Annals of the College of Medicine Mosul

Background: Toxoplasmosis is a condition resulting from the protozoan parasite Toxoplasma Gondii, which can impact the health of humans and animals in various ways.
Aim: This study aimed to assess the seroprevalence of T. Gondii in females and to identify the risk factors associated with urban and rural areas within Duhok Province, Kurdistan region of Iraq.
Methods: In this study, 211 females of different ages attended medical laboratories in urban and rural areas of Duhok province from December 2023 to February 2024. Blood samples were used to detect specific anti-Toxoplasma gondii IgG and IgM antibodies using serological tests.
Results: In the current study, the total Seropositive toxoplasma antibodies IgG and IgM rate was 31.75% in urban and rural areas, with seropositivity of 3.79% in IgM and 27.96% in IgG. Urban seropositive of anti-Toxoplasma IgM and IgG was recorded in 1.58% and 23.01%, with rural seropositive of anti-Toxoplasma IgM and IgG in 7.05% and 35.29% respectively. Regarding the age groups, high seropositivity of IgM and IgG in urban areas was recorded in the age group of ≤ 20 years, whereas in rural areas, the high IgM and IgG seropositive were shown respectively in the age groups of 21-30 and 31-40 years.
Conclusion: Based on the study's findings, we can conclude that factors like stray cats, increased contact with contaminated soil, farming, caring for cattle or hens, dietary and culinary practices, and personal cleanliness are all responsible for the higher frequency of infection in rural areas.

Background: Reference ranges of thyroid-stimulating hormones are needed for diagnosing and monitoring children's thyroid disorders based on age and sex.
Aims: The main objective of this study is to establish thyroid-stimulating hormone reference ranges for healthy children below five years old in Nineveh province, Iraq, based on age and sex.
Methods: A cross-sectional study was conducted on one hundred sixty-six healthy children (84 males, 82 females, aged from 2 days to 5 years), and their blood samples were collected at Ibn Al-Atheer and AL-Khansaa Teaching Hospital at Nineveh, Iraq, from October 2023 - March 2024. They were divided into three groups: G1=0–1 months, G2= 1–12 months, and G3=1–5 years. Serum TSH was measured using the enzyme-linked fluorescent assay method (ELFA) by Biomerieux Mini Vidas.
Result: Because of the non-normally distributed data of TSH, reference values were determined using the 2.5% and 97.5 % percentiles. Highly significant difference (p<0.02) among mean TSH(µIU/ml) of G 1(5.57±7.86), G 2 (2.67±1.80) and G 3 (2.64±1.72) for males and highly significant difference (p<0.001) among mean TSH G 1(6.01±5.94), G 2 (2.18±1.82) and G 3 (2.91±1.71)for females.
Conclusions: Higher TSH values are encountered in the G1 with no sex difference of mean TSH, yet the 2.5th%-97.5th% percentile for males is evidently higher than that of females of similar age groups.

Background: Type 2 diabetes mellitus (T2DM) and pre-diabetes represent a major health problem around the world, and their incidence and prevalence rates are rising. Data about changes in their prevalence rates in Iraq over the last few decades is limited.
Objectives: To determine the prevalence rates of T2DM and pre-diabetes among the adult (≥ 25 years old) population in Mosul City, Northern Iraq, and to compare them to the previous figures revealed by the previous literature.
Methods: This is a cross-sectional study that involved the screening of (410) adult subjects of both sexes from 7 different urban and rural areas in Mosul, 4 from the Mosul district itself (Al-Qahiraa, Al-Tise’en, Tammuz, and Althawra Quarters) and two from some rural areas surrounding the city (Al-Hamdaniyah town, and Bejwanyah village). In addition, the last sample consisted of subjects accompanying in-patients in different hospitals in the city. The study was conducted over 4 months starting from the 1st of September through 31st December 2024. Two blood tests, glycated hemoglobin (HbA1c) and fasting serum glucose (FSG) were measured after 12-16 hours of fasting and their values were used to classify participants into three groups; normal blood sugar group, pre-diabetic group, and diabetic group based on ADA diagnostic criteria. Known cases of T2DM were also included in the calculations of the prevalence of pre-diabetes and diabetes. The study followed a strict systematic randomization approach and was ethically approved.
Results: The overall prevalence of T2DM among study participants was 11.46% (14.77% for males, and 9.58 for females), and of prediabetes was 18.78%, (16.77% for males, and 19.9% among females). The prevalence of T2DM has increased by about 1.11% compared to our previous report (10.35%) published in 2002 with a dramatic increase in the rate of pre-diabetes.
Conclusion: There has been an increase in the prevalence rate of T2DM and a dramatic increase in the prevalence rate of pre-diabetes in Mosul City over the last two decades, this increment may be partly explained by changes in lifestyle and modifications in ADA diagnostic criteria for prediabetes.

