{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:58:58Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 21.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094d6-1a37-7632-9445-34c8f90bc9ff\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: cystic lymphangioma\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: ", "usd": 0.0, "recall": true }, "codex": { "seconds": 85.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094d6-1a29-7451-9bba-6147196eb424\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: cystic lymphangioma\nRegistry id: vr.tr.cystic-lymphangioma\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this " } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:46:50+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:31+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q459896", "registryId": "vr.tr.cystic-lymphangioma", "name": "cystic lymphangioma", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q459896/", "model": { "registry_id": "vr.tr.cystic-lymphangioma", "name": "cystic lymphangioma", "purpose": "Enable an agent to recognize a lesion recorded as cystic lymphangioma, characterize its extent and clinical state, and support evidence-based specialist assessment and follow-up.", "definition": "Cystic lymphangioma is a historical term for a benign lymphatic malformation composed of dilated, fluid-filled lymphatic spaces, usually corresponding to a macrocystic lymphatic malformation in modern vascular-anomaly terminology.", "scope_statement": "This model owns the lesion-level representation of vr.tr.cystic-lymphangioma within XCT / XCT.STA, provisionally interpreted as a cystic lymphatic malformation while preserving the original diagnostic terminology and uncertainty about its precise modern classification.", "in_scope": [ "Original diagnostic label, supporting evidence, and mapping to current lymphatic-malformation terminology", "Cyst architecture, anatomical extent, and relationships to vulnerable structures", "Symptoms, functional impairment, and acute complications attributable to the lesion", "Diagnostic uncertainty and distinctions from other cystic or vascular lesions", "Lesion-specific management decisions, response, residual disease, and recurrence" ], "out_of_scope": [ "The full classification of vascular anomalies and all lymphatic malformations", "Independent models of venous malformations, vascular tumors, and nonlymphatic cystic masses", "Whole-person management of associated overgrowth syndromes or complex lymphatic anomalies", "Prenatal chromosomal conditions and screening findings without an established corresponding lesion", "Detailed procedural protocols, medication dosing, and autonomous treatment prescribing" ], "distinguishing_features": [ "Determine whether the historical label denotes a lymphatic malformation rather than a vascular tumor; ISSVA treats lymphangioma as historical terminology for lymphatic malformation. [ISSVA glossary](https://www.issva.org/UserFiles/file/ISSVAGLOSSARY_UpdatedFullVersion_03152025_Submission_copyright.pdf)", "Document actual cyst architecture before assigning macrocystic, microcystic, or mixed morphology; the word cystic alone does not establish a subtype, and ISSVA does not define a universal precise dividing threshold. [ISSVA glossary](https://www.issva.org/UserFiles/file/ISSVAGLOSSARY_UpdatedFullVersion_03152025_Submission_copyright.pdf)", "Compare enhancement of septa and cyst contents when distinguishing a macrocystic lymphatic lesion from a venous malformation; preserve the interpreting clinician's conclusion rather than treating one imaging feature as definitive. [French national care protocol](https://pmc.ncbi.nlm.nih.gov/articles/PMC9837920/)", "Require a location-specific differential for a cystic mass; an unexplained solid component or discordant clinical course should remain an unresolved diagnostic finding.", "Distinguish a localized lesion from manifestations of a combined malformation or complex lymphatic disorder before extending this entry to systemic disease." ], "characteristics": [ { "name": "Diagnostic terminology and confidence", "kind": "category", "unit_or_values": "Original label; proposed current classification; suspected, supported, confirmed, or disputed; evidence basis", "why_it_matters": "Prevents historical terminology from being mistaken for a verified modern subtype." }, { "name": "Anatomical distribution", "kind": "relation", "unit_or_values": "Body site, laterality, tissue compartments, and continuity between involved regions", "why_it_matters": "Defines the lesion being followed and the specialties required to assess it." }, { "name": "Cyst architecture", "kind": "category", "unit_or_values": "Macrocystic, microcystic, mixed, or indeterminate; classification convention recorded", "why_it_matters": "Separates observed morphology from assumptions embedded in the diagnostic name." }, { "name": "Lesion and cyst dimensions", "kind": "measurement", "unit_or_values": "Lesion dimensions and representative cyst diameters in mm; volume in mL when measured; modality and date", "why_it_matters": "Supports reproducible assessment of growth and response without confusing whole-lesion size with cyst size." }, { "name": "Internal imaging characteristics", "kind": "category", "unit_or_values": "Septations, fluid characteristics, Doppler findings, enhancement distribution, and any solid component", "why_it_matters": "Supports differential diagnosis and identification of changes requiring reassessment." }, { "name": "Critical-structure involvement", "kind": "relation", "unit_or_values": "Displacement, compression, encasement, or uncertain relationship to airway, nerves, vessels, bowel, or other site-specific structures", "why_it_matters": "Connects