{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T11:08:54Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 19.5, "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: 01a0954c-ff82-7903-8c8a-5b2cfc0cbdbd\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: malignant Sertoli-Leydig cell tumor\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 thing", "usd": 0.0, "recall": true }, "codex": { "seconds": 87.9, "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: 01a0954c-ff7b-7f60-87f0-24a0e13d5ae3\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: malignant Sertoli-Leydig cell tumor\nRegistry id: vr.tr.malignant-sertoli-leydig-cell-tumor\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none r" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:41:26+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation" ] }, "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-Q586009", "registryId": "vr.tr.malignant-sertoli-leydig-cell-tumor", "name": "malignant Sertoli-Leydig cell tumor", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q586009/", "model": { "registry_id": "vr.tr.malignant-sertoli-leydig-cell-tumor", "name": "malignant Sertoli-Leydig cell tumor", "purpose": "Enable an agent to recognize a documented malignant Sertoli-Leydig cell tumor, assess its disease state and evidential uncertainty, and support specialist decisions about investigation, treatment and surveillance.", "definition": "A malignant Sertoli-Leydig cell tumor is a sex cord-stromal neoplasm, usually arising in the ovary, that shows Sertoli-cell and Leydig-cell differentiation and has malignant biological potential or demonstrated invasive or metastatic behavior.", "scope_statement": "This model owns the malignant disease entity registered as vr.tr.malignant-sertoli-leydig-cell-tumor, including diagnostic justification, tumor composition, extent, endocrine activity, molecular associations and disease course; ovarian disease is the working anatomical scope pending clarification of the undefined registry entry.", "in_scope": [ "Evidence establishing Sertoli-Leydig differentiation and the basis for classifying the tumor as malignant", "Histological differentiation, retiform architecture and separately characterized heterologous components", "Primary site, surgical staging, rupture, dissemination and residual disease", "Tumor-associated androgen production and individually informative circulating markers", "Tumor and constitutional DICER1 findings relevant to this disease", "Specialist management decisions, treatment response and recurrence assessment" ], "out_of_scope": [ "Benign Sertoli-Leydig cell tumors and the full parent tumor family", "Pure Sertoli cell tumors, pure Leydig cell tumors and other ovarian neoplasms", "Non-neoplastic causes of androgen excess", "DICER1-related tumor predisposition as a complete inherited syndrome", "General ovarian anatomy, reproductive physiology and infertility care", "Detailed surgical techniques, chemotherapy prescribing and drug pharmacology" ], "distinguishing_features": [ "Require a pathology-supported Sertoli-Leydig diagnosis plus a separately documented malignant classification; the parent family includes both benign and malignant tumors. [NCI tumor definition](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/sertoli-leydig-cell-tumor)", "Assess the combined Sertoli, Leydig and stromal differentiation across sampled tissue; an isolated androgen-producing cell population does not establish this mixed tumor identity.", "Resolve retiform areas through integrated morphology and immunohistochemistry because they can resemble epithelial tumors; retiform architecture alone does not establish malignant behavior. [Retiform tumor series](https://pubmed.ncbi.nlm.nih.gov/12147087/)", "Identify heterologous tissue within the overall tumor architecture rather than automatically reclassifying the lesion as a separate epithelial, germ-cell or sarcomatous neoplasm. [Diagnostic pitfall case study](https://pmc.ncbi.nlm.nih.gov/articles/PMC6083536/)", "Treat virilization as supporting clinical context, not a required diagnostic test: confirmed retiform tumors have also presented without virilization. [Retiform tumor series](https://pubmed.ncbi.nlm.nih.gov/12147087/)" ], "characteristics": [ { "name": "Diagnostic and malignant-classification status", "kind": "state", "unit_or_values": "Suspected, provisional, specialist-confirmed or disputed; classification authority, edition and stated malignant criteria", "why_it_matters": "Prevents a possible diagnosis or generic malignant potential from becoming an unsupported malignant case." }, { "name": "Primary anatomical site", "kind": "relation", "unit_or_values": "Organ, laterality and evidence of primary origin; unresolved site explicitly recorded", "why_it_matters": "Determines whether ovarian staging and evidence are applicable." }, { "name": "Histological differentiation", "kind": "category", "unit_or_values": "Well, intermediate, poorly differentiated or unassessable, retaining the original report terminology", "why_it_matters": "Supports pathology interpretation and risk assessment without conflating differentiation with