Background: Regional factors influence reproductive behavior worldwide, including political instability and social, economic, and cultural factors. Recently, Iraq has been subjected to a different mix of factors that affect its people's reproductive behavior.
Aim: To examine the reproductive behavior of the Iraqi community and the factors influencing it.
Methods: Data were collected through several methods, including a cross-sectional survey during the year 2023, a review of the birth registry database from the Nineveh Health Directorate, and the analysis of a statistical database available from the total fertility rate of Iraq 1925-2020.
Results: The findings indicate a significant shift in reproductive behavior among Iraqi people as there has been a decline in fertility rates in the last decade, followed by a slight increase in the previous 3 years. Political stability and the provision of health services significantly impact determining the number of children a family prefers. However, personal desire, war, displacement, increased living expenses, higher parental education, increased health awareness, and wife's employment could negatively influence family size (P < 0.001). Individuals aged 35–44 years who are employed, have a higher educational level, and live in urban areas typically have the lowest mean number of children, with a preference for having approximately 2–4 children per family.
Conclusion: Many modulating factors appeared to affect the reproductive behavior in the Iraqi community. Governmental planning and studies health departments should anticipate demographic shifts to mitigate potential adverse outcomes and capitalize on demographic opportunities.

Background: Maternal health problems significantly impact child development, influencing physical, cognitive, and emotional well-being. This study investigates the effect of maternal health issues on child health outcomes among children attending special education schools in Sulaimani City.
Methods: A descriptive, quantitative study was conducted among 100 mothers of children enrolled in two special education schools. Data were collected between October and December 2022 using a structured questionnaire covering socio-demographics, maternal health issues, and child health status. A purposive sampling technique was used to recruit participants. Ethical considerations, including informed consent and confidentiality, were strictly observed.
Results: The study identified significant associations between maternal health conditions, including chronic illnesses, mental health disorders, pregnancy-related complications, and adverse child health outcomes. Children of mothers with persistent health problems exhibited higher rates of developmental delays, behavioral issues, and frequent illnesses, necessitating specialized healthcare and educational interventions. Furthermore, maternal health service utilization and preventive care were associated with better child health outcomes, underscoring the importance of accessible maternal healthcare services.
Conclusion: Maternal health plays a critical role in shaping child health and developmental outcomes, particularly in special education settings. Strengthening maternal healthcare services, early interventions, and integrated maternal-child health programs could improve overall outcomes for both mothers and children.

Background: Thyroid hormones are essential for the function of the respiratory system. Hypothyroidism affects respiration by a decrease in lung compliance, muscle weakness, and a reduction in ventilatory drive. Lung function is influenced by age and body mass index, but the correlation of spirometry with BMI and age in hypothyroid women remains poorly understood.
Aims: To investigate the effect of age and BMI on spirometry parameters in hypothyroid women in Nineveh Governorate.
Materials and Methods: A case-control study of 50 newly diagnosed hypothyroidism and 50 euthyroid individuals. Measurement of spirometry parameters such as FVC, FEV1, and FEV1/FVC with a spirometer. Weight and height were measured to calculate BMI.
Results: A significant negative correlation between age and FVC% was predicted in the hypothyroid group (r = -0.364, p = 0.009). Nevertheless, FEV1/FVC exhibited a significant negative correlation with BMI in the hypothyroid group (r = -0.296, p = 0.037).
Conclusion: Lung function declines with age in women with hypothyroidism, especially FVC% predicted. BMI appears to increase the airflow limitation as pronounced by a decrease in FEV1/FVC in hypothyroid women.

