Al- Anbar Medical Journal

Background: Thyroid cancer has emerged as one of the fastest-rising malignancies globally. Its Incidence, aggressiveness, and prognosis vary between gender.
Objectives: To assess thyroid cancer incidence trends in Iraq from 2009 to 2023 and examine patterns related to gender, age, cancer ranking, and histopathology.
Materials and Methods: A retrospective descriptive epidemiological analysis was conducted using data from the Iraqi Cancer Registry (2009-2023), focusing on annual incidence, gender distribution, age-specific rates, and histological subtypes. Crude incidence rates (CIRs) were calculated as the number of new thyroid cancer cases per 100,000 population per year for each gender and year.
Results: Over the 15 years, thyroid cancer in Iraq increased significantly, approximately tenfold (288 in 2009 and 2823 in 2023), with female incidence rising 11-fold (1.3 per 100,000 in 2009-9 per 100,000 in 2023) and male incidence 6.7-fold (0.5 per 100,000 in 2009-3 per 100,000 in 2023). The female-to-male ratio increased from 2.5:1 in 2009 to 4:1 in 2023. Thyroid cancer ranked rose from 17th to 4th. The age category of 30 and 34 was the highest, while the highest rates of new cases were among individuals 70 years and older. The Papillary subtype form 82% of the cases.
Conclusion: Thyroid cancer is increasing in Iraq, especially among women. This is consistent with the global pattern and may be because of overdiagnosis or environmental factors. The results show that we need to improve screening, better diagnostics, and cancer registry systems so that we can find cancer earlier to provide patients with better care.

Background: Acne vulgaris is a common chronic skin condition affecting a significant proportion of adults and 85% of adolescents. Acne is frequently underestimated in Anbar governorate, despite anecdotal evidence suggesting a high prevalence.
Objectives: To identify the prevalence and clinical characteristics of acne among medical students in the College of Medicine, University of Anbar.
Materials and Methods: A cross-sectional survey was conducted from October 2024 to April 2025 among all Anbar medical students. Cases of acne have been enrolled for assessment of prevalence and severity. Duration of disease, food type, drug history, sites, severity, scarring grade, body mass index, and complications have been studied.
Results: Out of 1218 medical students, 270 (22.16%) were diagnosed with acne. The mean age was 19.72 ± 2.15 years. The female-to-male ratio was 1.5:1. The most affected site was the face, followed by the back, while the chest was the least commonly involved. Nearly a third of participants had moderate acne. The most frequent complication was erythema, followed by scarring and hyperpigmentation. The association between acne severity and dietary factors was statistically significant for spicy foods (P-value = 0.006) and cola (P-value = 0.002), but not for sweets (P-value = 0.148).
Conclusions: Acne vulgaris is a prevalent condition among Anbar medical students. The multifactorial nature of acne highlights the need for awareness among young adults. The strong association between acne severity and scarring reflects the importance of early and effective treatment to minimize scar formation.

Background: The link between interleukin-40, a newly discovered cytokine, and the increased risk of type 2 diabetes after menopause has not been previously explored.
Objectives: To assess the correlation between blood levels of IL-40 and glycemic status in post-menopausal women.
Materials and Methods: In a cross-sectional study, HbA1c was employed to categorize 80 menopausal women into three groups: normoglycemic (n = 22), prediabetic (n = 22), and type 2 diabetes (n = 36). Serum IL-40 levels were measured by an enzyme-linked immunosorbent assay (ELISA) kit. Besides, hematologic tests, liver and kidney indicators, and the fundamental indices (glycemic, inflammatory, and atherogenic) were assessed. Statistical studies performed included receiver operating characteristic (ROC) analysis, group comparisons, correlation, and logistic regression.
Results: IL-40 concentrations were significantly lower in prediabetic women (P-value = 0.031) than in normoglycemic individuals. Additionally, they demonstrated a negative connection with HbA1c (r = -0.264, P-value = 0.018) and hemoglobin (r = -0.227, P-value = 0.043). For every 1 ng/mL increase in IL-40, the risks of prediabetes reduce by 16% (OR = 0.84, 95% CI: 0.73–0.97, P-value = 0.015). Although C-reactive protein (CRP) had a higher overall (AUC) area under the curve (0.841), IL-40 demonstrated acceptable discrimination (AUC = 0.726) with higher specificity (86.4%) after recoding prediabetes as the positive state. When controls were classified as positive, ROC analysis showed an inverse effect (AUC = 0.274).
Conclusion: IL-40 differentiates between normoglycemic and prediabetic women in postmenopausal women with higher specificity. It also has a negative correlation with glycemic status and hemoglobin levels. In this high-risk group, these results suggest that it may have clinical significance and diagnostic utility as a supplementary biomarker alongside CRP and fasting glucose, warranting confirmation in longer-term research.

