Extended Hormone Profiling Identifies a Wider Network of Duodenal Neuroendocrine Tumor Subtypes
Bibliographic record
Abstract
We studied transcription factors and hormones expressed by duodenal neuroendocrine cells in a consecutively diagnosed series of 53 patients with well-differentiated duodenal NETs. There were 30 men; the mean age was 65 years (33 to 81). The study included biopsies (n = 18), endoscopic mucosal resections (n = 19), and surgical resections (n = 16). Three patients had multifocal disease; two had MEN1. Two patients had neurofibromatosis. Metastases were identified in 15/23 patients with biopsied lymph nodes. PAX6 was expressed in 85%, followed by CDX2 in 65%; ARX was expressed in 33%, and no tumors expressed PAX4. The commonest hormone expressed was gastrin; 23 (43%) had diffuse expression, and 12 (23%) had focal reactivity. Pancreatic polypeptide was diffuse and strong in 17 tumors (32%) classified as PP cell NETs; another 3 tumors had focal staining (total n = 20, 38%). Serotonin was identified only focally in 14 tumors (26%). Somatostatin was positive in 13 tumors (25%), 3 classical D cell tumors and 10 tumors with focal positivity. PYY was expressed in 10 tumors (19%), diffusely in 1 and focally in 9. CCK was identified in 6 tumors (11%), diffusely in 1 and focally in 5. Staining for glucagon/GLPs, insulin, and motilin was completely negative in all tumors. Thirty tumors (57%) expressed more than one hormone; gastrin was the most frequent. In 2 composite gangliocytoma/NETs (CoGNETs), the NET component expressed PP, and both NET and ganglion cells expressed ARX. These data identify a broad spectrum of duodenal NETs including novel cell types and a high incidence of plurihormonality.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".