Background: Ovarian cancer (OC) is the most deadly gynecological cancer in women. It is usually presented with non-specific symptoms leading to late diagnosis.
Aim: To investigate some reproductive and gynecological risk factors for OC in Nineveh governorate in an attempt to participate in the prevention strategy.
Methods: The current study has been conducted in Mosul city, Northern Iraq. It is a case-control study that has included 100 women diagnosed histopathologically with OC (cases) and 200 women with no ovarian problems by ultrasonographical examination (control). Using Minitab version 20 software statistical program, descriptive and analytic statistics have been done.
Results: This study reveals that there is a highly significant risk of OC with nulliparity (OR= 4.72, P-value<0.001), the history of hysterectomy (OR=6,32, P-value=0.018), the past history of period of infertility (OR= 3.27, P-value< 0.001), and the women who used medications for induction of ovulation for more than or equal to six months (OR=2.25, P-value=0.031). While highly significant protective effects against OC have been shown in the parous women as (OR=0.16, 0.19, 0.26), (P-value<0,001, <0.001, 0.001) for women with parity (1-2), (3-4), (≥ 5) respectively and the usage of any type of oral contraceptive pills (OCP) as (OR=0.32, P-value <0.001).
Conclusion: This study explores some important risk factors for OC development in Nineveh governorate like nulliparity, hysterectomy, and the history of periods of infertility.

Background: The early post-natal period is critical for left ventricular (LV) development, with significant structural differences between term and preterm neonates. Gestational age and birth weight influence LV wall dimensions and mass, which is vital for assessing neonatal cardiac health. This study compares LV dimensions and mass in term and preterm neonates to highlight developmental variations.
Objectives: This study compares the left ventricular wall dimensions, left ventricular mass, and index throughout the 1st 7 days of the post-natal period in preterm and term neonates.
Methods: The (50) term neonates and the (30) preterm neonates enrolled in the study who fulfilled the inclusion criteria were assessed by echocardiography to measure the left ventricular wall dimensions, left ventricular mass, and index throughout the early post-natal period of life as well as it's correlations with body weight, body surface area, and gestational age.
Results: A statistically significant difference between the research groups was found for all variables including left ventricular wall dimensions, left ventricular mass, and index. Preterm newborns had less values in the first week of life than mature neonates, which could be explained by the latter having less time to nurture and grow in the uterus.
Conclusion: At the 1st week of post-natal life, neonates had a greater value of left ventricular dimensions, left ventricular mass, and index when compared with the values obtained from the preterm neonates.

Background: Incidental prostate malignancy can be detected in men who are undergoing transurethral resection of the prostate for nodular hyperplasia. Consequently, it is crucial to thoroughly assess the transurethral resection specimen for precise diagnosis, grading, and staging.
Objectives: To investigate the frequency of prostate cancer incidentally discovered in transurethral resection specimens and to ascertain its correlation with some clinicopathological factors.
Methods: This study included 200 patients who had undergone transurethral resection of the prostate for the treatment of nodular prostatic hyperplasia between January 2020 and January 2023. Patients' age, prostate-specific antigen serum levels, and the resected prostate weight were assessed. Additionally, tumor stage, Gleason grade group, perineural invasion, and lymphovascular status were evaluated in the prostate cancer group. Statistical analysis was done to investigate the relationship between these parameters and the detection of prostate cancer.
Results: The study revealed an incidental detection rate of prostate cancer at 11.5%. This group exhibited notably higher average ages and prostate-specific antigen levels than the nodular prostatic hyperplasia group. Furthermore, the weight of the removed specimen influenced the detection rate of incidental prostate cancer. Out of the 23 identified cases of incidental prostate cancer, 17 (73.9%) were categorized as stage T1b. Statistically significant disparities were observed among the T1 stages concerning prostate-specific antigen levels and the weight of the excised specimen.
Conclusions: This study demonstrates a rise in the frequency of unsuspected prostate cancer following transurethral resection of presumed nodular prostatic enlargement in Nineveh province. Most of these neoplasms were of the high-grade group, indicating a higher likelihood of clinical significance. Precise histopathological assessment of all transurethral resection of prostate specimens might enhance the possibility of detecting incidental cancer in nodular prostate hyperplasia.