Background: High-grade B-cell lymphoma (HGBCL) is characterized by chromosomal rearrangements involving specific oncogenes. The most commonly identified oncogenes in B-cell lymphomas are MYC, BCL2, and BCL6. Translocations involving these genes are associated with aggressive tumor behavior and poor clinical outcomes. In these lymphomas, the MYC gene is involved in one rearrangement, while BCL2 and, less commonly, BCL6 participate in additional rearrangements.
Objectives: To evaluate the immunohistochemical expression of C-MYC, BCL2, and BCL6 markers in HGBCL cases, as well as to determine the percentage of double-hit and triple-hit lymphoma among HGBCL cases.
Materials and methods: Immunohistochemical investigations were conducted for biopsies of 70 selected cases of HGBCL, using the three markers of C-MYC, BCL2, and BCL6. Also, CD20 in conjunction with CD3 was performed for all cases to confirm their B-cell origin.
Results: Out of 70 HGBCL patients, C-MYC alteration was expressed in 41% of cases. Eighty-three percent of them expressed BCL2, whereas BCL6 was expressed in 64% of cases. Conversely the double expression of C-MYC/BCL2 was established in 3 cases only (2.1%), while the C-MYC/BCL6 expression was found in 6 cases (4.2%). Most cases of double-hit lymphoma (MYC/BCL2 and MYC/BCL6) occurred in males (67% and 83%, respectively), whereas triple-hit cases were more common in females (61.1%).
Conclusion: Regular evaluation of C-MYC, BCL2, and BCL6 expression by immunohistochemistry is fundamental for pathological assessment, risk stratification, and therapeutic planning for affected patients.

Background: The incidence of type 2 diabetes mellitus (T2DM) in Iraq is rising continuously. Glibenclamide (GLB), which is a sulfonylurea member, is an important treatment for T2DM. The sulfonylurea receptor-1 is encoded by the ABCC8 gene, and its rs1799854 genetic variation may alter the hypoglycemic activities of GLB.
Objective: To determine the rs1799854 polymorphism in the ABCC8 gene and assess its potential role in modifying the therapeutic response to GLB among T2DM patients.
Materials and methods: An observational pharmacogenetic association study involved 120 T2DM patients on GLB medication who were screened for ABCC8 G>A (rs1799854) genotypes and glycemic health.
Results: The wild type (GG) was detected in 21.67% of T2DM cases. The mutant type (AA) and the heterozygous type (GA) were detected in 37.5% and 40.83% of the cases, respectively. The results did not exhibit a significant difference among GG, GA, and AA genotypes regarding glycemic status parameters (HOMA 2-IR (1.24 ± 0.93 for GG genotype, 1.3 ± 2.98 for GA genotype, and 1.52 ± 1.79 for AA genotype), HOMA 2-%β (27.05 ± 39.75 for GG genotype, 22.3 ± 44.6 for GA genotype, and 25.8 ± 31.85 for AA genotype), and HbA1c (9.7 ± 3.75for GG genotype, 8.7 ± 2.65 for GA genotype, and 8.9 ± 2.35 for AA genotype) at P-value > 0.05.
Conclusion: The ABCC8 G>A (rs1799854) genotype was significantly prevalent among individuals with T2DM. There was no discernible association between the ABCC8 G>A (rs1799854) genomic variant and GLB’s therapeutic effect.

Background: Hodgkin Lymphoma (HL) is among the top ten cancers affecting children and young adults in Iraq, yet epidemiologic and clinical data remain limited.
Objective: To identify the epidemiologic and histopathologic trends of HL patients in the Middle Euphrates region of Iraq.
Materials and Methods: Medical information of patients registered at the Middle Euphrates Cancer Centre from January 2020 to December 2024 was retrospectively collected and analysed. Demographic, histopathologic, and clinical staging data were extracted. The data were summarized, and correlations were assessed using 95% confidence interval and a significance level of < 0.05.
Results: A total of 293 HL cases were included with a median age of 28 years, and a male-to-female ratio of 1.22:1. Seventy percent of patients were younger than 40 years, with a dominant peak between 10 and 30 years. Nodular sclerosis (NS) and mixed cellularity (MC) were the dominant histologic subtypes (40.27% and 38.91%, respectively). NS subtype was significantly more likely to present in pediatric and younger age groups (P-value < 0.001) and at an earlier stage (P-value = 0.018). Conversely, MC showed a tendency to affect older adults (P-value = 0.014). Paediatric and young age groups had higher odds of presenting at an earlier stage than older adults (OR=3.56, P-value=0.031, 95%CI:1.12-11.36) and (OR=5.35, P-value=0.001, 95%CI:1.92-14.93), respectively.
Conclusion: HL mainly affects younger age groups, with NS and MC being the most prevalent subtypes. Younger age and NS subtype are significantly associated with earlier stage at presentation, suggesting the need for more age-specific diagnostic and management strategies in this patient population.

