imaging (M-BLI), the body of the stomach exhibited a groove/tubular pattern consistent with atrophy (Fig. 1b).1,2 Additionally, a small white lesion with a globular shape was noted in the atrophic gastric body (Fig. 1b and 1c). The remainder of the upper endoscopy was unremarkable. The diagnosis of AIG was confirmed through histology and immunology, which showed atrophic gastritis and neuroendocrine hyperplasia (Fig. 1d), and positive anti-parietal cell antibodies, respectively. Histology of the white lesion demonstrated a microcyst containing necrotic and proteinaceous debris. This was consistent with what has been termed White Globe appearance (WGA) has been demonstrated to be associated with gastric cancer.3 Atrophic gastritis with WGA, (a) Atrophic Gastric Body with loss of gastric folds and marked vascular visibility, (b) Blue light imaging of gastric body with WGA low magnification, (c) Blue light imaging of WGA high magnification, (d) 100× Hematoxylin phloxine saffron (HPS) stain Atrophic Gastritis with intestinal metaplasia and neuroendocrine hyperplasia, (e) HPS stain of microcyst with intraglandular necrotic and proteinaceous debris, (f) Higher magnification HPS stain of microcyst with intraglandular necrotic and proteinaceous debris. AIG is associated with anemia and is known to increase the risk of gastric cancer. Its recognition relies on the identification of gross findings such as loss of gastric folds, as well as magnifying findings such as oval/slit, tubular, and foveolar patterns.4 The finding of WGA in association with AIG has not been previously described in North American literature. Nonetheless, there have been two case reports in Japanese literature. The exact significance of WGA in the context of AIG at this time is unknown. It is speculative that in the context of its association with early gastric cancer, patients with AIG and WGA may perhaps be at an even higher risk of gastric cancer. However, a large series with long-term follow-up would be required to substantiate such speculation. K. K., C. Y., T. W. Conception, design, interpretation of findings, and co-writing. R. B.: Endoscopic procedure, data acquisition, analysis, interpretation, co-writing, and critical revision. All authors approved the final manuscript. Funding None declared. Conflicts of interest R. B. receives consulting fees and honoraria payments from Olympus, Pentax, Pendopharm, Vantage Endoscopy. None of the other authors declare any relevant conflicts. None declared. The data underlying this article will be shared on reasonable request to the corresponding author.
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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 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".