Adenomyoma/adenomyomatosis-associated mural intracholecystic neoplasms: analysis of clinico-pathologic, imaging, and molecular features of a consecutive case series
Bibliographic record
Abstract
Adenomyoma/adenomyomatosis (AM) of the gallbladder is generally considered an incidental and innocuous finding; however, neoplastic lesions, including intracholecystic neoplasms (ICNs), flat-type dysplasia, and carcinomas, may arise within AM. AM-associated ICNs, composed of mural cystically dilated glands containing florid papillary proliferations lined by mucinous and/or overtly dysplastic epithelium, are very rare and poorly characterized. This study aimed at investigating the clinico-radiologic, phenotypic/immunophenotypic, and molecular features of a mono-institutional case series of four AM-ICNs (0.2% of cholecystectomies). Immunohistochemistry for CDX2, MUC2, MUC5AC, MUC6, MUC1, HER2, ß-catenin, and p53, as well as next-generation sequencing of 110 tumor-related genes (AmoyDx® Comprehensive Panel), were performed. Our study confirms the AM-ICN-associated clinico-demographic characteristics previously described, including the relatively low frequency of associated invasive carcinoma (one case, 25%), although high-grade dysplasia (HGD) was observed in three out of four cases. In two cases, imaging findings suspicious for neoplasm were seen. Segmental-type AM was seen in two cases. Predominantly cell phenotype was gastric foveolar in two AM-ICNs and pancreatobiliary in the other two cases (both with HGD), while the immunophenotype was hybrid/mixed in all cases. No case had nuclear ß-catenin expression nor Wnt pathway or KRAS gene alterations. One case showed both HER2 point mutation and HER2 amplification, while the AM-ICN associated with an invasive adenocarcinoma harbored TP53 mutation and p53 overexpression. In conclusion, our findings suggest the separation of AM-ICNs from other gallbladder dysplastic lesions.
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".