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In developing countries, breast cancer is diagnosed at a much younger age. In this study we investigate the dichotomies between older and young breast cancer patients in our region. The study involved two cohorts; older patients (≥ 65 years, n = 553) and younger ones (≤ 40 years, n = 417). Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Compared to younger patients, older patients were more likely to present with advanced-stage disease (20.6% vs. 15.1%, p  = .028). However, among those with non-metastatic disease, younger patients tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p  < .001), T-3/4 (28.2% vs. 13.8%, p  < .001) and HER2-positive disease (29.3% vs. 16.3%, p  < .001). The 5-year overall survival (OS) rate was significantly better for the younger (72.1%) compared to the older (67.6%), p  = .035. However, no significant difference was observed in disease-free survival (DFS) between the two groups.In conclusion, younger patients with breast cancer present with worse clinical and pathological features, albeit a better OS rate. The difference in DFS between the two groups was not insignificant, suggesting that older women were more likely to die from non-cancer related causes.

Background: Pulmonary hypertension (PH) is a complex disorder associated with various underlying conditions, including cardiac and respiratory diseases. PH is classified into five groups based on etiology, disease mechanisms, hemodynamic data, and treatment options. Preliminary data suggest that sodium-glucose cotransport-2 inhibitors (SGLT2-I), known for their benefits in chronic kidney disease, heart failure, and type-2 diabetes mellitus, may have therapeutic implications in PH through their metabolic effects, which include reducing aerobic glycolysis, improving mitochondrial function, and enhancing fatty acid oxidation. Objective: This study aimed to evaluate the clinical effects of SGLT2-I in PH by analyzing a large multicenter database of medical records from the TriNetX Network. Design: The cohort included adult patients with PH diagnosed between January 1, 2012, and January 1, 2023, classified by PH group and treatment with SGLT2-I. Propensity score matching (PSM) was used to balance baseline characteristics between the SGLT2-I and non-SGLT2-I groups. Methods: The primary endpoint was a composite of all-cause mortality, RHF, and hospital admissions over 365 days. Secondary endpoints included the individual components of the primary endpoint, intubations, RHF incidence, IV diuretic use, and NT-Pro-BNP levels. PSM was used to adjust for baseline differences between cohorts. Results: A total of 771,490 patients with PH were identified, with 58,303 treated with SGLT2-I. After PSM, each cohort of treated and untreated patients included 58,302 patients. Patients treated with SGLT inhibitors had a significant reduction in the primary composite endpoint (HR 0.71, 95% CI: 0.707–0.729). Secondary outcomes, including all-cause mortality, hospitalization, and the number of intubations, were also significantly lower in patients treated with SGLT-2 inhibitors. Beneficial effects of SGLT2-I were observed across all PH groups. Conclusion: This study demonstrates that SGLT2-I may be clinically beneficial in patients with PH by reducing all-cause mortality, RHF, and hospital admissions. Our findings support the role of SGLT2-I as a therapeutic option in PH and provide support for future randomized controlled trials using this treatment.

Malignancy, including testicular tumors, significantly increases the risk of venous thromboembolism (VTE). In this study, we search for predictors that may help identify subgroups of patients at higher risk of VTE. Patients with confirmed diagnosis of testicular germ cell tumor and proven VTE were identified. Clinical and pathological features possibly associated with VTE were reviewed. A total of 322 patients, median age (range) 31 (18-76) years were identified. Tumors were mostly non-seminoma (n = 194, 60.2%), node-positive (n = 130, 40.4%) and 58 (18.0%) had metastatic disease at diagnosis. Venous thromboembolism were confirmed in 27 (8.4%) patients; however, rates were significantly higher (P < 0.001) in patients with node-positive (18.5%), metastatic disease (22.4%), and those with high lactate dehydrogenase (LDH) (21.3%). Rates were also significantly higher among those who received multiple lines of chemotherapy (27.5%) compared to those who received one line (13.8%) or none (<1.0%), P < 0.001. Patients with testicular tumors and high tumor burden, including nodal involvement, high LDH or metastatic disease, and those treated with multiple lines of chemotherapy have significantly higher rates of VTE.

Background: Primary isolated extra-medullary plasmacytoma (EMP) is a rare entity that most commonly involves the nasopharynx or upper respiratory tract. Only 10% of cases involve the gastrointestinal tract, mainly the small intestine and the stomach. Involvement of the colon is extremely rare with less than 40 reported cases worldwide. Case Presentation: We report a case of a 57-year-old man who was presented with a 3-week history of fresh bleeding from the rectum. Colonoscopy showed a polypoidal mass arising from the ascending colon; biopsy showed clonal plasmacytosis and a primary colonic solitary EMP diagnosis was made after exclusion of multiple myeloma (MM). Accordingly, the patient underwent a right hemicolectomy, followed by 6 cycles of bortezomib, cyclophosphamide, and dexamethasone (VCD). The patient continued to be disease-free 30 months after the completion of his chemotherapy. Conclusion: To our knowledge, this is the first reported case of primary colonic plasmacytoma managed with surgical resection followed by an adjuvant bortezomib-based regimen with a durable response. Keywords: primary plasmacytoma, plasmacyte dyscrasia, myeloma, colon, bortezomib

Background Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths worldwide. Between 5% and 10% of PDACs are attributable to inherited genetic alterations, identification of which may enhance targeted screening and inform treatment decisions. Data on germline variants among Arab patients with PDAC are lacking. Methods This prospective study included adult patients with PDAC treated at King Hussein Cancer Center in Amman, Jordan. Patients underwent multigene panel (MGP) testing using either standard or investigational panels. Cascade family testing was offered to relatives of patients with positive results. Germline testing results were classified as benign (negative), pathogenic/likely pathogenic (P/LP) (positive) or variants of uncertain significance (VUS). Results A total of 211 patients, all of whom had PDAC as their first cancer diagnosis upon enrollment, were included in the analysis. The median age at diagnosis was 59 years, and 63.0% were males. In total, 22 (10.4%) patients had positive mutations; 14 (6.6%) as pathogenic/likely pathogenic (P/LP) variants, mostly in BRCA2 ( n  = 8), while 8 others (3.8%) had increased risk allele in APC . Other variants identified included ATM , CFTR , CHEK2 , BRCA1 , and MSH6 . Half ( n  = 11, 50.0%) of patients with P/LP variants or APC increased risk allele communicated results with their relatives; 18 (69.2%) of 26 relatives tested had positive results. Conclusions Our study underscores the relevance of PDAC germline genetic testing among the Arab population. Given its clinical implications for screening and management, universal testing should be advocated. Communicating test results with at-risk relatives, despite its importance, remains suboptimal and warrants further investigation.