Background: Different types of Haemoglobin is synthesized as consequence of the differences in oxygen (O2) demands at different stages of growth to mantis optimal O2 delivery to the tissues. Thus, haemoglobin A1 is the most common form of haemoglobin in the adult people , haemoglobin A1, is a combination of two alpha chains and two beta ( α2β2 )chains.
Aim: The study aimed to assess the level of adult haemoglobin and fetal haemoglobin in normal pregnancy and correlate the results with complete blood picture.
Methods: Study design: cross sectional study carried from Oct. 2024- Jan. 2025. Blood samples were used to determine complete blood picture by using hematology autoanalyser and haemoglobin electrophoresis by using Gel electrophoresis chamber.
Result: Seventy pregnant women in the third trimester were included in the study. The mean ± SD of their age was 27.55±9.17years.The mean of HbA1 was (92.63±2.47) while for HbA2 was (2.80±0.83) and fetal haemoglobin was (2.15±2.48). Twenty four of them were taking iron supplement (group 1) and 46 pregnant women not taking iron supplement (group 2), HbA1 higher in group 1 and Hb F was lower in group 1 but both results were statically not significant. Positive association between HbA1 with Hb, PCV, RBC and reticulocytes (P < 0.0001), (P<0.0001), (P<0.044) (P < 0.034), respectively.There was a negative correlation of Hb A1 with the platelets ( P<0.037).
Inverse correlation was found between HbA1 and HbA2 (P<0.017). A significant negative association between HbA2 and HbA1(p < 0.017).
Conclusion: Adult hemoglobin positively associated with red blood cell count packed cell volume and reticulocyte count and negatively correlated with platelets count. Significant negative correlation of HbA1 with the HbA2 ,fetal hemoglobin higher in pregnant women and in those not taking iron it has negative association with monocyte.

Background: Many methods are used to perform tests for students, but the best are those that achieve the highest level of deep and high learning for students and ease of analysis. One of the most important testing methods is multiple-choice questions (MCQs).
Aim: To analyze the multiple-choice questions in embryology subject for the students of the second class in the College of Medicine, University of Mosul, Iraq.
Methods: The multiple-choice method was used to conduct the final exam (first attempt/2022) for the embryology subject for second-year students at the College of Medicine in Mosul (697 students). The results were analyzed prospectively through a non-interventional observational study. The test included 100 multiple-choice tests, so each question had five choices (four wrong choices were used as distractions because they were close).
Results: Two tools are used to analyze each multiple-choice question: Difficulty Index and Discrimination Index. About 52 (52.0%) out of 100 multiple-choice questions were average (between 41-60), while about 46 (46.0%) were moderately easy (more than 61-80). About 2 (2.0%) were moderately difficult (between 21-40(. In contrast, about 10 (10%) items were within acceptable values (0.2-0.29), while about 0 (0%) items were considered good (0.3-0.4), and about 0 (0%) were excellent (more than 0.4), about 1(%) was within the false zone (less than 0). The weak category (0-0.19) was seen in 89 (8.9%) students.
Conclusion: The test must use the Medium Difficulty Index and Good Discrimination Index items. Such an analysis could improve the quality of examinations in medical schools and review weak questions through the Discrimination index.