lesion anatomy to functional risk and intervention constraints." }, { "name": "Current clinical activity", "kind": "state", "unit_or_values": "Stable, enlarging, acutely swollen, improving, or indeterminate; observation interval", "why_it_matters": "Distinguishes longitudinal behavior from an isolated examination." }, { "name": "Complication and functional burden", "kind": "state", "unit_or_values": "Pain, suspected infection, hemorrhage, leakage, and site-specific functional impairment; severity and attribution", "why_it_matters": "Supports prioritization by clinical consequences rather than size alone." }, { "name": "Management and response", "kind": "state", "unit_or_values": "Observation or documented intervention; symptom and imaging response; adverse effects; residual or recurrent lesion", "why_it_matters": "Preserves the rationale and outcome of each management episode." } ], "affordances": [ "Reconcile a historical diagnosis with current terminology while retaining the original report and uncertainty.", "Assemble a lesion map from imaging and clinical assessments, including vulnerable adjacent structures.", "Flag documented acute swelling or functional compromise for clinician review under an established escalation plan.", "Prepare a specialist review summary comparing observation and intervention against lesion-specific goals and constraints.", "Track symptoms and imaging over time, distinguishing residual disease, recurrence, and transient changes." ], "agent_conduct": { "may": [ "Describe lymphatic malformations and the historical term from medical sources.", "Point families to specialist vascular anomaly centres." ], "must_not": [ "Diagnose a lump in a child as a lymphatic malformation without a clinician.", "Advise draining or treating a swelling at home.", "Share images of a child's condition without the parents' consent.", "Use outdated terms in a way that confuses patients about their diagnosis." ], "requires_human": [ "Any decision about surgery or sclerotherapy." ] }, "ethics": { "considerations": [ "Visible malformations in children's faces and necks can bring stigma and staring.", "Families need clear information about a benign but sometimes serious condition." ], "affected_parties": [ "Children with malformations", "Parents and carers" ] }, "owners": { "steward": "Nobody owns the condition; the treating specialist answers for each patient's care.", "master_systems": [] }, "visual_identification": [ "A soft, painless swelling under the skin, often in the neck or armpit of a young child." ], "failure_modes_and_hazards": [ "Large malformations in the neck can press on the airway.", "Infection or bleeding into cysts can cause sudden swelling." ], "what_it_is_for": [ "Cystic lymphangioma appears in clinical records, imaging reports, and pathology descriptions of lymphatic malformations.", "The term is encountered particularly in pediatric care and vascular anomaly services when assessing lesion extent, symptoms, and effects on nearby structures.", "Modern documentation relates the historical label to the lesion's cyst pattern and current lymphatic malformation terminology." ], "standards_and_regulation": [ "The Classification of Vascular Anomalies, issued by the International Society for the Study of Vascular Anomalies, classifies lymphatic malformations and distinguishes macrocystic, microcystic, and mixed forms." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q459896: cystic lymphangioma", "url": "https://www.wikidata.org/wiki/Q459896", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Cystic hygroma", "url": "https://en.wikipedia.org/wiki/Cystic_hygroma", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "diagnostic-identity", "name": "Diagnostic identity", "description": "Establish what the label cystic lymphangioma means in this case and which evidence supports that interpretation.", "rationale": "The registry lacks a definition, and historical terminology can obscure the lesion's current classification.", "layers": [ { "id": "terminology-mapping", "name": "Terminology mapping", "description": "Preserve the original diagnosis alongside its proposed modern interpretation.", "findings": [ { "id": "historical-label-interpretation", "name": "Historical label interpretation", "description": "Record who used the label, its clinical context, and whether a specialist has mapped it to a specific lymphatic-malformation category.", "questions": [ { "text": "Which report first called the lesion cystic lymphangioma, and what evidence accompanied that label?", "kind": "provenance", "id": "historical-label-interpretation-q01" }, { "text": "Does the available evidence support a particular lymphatic-malformation subtype, or only an unspecified cystic lymphatic lesion?", "kind": "definition", "id": "historical-label-interpretation-q02" } ] } ] }, { "id": "diagnostic-support", "name": "Diagnostic support", "description": "Connect the interpretation to clinical, imaging, and any available pathological evidence.", "findings": [ { "id": "concordance-and-mimics", "name": "Concordance and mimics", "description": "Record the location-specific differential, evidence favoring lymphatic origin, and unresolved discrepancies without making tissue sampling a universal requirement.", "questions": [ { "text": "Which examination, imaging, or existing pathology findings support lymphatic origin?", "kind": "provenance", "id": "concordance-and-mimics-q01" }, { "text": "Which competing diagnosis remains plausible, and what discordant feature would require specialist reassessment?", "kind": "boundary", "id": "concordance-and-mimics-q02" } ] } ] } ] }, { "id": "cyst-architecture-and-extent", "name": "Cyst architecture and extent", "description": "Describe the cystic lesion