stage." }, { "name": "Retiform and heterologous composition", "kind": "category", "unit_or_values": "Retiform pattern present, absent or unassessed; heterologous tissue type, extent and component-specific benign or malignant interpretation", "why_it_matters": "Preserves diagnostically confusing components and distinctions relevant to specialist review." }, { "name": "Tumor dimensions", "kind": "measurement", "unit_or_values": "Three dimensions in cm, with specimen or imaging method and date", "why_it_matters": "Allows comparison of the primary lesion and later measurable disease." }, { "name": "Anatomical extent", "kind": "state", "unit_or_values": "FIGO stage and edition for ovarian disease, with site-level evidence and staging completeness", "why_it_matters": "Separates documented confinement from apparent confinement caused by incomplete assessment." }, { "name": "Capsule and rupture status", "kind": "category", "unit_or_values": "Intact, preoperative rupture, intraoperative spill or unknown; surface involvement and washings recorded separately", "why_it_matters": "Preserves distinctions needed to interpret early ovarian stage." }, { "name": "Endocrine and marker activity", "kind": "measurement", "unit_or_values": "Testosterone in nmol/L or ng/dL; other measured markers in reported units, with assay ranges and dates", "why_it_matters": "Establishes whether a circulating measurement is informative for this particular tumor." }, { "name": "DICER1 testing context", "kind": "category", "unit_or_values": "Tumor or constitutional specimen; variant, laboratory classification, assay coverage, date and untested status", "why_it_matters": "Distinguishes tumor biology from evidence of inherited predisposition." }, { "name": "Post-treatment disease state", "kind": "state", "unit_or_values": "No evidence of disease, residual disease, response, stable disease, progression, recurrence or indeterminate, with assessment date", "why_it_matters": "Supports longitudinal decisions without equating a normal hormone result with disease clearance." } ], "affordances": [ "Assemble a specialist pathology review packet showing the evidence for both tumor lineage and malignant classification", "Identify missing sampling, staging or rupture documentation that limits disease assessment", "Compare hormone and imaging trajectories against the tumor's documented baseline phenotype", "Prepare a multidisciplinary decision summary linking stage, histology, residual disease and reproductive priorities", "Flag unresolved constitutional DICER1 assessment for genetics review", "Compare new lesions with the original tumor to support assessment of recurrence, metastasis or another primary" ], "agent_conduct": { "may": [ "Explain the tumour in general terms from reputable medical sources.", "Direct a person with signs such as new body hair growth or pelvic pain to a qualified clinician." ], "must_not": [ "Diagnose or stage the tumour for a specific person.", "Recommend or advise against surgery or chemotherapy for a person.", "Disclose a person's diagnosis, fertility status or genetic results without consent.", "Comment on changes in a patient's appearance in a demeaning way." ], "requires_human": [ "Any treatment, fertility or surgical decision." ] }, "ethics": { "considerations": [ "Masculinising effects of the tumour can be distressing; dignity matters.", "Young patients face hard choices between treatment and fertility." ], "affected_parties": [ "Patients, often young women", "Families", "Relatives with inherited risk" ] }, "owners": { "steward": "Nobody owns the disease; patients and their clinicians answer for care.", "master_systems": [ "Cancer registries" ] }, "failure_modes_and_hazards": [ "Hormone excess can cause virilisation and other effects.", "Some cases are linked to inherited DICER1 variants that affect relatives." ], "standards_and_regulation": [ "WHO Classification of Tumours, Female Genital Tumours, International Agency for Research on Cancer." ], "what_it_is_for": [ "This diagnosis is encountered in specialist gynaecological oncology and pathology when evaluating a rare tumour with Sertoli-cell and Leydig-cell differentiation.", "It is used in clinical records and multidisciplinary review to organise evidence about tumour classification, extent and behaviour.", "Documented findings support specialist treatment planning and surveillance while preserving uncertainty about an individual tumour's course." ], "facets_not_applicable": { "recognition": "This disease cannot be reliably identified by outward appearance and requires specialist assessment of clinical and pathological evidence." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q586009: malignant Sertoli-Leydig cell tumor", "url": "https://www.wikidata.org/wiki/Q586009", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Sertoli–Leydig cell tumour", "url": "https://en.wikipedia.org/wiki/Sertoli%E2%80%93Leydig_cell_tumour", "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 makes this lesion a malignant member of the Sertoli-Leydig tumor family.", "rationale": "The absent registry definition requires explicit separation of lineage, classification and observed behavior.", "layers": [ { "id": "sertoli-leydig-lineage", "name": "Sertoli-Leydig lineage", "description": "Record the integrated tissue evidence and competing diagnoses.", "findings": [ { "id": "integrated-lineage-evidence", "name": "Integrated lineage evidence", "description": "Retain the morphology, ancillary results and specialist interpretation supporting the mixed tumor identity.", "questions": [ { "text": "Which sampled areas demonstrate Sertoli differentiation, Leydig differentiation and associated stroma?", "kind": "definition", "id": "integrated-lineage-evidence-q01" }, { "text": "Which competing diagnosis remains plausible, and what morphology or ancillary result discriminates it?", "kind": "boundary", "id": "integrated-lineage-evidence-q02" }, { "text": "Which specimen and reviewing pathologist support the final integrated diagnosis?", "kind": "provenance", "id": "integrated-lineage-evidence-q03" } ] } ] }, { "id": "malignant-designation", "name": "Malignant designation", "description": "Separate the assigned malignant category from risk indicators and subsequently observed behavior.", "findings": [ { "id": "basis-of-malignancy", "name": "Basis of malignancy", "description": "Record the exact justification for the malignant label without requiring metastasis or treating every adverse feature as sufficient.", "questions": [ { "text": "Which classification edition and diagnostic criteria justify calling this Sertoli-Leydig tumor malignant?", "kind": "definition", "id": "basis-of-malignancy-q01" }, { "text": "Does the record establish malignancy, describe malignant potential only, or leave behavior uncertain?", "kind": "boundary", "id": "basis-of-malignancy-q02" }, { "text": "What specialist review is needed if the behavior code and pathology narrative disagree?", "kind": "action", "id": "basis-of-malignancy-q03" } ] } ] } ] }, { "id": "histological-composition", "name": "Histological composition", "description": "Describe differentiation and variant components while preserving sampling limitations.", "rationale": "A heterogeneous Sertoli-Leydig tumor can be misidentified or incompletely characterized from a limited sample.", "layers": [ { "id": "differentiation-and-sampling", "name": "Differentiation and sampling", "description": "Connect the reported differentiation to the tissue actually examined.", "findings": [ { "id": "representative-differentiation", "name": "Representative differentiation", "description": "Document the differentiation assessment, variation across the tumor and adequacy of representation.", "questions": [ { "text": "What differentiation category was assigned, and which architectural and cytological observations support it?", "kind": "definition", "id": "representative-differentiation-q01" }, { "text": "Were morphologically distinct solid, cystic and suspicious areas sampled sufficiently to support that assessment?", "kind": "provenance", "id": "representative-differentiation-q02" } ] } ] }, { "id": "retiform-and-heterologous-elements", "name": "Retiform and heterologous elements", "description": "Preserve architectural variants and the identity of additional tissue components.", "findings": [ { "id": "component-specific-interpretation", "name": "Component-specific interpretation", "description": "Record retiform architecture separately from heterologous epithelial or mesenchymal tissue and its interpreted behavior.", "questions": [ { "text": "Which retiform and heterologous components are present, and what proportion or distribution was reported?", "kind": "measurement", "id": "component-specific-interpretation-q01" }, { "text": "Which heterologous components are interpreted as benign or malignant, and what supports each interpretation?", "kind": "boundary", "id": "component-specific-interpretation-q02" }, { "text": "Could an overrepresented component have obscured Sertoli-Leydig differentiation in the original specimen?", "kind": "boundary", "id": "component-specific-interpretation-q03" } ] } ] } ] }, { "id": "extent-and-endocrine-phenotype", "name": "Extent and endocrine phenotype", "description": "Represent the tumor's anatomical burden and functional manifestations as separate dimensions.", "rationale": "Stage and hormone production answer different questions about the same tumor.", "layers": [ { "id": "ovarian-extent", "name": "Ovarian extent", "description": "Reconstruct stage from operative, imaging and pathological evidence.", "findings": [ { "id": "stage-and-rupture-evidence", "name": "Stage and rupture evidence", "description": "Preserve primary site, extraovarian findings, capsule status and the completeness of staging.", "questions": [ { "text": "Which findings establish the ovarian primary, laterality and any pelvic, peritoneal, nodal or distant involvement?", "kind": "measurement", "id": "stage-and-rupture-evidence-q01" }, { "text": "Was rupture preoperative or intraoperative, and were surface involvement and washings assessed?", "kind": "provenance", "id": "stage-and-rupture-evidence-q02" }, { "text": "Which FIGO stage is supported, and which missing observations prevent a firmer assignment?", "kind": "boundary", "id": "stage-and-rupture-evidence-q03" } ] } ] }, { "id": "functional-presentation", "name": "Functional