Background: The treatment of osteoarthritis was analgesia, and physiotherapy with intra-articular steroid injection improved the symptoms of the disease. It was found that cartilage damage will enhance an inflammatory process.
Aim: This study assesses the adjuvant effect of treatment with colchicine and analgesia in knee osteoarthritis.
Methods: This study includes 60 patients confirmed to have osteoarthritis of knee joints as diagnosed by a rheumatologist. Blood tests include ESR and CRP as inflammatory markers. We divided the patients into two groups matching age and gender; the duration of treatment and follow-up was 8 weeks. The first group enrolled 30 patients who received paracetamol (2 g/day) with physiotherapy; the other group enrolled 30 patients who received colchicine with a dosage of 0.5 mg daily and analgesics (2 g/day) and physiotherapy for the same period.
Results: Colchicine had significantly improved knee pain by 44.7%. Visual Analogue Scale-pain score (45.20 ± 12.9 to 24.9 ± 12.9, p<0.001).
Conclusion: Colchicine appears to be useful for treating knee osteoarthritis. It improves pain and decreases the need for joint replacement.

BACKGROUND: Acute myeloid leukemia (AML) is an abnormal clonal proliferation of early hematopoietic precursor cells leading to maturation arrest and accumulation of immature myeloid cells in the bone marrow, blood, and other tissues. Bone marrow microenvironment plays a crucial role in supporting hematopoiesis, illness progression, and response to chemotherapy. Tumor necrosis factor -α is one of these microenvironments with a pleiotropic action.
OBJECTIVE: Evaluate the level of tumor necrosis factor-α in patients with AML and study its relation to other clinical prognostic factors and laboratory parameters.
METHODS: This study is a prospective case series study conducted on 40 recently diagnosed AML patients from May 2023 to October 2023. The patients were collected from the hematology units of Ibn Sina and Ibn Al-Atheer Teaching Hospitals in Mosul City, Iraq. Verbal consent was obtained for each patient, and a questionnaire was administered; blood samples and laboratory investigations were also conducted.
RESULTS: Out of 40 patients, 24 males and 16 females were between 5 and 82 years old. The serum TNF-α level of patients at presentation was much higher than that in the control group (p-value 0.000), with a significant positive relation with the marrow blast percent (p-value 0.002). The relation between TNF- α and age, neutrophils, and LDH (Lactate Dehydrogenase) level are negative and non-significant; the relation between TNF- α mean and the disease outcome is significant, with a higher level in the dead group, near the normal control level in patients went to complete remission and in between in relapse group.
CONCLUSION: A high level of TNF- α is a bad prognostic factor as it is associated with high blast count and high mortality rate secondary to high disease-related complications.

Background: COVID-19 disease has been associated with disproportionate mortality amongst the world population. National and international health agencies have been monitoring the mortality of this disease day after day. So far, this has ranged from 0.9% in Russia to 18.3% in France and affected by many factors.
Aim: To estimate the case fatality rate of COVID-19 in Iraq and each Iraqi province including sex difference, and to compare the case fatality rate with the neighboring countries.
Methods: To achieve the aim of the present study, a biometric descriptive study design was adopted. Collecting the cumulative number of COVID-19 cases and deaths for 28 Months: from February 24, 2020, till August 6, 2022, and then after that the case fatality rate and recovery rate were estimated and comparing them among the eighteen Iraqi province and neighboring countries. With an extension period until 13 April 2024 to recognize the temporal changes in case fatality rates. Sources of data were the Iraqi Ministry of Health and World Health Organization.
Results: The case fatality and recovery rates for Iraqi people till August 6, 2022, were 1.033 % and 98.226 %, respectively. There was a wide variation in case fatality rates among the eighteen Iraqi provinces. Highest in Sulaymaniyah (2.15 %) followed by Kirkuk (1.65 %), Thi-Qar (1.58 %), Babil (1.53 %) and Erbil (1.47 %), and lowest in Anbar (0.41%), and Wassit (0.56 %) and the capital in-between (Baghdad 0.76 %). It was also found higher proportional mortality in males than in females (54.6 % Vs. 45.4 %) which reflects the global trends. No significant temporal changes in the cumulative case fatality rate of COVID-19 in Iraq between August 6, 2022, and April 13, 2024, (1.033 %, and 1.029 % respectively) were noticed.
Conclusions: The study revealed that the mortality rate from COVID-19 in Iraq is within the average level world-wide and lower than that of the neighboring countries. With a non-significant reduction in cumulative mortality in the last two years.