as a spatial structure with measurable components.", "rationale": "Whole-lesion size alone cannot represent cyst morphology, tissue extension, or access constraints.", "layers": [ { "id": "cyst-morphology", "name": "Cyst morphology", "description": "Characterize individual cysts and their contribution to the overall lesion.", "findings": [ { "id": "cyst-pattern-and-measurement", "name": "Cyst pattern and measurement", "description": "Record representative cyst sizes, septations, contents, and the convention used to assign a morphology category.", "questions": [ { "text": "What are the measured cyst diameters and overall lesion dimensions, using which modality and date?", "kind": "measurement", "id": "cyst-pattern-and-measurement-q01" }, { "text": "Which observed features justify macrocystic, microcystic, mixed, or indeterminate classification?", "kind": "definition", "id": "cyst-pattern-and-measurement-q02" } ] } ] }, { "id": "anatomical-relationships", "name": "Anatomical relationships", "description": "Locate the lesion across tissue compartments and relative to structures that constrain management.", "findings": [ { "id": "extent-and-critical-interfaces", "name": "Extent and critical interfaces", "description": "Record mapped boundaries, uncertain extension, and compression or encasement of relevant structures.", "questions": [ { "text": "Which compartments are involved, and which lesion boundaries remain incompletely visualized?", "kind": "measurement", "id": "extent-and-critical-interfaces-q01" }, { "text": "Which relationships to airway, nerves, vessels, or abdominal organs alter functional risk or procedural access?", "kind": "action", "id": "extent-and-critical-interfaces-q02" } ] } ] } ] }, { "id": "clinical-state-and-complications", "name": "Clinical state and complications", "description": "Represent the lesion's current burden and distinguish baseline disease from acute change.", "rationale": "Management urgency depends on symptoms, functional effects, and the tempo of change.", "layers": [ { "id": "baseline-burden", "name": "Baseline burden", "description": "Establish the person's usual lesion-related symptoms and limitations.", "findings": [ { "id": "functional-impact", "name": "Functional impact", "description": "Record pain, visible or palpable burden, and effects on functions relevant to the anatomical site.", "questions": [ { "text": "How does the lesion affect breathing, swallowing, vision, movement, or abdominal function where relevant?", "kind": "measurement", "id": "functional-impact-q01" }, { "text": "Which symptoms are attributed to this lesion, and what evidence separates them from unrelated conditions?", "kind": "boundary", "id": "functional-impact-q02" } ] } ] }, { "id": "acute-change", "name": "Acute change", "description": "Capture new swelling and suspected complications as time-stamped episodes.", "findings": [ { "id": "swelling-episode-and-escalation", "name": "Swelling episode and escalation", "description": "Record the onset and associated findings of an acute episode, including uncertainty between hemorrhage, infection, inflammation, or another cause.", "questions": [ { "text": "When did swelling change, and what associated pain, fever, skin change, or imaging evidence was documented?", "kind": "measurement", "id": "swelling-episode-and-escalation-q01" }, { "text": "Does the episode meet the treating team's escalation criteria for airway compromise or another threatened function?", "kind": "action", "id": "swelling-episode-and-escalation-q02" } ] } ] } ] }, { "id": "presentation-and-associated-disease", "name": "Presentation and associated disease", "description": "Place the lesion in its developmental and wider clinical context without absorbing neighboring disease models.", "rationale": "Age at recognition and accompanying abnormalities affect interpretation, but neither proves lesion origin or systemic involvement.", "layers": [ { "id": "presentation-history", "name": "Presentation history", "description": "Separate first detection from inferred onset and document the circumstances of recognition.", "findings": [ { "id": "detection-versus-onset", "name": "Detection versus onset", "description": "Preserve prenatal, childhood, or adult detection history and the evidence supporting any claim about earlier existence.", "questions": [ { "text": "Was the lesion first identified prenatally, through symptoms, incidentally on imaging, or during surgery?", "kind": "provenance", "id": "detection-versus-onset-q01" }, { "text": "What evidence establishes onset rather than merely the date of first recognition?", "kind": "boundary", "id": "detection-versus-onset-q02" } ] } ] }, { "id": "associated-anomalies", "name": "Associated anomalies", "description": "Identify findings that may require links to combined vascular, overgrowth, or complex lymphatic models.", "findings": [ { "id": "isolated-or-associated-lesion", "name": "Isolated or associated lesion", "description": "Record accompanying abnormalities and specialist conclusions without inferring a syndrome or molecular cause from the lesion name.", "questions": [ { "text": "Are there additional vascular components, regional overgrowth, or distant lymphatic abnormalities that challenge an isolated-lesion interpretation?", "kind": "boundary", "id": "isolated-or-associated-lesion-q01" }, { "text": "If molecular testing was performed, what specimen and result support a lesion-specific or syndromic interpretation?", "kind": "provenance", "id": "isolated-or-associated-lesion-q02" } ] } ] } ] }, { "id": "management-and-longitudinal-outcome", "name": "Management and longitudinal outcome", "description": "Connect management choices to explicit goals and assess their consequences over time.", "rationale": "A