presentation", "description": "Relate endocrine symptoms and circulating measurements to this tumor episode.", "findings": [ { "id": "individual-secretory-phenotype", "name": "Individual secretory phenotype", "description": "Record symptoms, hormone measurements and their timing without presuming that every tumor is clinically androgenic.", "questions": [ { "text": "What virilization, menstrual changes, pain or mass-related symptoms occurred, and when did they begin?", "kind": "measurement", "id": "individual-secretory-phenotype-q01" }, { "text": "Which hormones or markers were abnormal before treatment, using which assays and reference intervals?", "kind": "measurement", "id": "individual-secretory-phenotype-q02" }, { "text": "What evidence distinguishes tumor-associated androgen excess from another endocrine cause?", "kind": "boundary", "id": "individual-secretory-phenotype-q03" } ] } ] } ] }, { "id": "dicer1-context", "name": "DICER1 context", "description": "Connect molecular findings to the tumor and to appropriate evaluation of constitutional predisposition.", "rationale": "Sertoli-Leydig tumors are associated with DICER1, but tumor testing and constitutional testing answer different questions. [NCI DICER1 overview](https://ppb.cancer.gov/dicer1.html)", "layers": [ { "id": "tumor-molecular-evidence", "name": "Tumor molecular evidence", "description": "Record what was tested in tumor tissue and how it was interpreted.", "findings": [ { "id": "tumor-variant-interpretation", "name": "Tumor variant interpretation", "description": "Preserve variant identity, laboratory interpretation and technical limitations without making a molecular result sufficient for diagnosis.", "questions": [ { "text": "Which DICER1 variants were detected in which tumor specimen, with what assay coverage and laboratory classification?", "kind": "provenance", "id": "tumor-variant-interpretation-q01" }, { "text": "Does the molecular result support the integrated diagnosis, conflict with it or remain uninformative?", "kind": "boundary", "id": "tumor-variant-interpretation-q02" } ] } ] }, { "id": "constitutional-assessment", "name": "Constitutional assessment", "description": "Link the tumor episode to genetics evaluation while leaving syndrome management to its own model.", "findings": [ { "id": "predisposition-evidence-and-referral", "name": "Predisposition evidence and referral", "description": "Distinguish documented constitutional findings from tumor-only results, family history and unresolved testing.", "questions": [ { "text": "Has constitutional DICER1 testing been performed, and what specimen, result and interpretive limitations were reported?", "kind": "provenance", "id": "predisposition-evidence-and-referral-q01" }, { "text": "What genetics review or additional evaluation is indicated under the applicable specialist guidance?", "kind": "action", "id": "predisposition-evidence-and-referral-q02" }, { "text": "Which findings belong to this tumor episode and which should link to a separate predisposition-syndrome record?", "kind": "boundary", "id": "predisposition-evidence-and-referral-q03" } ] } ] } ] }, { "id": "management-and-disease-course", "name": "Management and disease course", "description": "Connect specialist decisions and follow-up observations to the tumor's documented characteristics.", "rationale": "The model must support reviewable decisions while retaining the limitations of evidence for this rare malignancy.", "layers": [ { "id": "treatment-decision-context", "name": "Treatment decision context", "description": "Capture why a particular surgical, systemic or observation strategy was selected.", "findings": [ { "id": "individualized-management-rationale", "name": "Individualized management rationale", "description": "Record stage, histology, residual disease, fertility priorities and the evidence used by the treating team; pediatric guidance requires explicit assessment before application to adults. [NCI childhood ovarian treatment guidance](https://www.cancer.gov/types/ovarian/hp/child-ovarian-treatment-pdq)", "questions": [ { "text": "What operation was performed, what reproductive structures remain, and what macroscopic or microscopic disease remains?", "kind": "measurement", "id": "individualized-management-rationale-q01" }, { "text": "How did stage, differentiation and any malignant heterologous component inform the specialist treatment decision?", "kind": "action", "id": "individualized-management-rationale-q02" }, { "text": "Which guideline or study supports the selected approach for this patient's age and tumor subtype?", "kind": "provenance", "id": "individualized-management-rationale-q03" } ] } ] }, { "id": "response-and-new-lesions", "name": "Response and new lesions", "description": "Track disease state and investigate possible relapse using evidence appropriate to the original tumor.", "findings": [ { "id": "longitudinal-disease-attribution", "name": "Longitudinal disease attribution", "description": "Link serial imaging, pathology and informative markers to dated disease assessments; retain uncertainty when a new lesion could represent recurrence or another