Primary Pancreatic Lymphoma: A Rare Cause of Massive Upper Gastrointestinal Hemorrhage
Bibliographic record
Abstract
1Department of Pathology and Laboratory Medicine; 2Department of Surgery; 3Department of Community Health Sciences; 4Department of Medicine, University of Calgary, Calgary, Alberta Correspondence: Dr Marc P Dupre, Department of Pathology and Laboratory Medicine, 3500 – 26th Avenue Northeast, Calgary, Alberta T1Y 6J4. Telephone 403-943-4036, fax 403-291-2931, e-mail mpdupre@gmail.com Received for publication May 27, 2011. Accepted May 29, 2011 Case Presentation A 68-year-old man presented with abdominal pain radiating to the back associated with a 25 kg weight loss. Abdominal ultrasound and computed tomography (CT) revealed an 8 cm partially cystic mass in the pancreatic head that encased the aorta and inferior vena cava (IVC) (Figure 1). A CT-guided fine-needle aspiration (FNA) was performed and confirmed a diagnosis of diffuse large B cell lymphoma. Subsequent staging CT demonstrated peripancreatic lymphadenopathy and air within the tumour, suggesting a possible communication between the intestine and the pancreatic mass. Direct visualization with gastroscopy confirmed a large penetrating ulcer between the second portion of the duodenum and the pancreatic tumour (Figure 2). Chemotherapy was delayed while pyloric exclusion surgery was performed to reduce the risk of chemotherapy-related uncontained perforation of the duodenum. The postoperative clinical course was complicated by a slowly declining hemoglobin level, followed by cardiopulmonary arrest in concert with a sudden drop in hemoglobin level to 50 g/L. An emergent upper endoscopy revealed copious amounts of blood within the stomach. The grave clinical deterioration precluded further resuscitative efforts, and the patient died from a massive upper gastrointestinal hemorrhage. A postmortem examination confirmed an 8 cm, extensively necrotic mass in the head of the pancreas. Significant peripancreatic lymphadenopathy was present; however, all nonregional lymph nodes were of normal size. The pancreatic head mass extended laterally and eroded into the adjacent duodenal wall producing the large mucosal erosion identified endoscopically. Posteriorly, the mass encased the aorta and the IVC, producing an irregular ulceration of the endolumenal surface of the IVC (Figure 3). This ulceration of the IVC resulted in a fistulous tract between the IVC and the duodenum via an intermediary of the pancreatic head mass. Histological examination revealed a poorly differentiated malignant neoplasm, which by immunohistochemical studies confirmed the original diagnosis of a diffuse large B cell lymphoma.
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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 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".