Background: Acute lymphoblastic leukemia is marked by the abnormal clonal expansion of early hematopoietic precursor cells in the bone marrow. In Mosul City, acute lymphoblastic leukemia is the most common form of leukemia, underscoring the importance of comprehensive evaluation and treatment.
Objectives: To evaluate the serum levels of interleukin 6 and interleukin 10 in patients newly diagnosed with Acute lymphoblastic leukemia and to assess their correlation with clinical and laboratory parameters.
Method: A case-control study, conducted in Nineveh Province from January to October 2024, included 30 newly diagnosed acute lymphoblastic leukemia patients and 30 healthy controls. Hematological, biochemical tests and serum interleukin 6 and interleukin 10 levels (measured by ELISA), were performed at diagnosis and post-induction chemotherapy.
Result: At diagnosis, the mean levels of hemoglobin and platelets in patients were significantly lower than those in healthy controls. In contrast, serum levels of interleukin 6, interleukin 10, and the percentage of blast cells in both peripheral blood and bone marrow were significantly higher. After induction chemotherapy, acute lymphoblastic leukemia patients exhibited a significant reduction in interleukin 10 and interleukin 6 levels and a reduction in blast percentages, along with increases in hemoglobin and platelet counts. A significant correlation was found between interleukin 6 and interleukin 10 levels and the percentage of blast cells pre-and post-treatment. In acute lymphoblastic leukemia patients with low interleukin 6 and interleukin 10 levels, complete remission was achieved.
Conclusion: Interleukin levels decrease post-induction chemotherapy, with lower levels linked to remission and higher levels to incomplete remission, suggesting their potential role as a biomarker for disease progression and treatment response.

Background: Low back pain is one of the most common presentation encountered by physicians. Reaching a correct diagnosis and reducing patient's pain is priority. The yield of routine lumbosacral MRI in patients presented with isolated low back pain (LBP) is still vague. Most patients with LBP will show different degenerative changes on MRI. As it is unclear whether surgical treatment of degenerative MRI changes results in reduction of back pain or not, the constraint of doing a diagnostic lumbosacral MRI stays questionable.
Aim: The objective of this study is to assess the causes of the lower back pain with more analysis of gender and age groups distribution.
Methods: We reviewed medical records of all patients presented with LBP and referred by their physicians for lumbosacral spine MRI in Radiation Institute in Mosul city as part of their clinical management. The study period was from March 2024 to February 2025. Only patients with a chief complaint of isolated LBP were included. We obtained the relevant data from the computerized medical files and detailed radiological findings from their MRI reports.
Results: three hundred and six patients (306) matched the inclusion criteria. We reported positive findings in MRI in 283 patients (92.5 %), only 23 patients (7.5 %) had normal MRI findings. Bulge of the intervertebral disc was the most common finding seen in (87.6 %). Positive MRI findings were most evident in the middle-age group (40-60 years old). Among the evaluated conditions, dehydration of the intervertebral disc showed a significant association with gender, with a higher prevalence in females (P = 0.015).
Conclusion: Mosul Iraqi patients presented with LBP have similar worldwide patterns of lumbar degenerative changes. Providing that only 7.5 % of patients with CLBP have normal MRI findings, suggestive that we have a relatively good referral protocol for imaging the truly indicated patients which save the cost effectiveness for the healthcare system and shorten the time on waiting list.