primary.", "questions": [ { "text": "Which clinical, imaging and individually informative marker findings support the current disease state?", "kind": "measurement", "id": "longitudinal-disease-attribution-q01" }, { "text": "What comparison with the original pathology and molecular findings supports calling a new lesion recurrent Sertoli-Leydig tumor?", "kind": "boundary", "id": "longitudinal-disease-attribution-q02" }, { "text": "What specialist surveillance plan and escalation triggers were agreed, including follow-up when baseline hormones were normal?", "kind": "action", "id": "longitudinal-disease-attribution-q03" } ] } ] } ] }, { "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 a recall-based description; no sources were consulted.", "Confirm the registry's intended anatomic scope, because Sertoli-Leydig cell tumor predominantly denotes an ovarian tumor.", "Verify the exact coding and criteria for malignant designation against the applicable classification edition; differentiation, architecture and heterologous elements are overlapping descriptors rather than mutually exclusive kinds." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of malignant Sertoli-Leydig cell tumor 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": [ "Intermediately differentiated tumors with malignant behavior", "Poorly differentiated tumors", "Tumors with retiform architecture", "Tumors with heterologous elements" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of malignant Sertoli-Leydig cell tumor 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": "International Classification of Diseases for Oncology (ICD-O)", "value_or_pattern": "Four-digit morphology code followed by a behavior suffix; /3 denotes malignant behavior", "note": "The precise morphology code depends on the documented histologic subtype and classification edition." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of malignant Sertoli-Leydig cell tumor 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": [ "WHO Classification of Female Genital Tumours, published by the International Agency for Research on Cancer, provides histopathologic classification.", "International Federation of Gynecology and Obstetrics (FIGO) ovarian cancer staging describes anatomic disease extent." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of malignant Sertoli-Leydig cell tumor 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": [ "Histopathologic diagnosis and distinction from other ovarian sex cord-stromal tumors.", "Investigation of an ovarian mass associated with androgen excess or virilization.", "Assessment of stage and histologic features to inform treatment and surveillance.", "Evaluation for DICER1-associated tumor predisposition in an appropriate clinical and genetic context." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of malignant Sertoli-Leydig cell tumor 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": [ "Local recurrence or metastatic spread.", "Androgen secretion causing virilization; absence of hormonal symptoms does not exclude the tumor.", "Diagnostic confusion with other sex cord-stromal tumors or epithelial ovarian malignancies.", "Limited tissue sampling missing poorly differentiated areas or heterologous elements.", "Assuming that a tumor DICER1 alteration necessarily establishes an inherited predisposition." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of malignant Sertoli-Leydig cell tumor 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": "Sertoli-Leydig cell tumor", "difference": "The broader category includes tumors with differing malignant potential; the registered thing specifically denotes malignant disease." }, { "name": "Sertoli cell tumor", "difference": "Lacks the characteristic combined Sertoli-cell and Leydig-cell differentiation." }, { "name": "Leydig cell tumor", "difference": "Shows Leydig-cell differentiation without the characteristic Sertoli-cell component." }, { "name": "Adult granulosa cell tumor", "difference": "Shows granulosa-cell differentiation; characteristic morphology and molecular findings help distinguish it from Sertoli-Leydig cell tumor." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of malignant Sertoli-Leydig cell tumor this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which authoritative definition and behavior-classification edition should delimit this registry entry, particularly for intermediate differentiation and uncertain malignant potential?", "Does the undefined registry entry intentionally include non-ovarian tumors, and which classifications and staging systems would apply to those instances?", "How much independent prognostic information do retiform architecture and each heterologous component add after accounting for stage, differentiation and rupture?", "Which patients benefit from adjuvant systemic treatment, and how should uncertainty from rare-tumor observational evidence be represented?", "What surveillance duration, modalities and marker strategy best detect recurrence or a metachronous primary across age groups, secretory phenotypes and constitutional DICER1 states?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 17, "questions": 35 } }