A RARE COLON CANCER Presentation: MEDULLARY CARCINOMA (MC)
Bibliographic record
Abstract
All articles of this category (opens in new window) Colon cancer is the third most incident neoplasia in the world. A rare subtype of this disease is the medullary carcinoma (MC), consisting of only 0,03% of all colon carcinomas. This subtype was added to the WHO databases in 2004, making it particularly new. MC is more common in white populations being particularly rare in populations of African origins. MC has a 2,12:1 female-male ratio. The average age of diagnosis is 64 y.o for males and 72 y.o for females. MC can be divided in two subgroups: Undifferentiated Medullary Carcinoma (UMC) and Poorly differentiated Medullary Carcinoma (PDMC) with an incidence of 72% and 22% respectively. When compared to colon adenocarcinoma, MC has a better prognosis due to rarely occurring distant and regional metastasis. The tumor growth is mainly non-glandular, solid, with intraepithelial lymphocytic infiltration and uniformly distributed malignant cell layers. The prognosis is based on microsatellite unstability, due to p53 loss and CDX2 activation, which is frequently present in MC. The 05-year-survival rate in MC is of 64,9%. The mass found at the time of the diagnosis was a stage T2 or T3, clinical staging IIA, with no lymph node involvement. The diagnosis is confirmed by imaging exams, an increase in tumoral markers and a biopsy of the lesion. The clinical presentation is similar to other lower-GI tract tumors: abdominal pain, presence of blood in the stool and bowel obstruction. This case's patient is a 70 y.o, female patient with no history of alcohol or tobacco use. The patient was referenced due to an abdominal pain with the duration of 01 year and a palpable, moving mass found during physical examination of the LRQ of the abdomen. MRI results showed a heterogenous image at the ileocecal region with a 08cm diameter and augmentation of the surrounding lymphnodes (1,65cm). The patient underwent a ileocolectomy and a retroperitoneal lymphadenectomy. The final pathological staging was T4aN1M0. The patient showed a good post-op evolution. An adjuvant chemotherapy was prescribed (Folfox scheme). After 05 therapeutical cycles, the patient underwent a PET-CET that showed no signs of neoplasia. The patient showed a good clinical evolution, with no symptoms or signs of disease recurrence in 10-month period. Because MC is a rare entity without a defined treatment protocol, most patients solely undergo surgical treatment. Publication History Article published online: 23 October 2019 © 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil Bibliographical Record Tariane Friedrich Foiato, Bruno Rafael Kunz Bereza, Eduardo de Biasio Milano, Tauana Karoline Friedrich Foiato, Vitor Arce Cathcart Ferreira, Lucas Tanamati Wisnieski, Ana Carolina Sayuri Tanamati, Alessandra Parmegiani de Biasio, Mateus Oliveira Damasceno, Phillipe Geraldo Teixeira de Abreu Reis. A RARE COLON CANCER Presentation: MEDULLARY CARCINOMA (MC). Brazilian Journal of Oncology 2019; 15. DOI: 10.1055/s-0044-1797851
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 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".