Background: Breast cancer is one of the most common malignancies diagnosed in women, and its incidence is increasing every day. Omentin-1 is a new class of adipocytokine expressed in the intestines, vascular tissue, visceral adipose tissue, and goblet cells of the respiratory system. Researchers have demonstrated that omentin-1 plays a critical role in the processes of carcinogenesis.
Aim: To evaluate the levels of serum omentin-1, aromatase, other hormones, and enzymes of patients women with breast cancer in Mosul City. Also, biotechniques will study omentin-1 of normal human plasma.
Methods: This study comprised 50 patients at the beginning of diagnosis with breast cancer and follow-up after surgery by one month from the same ones in addition to 50 healthy women as control samples with ages between (25 and 75) years. The samples were classified into pre and postmenopausal women. Samples were collected from October 2023 to March 2024.
Results: Omentin-1 and other variables levels in breast cancer affected before or after menopause. Also, from biochemical techniques, the results indicated that omentin-1 has a low molecular weight of nearly 39810 Dalton with specific activity (5.25 ) and recovery (70%) with purification folds (40.38).
Conclusion: Breast cancer is affected by many factors, such as menopause, family history, old age as well as obesity. The concentration of Omentin-1 as adipokine is influenced by many types of cancer, such as breast cancer. It has been observed that postmenopausal women with breast cancer have high aromatase activity and thus increase the level of estradiol, which in turn can interact with its metabolites with DNA to cause carcinogenic mutations, which contribute to the development of breast cancer.

Background: Body weight and dental caries are shared risk factors in diet. They are worldwide public health diseases that affect kids and continue throughout their lives. A number of studies have discussed an association between body weight and dental caries. This will give the outline for a review to discuss a question about the possible relationship between body weight and caries in children.
Methods: This study summarized the process that carries out a review that will synthesize preceding studies of childhood body weight problems and suffering from tooth caries, which could help to categorize and report the quality of existing evidence.
This study reviews the existing literature on the relationship between obesity and childhood dental caries to provide recommendations for healthcare providers.

Extraskeletal Ewing sarcoma is a rare malignant soft tissue tumor. It belongs to a group of small round blue cell tumors known as the Ewing sarcoma family of tumors, with common histological and genetic features. Mainly encountered in adolescents and young adults, it commonly develops in the extremities (36%) of patients and, in others, arises in central locations (commonly paravertebral regions).
The Presnting case of a 13-year-old female presented to the private clinic after a history of trivial trauma to the back; her family noticed amass in the left paravertebral area, and the mass was painless. During the physical examination, the mass measured about 5*5 cm. It was not tender, hard inconsistency and fixed to the ribs, and the skin was not tethering; a radiological examination showed a mass of about 8*10*12 cm. involving three intercostal spaces and their ribs bulging into the thoracic cavity. A tru cut biopsy and histopathological examination revealed round cell tumors (Extraskeletal Ewing sarcoma) confirmed by immunohistochemical marker CD99 strongly positive. The patient was treated by chemotherapy and surgery, and she responded well to treatment. After eight cycles of chemotherapy, the patient was referred to the surgeon for resection of the residual mass; a left posterolateral thoracotomy was done, and the remnant of the mass was mainly fibrous tissue removed with 10 cm. of the posterior part of the 8th rib removed and sent again for histopathological examination, then the patient sent to an oncologist for prophylactic chemotherapy the patient followed for 5 months with no evidence of recurrence

The transition from peripheral to central precocious puberty may occur from prolonged exposure to sex hormones from gonadotropin-releasing hormone-independent etiologies, including congenital adrenal hyperplasia. Herby, we present a case report in a 6-year-old and 5-month-old boy with congenital adrenal hyperplasia developing into central precocious puberty preceded by peripheral precocious puberty. Early detection and therapy of precocious puberty due to congenital adrenal hyperplasia should begin as soon as feasible because failure to do so may result in short stature and other long-term mental and physical consequences.