lesion model must preserve why an action was chosen and whether it improved the outcomes that mattered.", "layers": [ { "id": "management-selection", "name": "Management selection", "description": "Capture the specialist's rationale for observation or an intervention.", "findings": [ { "id": "goal-and-option-fit", "name": "Goal and option fit", "description": "Record the intended benefit and how morphology, extent, symptoms, and adjacent structures affect options considered by the treating team.", "questions": [ { "text": "Is the immediate goal surveillance, symptom relief, protection of function, or reduction of lesion burden?", "kind": "action", "id": "goal-and-option-fit-q01" }, { "text": "What case-specific evidence supports observation, sclerotherapy, surgery, or specialist-directed medical treatment?", "kind": "action", "id": "goal-and-option-fit-q02" } ] } ] }, { "id": "response-and-surveillance", "name": "Response and surveillance", "description": "Compare follow-up against a documented baseline and distinguish different forms of persistent or returning disease.", "findings": [ { "id": "durable-benefit-and-residual-lesion", "name": "Durable benefit and residual lesion", "description": "Track functional and imaging outcomes separately, including adverse effects and whether a later finding represents residual disease, recurrence, or temporary swelling.", "questions": [ { "text": "What changed in symptoms, function, and measured lesion burden over a specified interval?", "kind": "measurement", "id": "durable-benefit-and-residual-lesion-q01" }, { "text": "What evidence distinguishes residual lesion from recurrence, and what finding triggers reassessment under the follow-up plan?", "kind": "action", "id": "durable-benefit-and-residual-lesion-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is recalled knowledge; no sources were consulted.", "Historical terminology is inconsistent, so cystic lymphangioma should not automatically be equated with an exclusively macrocystic lesion.", "Verify the applicable classification edition and local coding rules before using the identifier for clinical coding." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of cystic lymphangioma this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Cervical cystic lymphangioma, often called cystic hygroma", "Axillary cystic lymphangioma", "Mediastinal cystic lymphangioma", "Intra-abdominal cystic lymphangioma, including mesenteric and retroperitoneal lesions" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of cystic lymphangioma this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "D18.1", "note": "Lymphangioma, any site; this category is broader than cystic lymphangioma." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of cystic lymphangioma this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "The International Society for the Study of Vascular Anomalies (ISSVA) classification distinguishes lymphatic malformations from vascular tumors and recognizes macrocystic, microcystic, and mixed forms." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of cystic lymphangioma this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "A diagnostic term encountered in pathology reports, imaging reports, and older medical literature.", "Prenatal ultrasonography may identify cervical lesions described as cystic hygromas.", "Ultrasound and MRI characterize cystic spaces, anatomical extent, and relationships to adjacent structures." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of cystic lymphangioma this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Airway or swallowing compromise from lesions involving the neck or adjacent structures.", "Infection or inflammation causing pain and sudden enlargement.", "Bleeding into cystic spaces causing swelling and pain.", "Compression of adjacent organs or neurovascular structures.", "Persistence or recurrence after treatment, particularly when the malformation extends across tissue planes." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of cystic lymphangioma this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Lymphatic malformation", "difference": "The broader category includes microcystic and mixed lesions as well as the predominantly macrocystic lesions historically called cystic lymphangiomas." }, { "name": "Cystic hygroma", "difference": "An overlapping historical term, particularly for cervical macrocystic lymphatic malformations, rather than a consistently separate disease." }, { "name": "Hemangioma", "difference": "A vascular tumor with endothelial proliferation, whereas cystic lymphangioma represents malformed lymphatic channels." }, { "name": "Venous malformation", "difference": "Consists of malformed venous channels rather than predominantly lymphatic cystic spaces; combined lymphatic-venous malformations also occur." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of cystic lymphangioma this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does the registry intend cystic lymphangioma to mean predominantly macrocystic lymphatic malformation, or a broader historical category that includes mixed lesions?", "Does an existing Vercy world model already own this concept, requiring this registry entry to link to that publication?", "Which morphology convention should the model adopt while preserving comparability across reports that use different cyst-size thresholds?", "How should prenatal uses of cystic hygroma map to this entry without conflating distinct screening findings and established lesions?", "Which site- and age-specific outcome measures and follow-up criteria have sufficient evidence to standardize across instances?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 17, "questions": 27 } }