Background: Phyllodes tumors (PT) are rare fibroepithelial neoplasms of the breast that represent 0.3% to 1% of all primary breast tumors and may occur in benign, borderline or malignant forms.
Objectives: To describe the clinical characteristics, surgical management, and outcomes of PT treated at a tertiary center in Oman.
Materials and Methods: A retrospective review of all PT cases managed between 2011 and 2024 at the Breast Program of Sultan Qaboos Comprehensive Cancer Care and Research Centre/University Medical City was conducted. Demographic, pathological, surgical, adjuvant treatment, and outcome data were analyzed.
Results: Seventeen Omani women were identified. Histological subtypes included malignant in 9 patients (52.9%), borderline in 6 (35.2%), and benign in 2 (11.7%). Breast-conserving surgery was performed in 13 patients (76.4%); 9 required re-excision for margin clearance, and 1 declined further surgery. Axillary staging was performed in 8 patients (47.1%) due to clinically suspicious nodes, with no pathological involvement detected. Adjuvant radiotherapy was administered to 3 patients (17.6%) with malignant PT. During a mean follow-up of 5.4 years (range 1-13 years), local recurrence occurred in 2 patients (11.7%) and distant metastases in 4 patients (23.5%).
Conclusions: PT in this cohort frequently required margin re-excision, highlighting the importance of maintaining a high index of suspicion, integrating oncoplastic surgical techniques, and adopting a multidisciplinary management approach. Selective axillary assessment based on preoperative evaluation and multidisciplinary discussion may help minimize unnecessary axillary surgery.

Background: Triple negative breast carcinoma (TNBC) is an aggressive disease, with a lack of response to targeted therapies, leaving a limited list of effective treatments, including chemotherapy and radiotherapy. Recent studies have shown that certain types of TNBC are immunogenic tumors, that may be suitable targets for immunotherapies. On the other hand, mismatch repair (MMR) expression status is considered an effective biomarker for assessing susceptibility to immunotherapies in multiple solid tumors.
Objectives: To assess the expression status of the MMR proteins and their correlation with the clinicopathological parameters in TNBC patients.
Materials and Methods: Fifty-three formalin-fixed paraffin-embedded histopathological blocks of diagnosed triple negative invasive ductal breast carcinoma cases were retrieved from the archives department of the histopathological laboratories in Medical City campus hospitals. These blocks were sectioned and stained with monoclonal antibodies, targeting four MMR proteins (MSH2, MSH6, MLH1, and PMS2) to assess the expression status of these proteins in the tumor cells.
Results: Of 53 cases, there were 10 (18.9%) deficient in the expression of one or more of the MMR proteins, the MSH2 protein was the least frequently missed protein (n = 3, 5.7%). While PMS2 was the most frequently missed one (n = 10, 18.9%). An insignificant correlation (P-value > 0.05) was found between MMR status and the clinicopathological parameters except for age (P-value < 0.05).
Conclusion: Deficient expression status of the MMR proteins was common and showed an insignificant relation with the clinicopathological parameters.

Background: Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced to avoid overtreatment of indolent tumours, although risks of misclassification and rare metastasis remain. According to the 2022 WHO (World Health Organization) classification, BRAF V600E-mutated cases should be reclassified as classical papillary thyroid carcinoma (PTC) with predominant follicular architecture. VE1 immunohistochemistry is a reliable surrogate for detecting the BRAF V600E mutation.
Objectives: To determine the frequency of BRAF V600E mutation among NIFTP using VE1 immunohistochemistry, and to assess its correlation with clinicopathological characteristics.
Materials and methods: Forty-six tumours originally diagnosed as NIFTP during the period from 2020 to 2024 were retrospectively identified. All haematoxylin-eosin slides were re-evaluated according to the WHO 2022 criteria. VE1 immunohistochemistry was performed on all cases (rabbit monoclonal anti-BRAF V600E, BIO-SB, USA). VE1 status was then correlated with clinicopathological features.
RESULTS: VE1 staining reclassified 13% of suspected NIFTPs. 2.2% showed capsular invasion highlighted by VE1 and were reclassified as invasive encapsulated follicular variant of PTC (IEFVPTC), while 11% demonstrated diffuse cytoplasmic VE1 positivity indicative of BRAF V600E mutation. No significant association was observed between VE1 positivity and clinicopathological parameters (P-value > 0.05); however, VE1-positive cases tended to be larger and more frequent in males.
Conclusions: VE1 immunohistochemistry identified a small but clinically important subset of tumours originally labelled as NIFTP that belong to the PTC category. Routine VE1 staining reduces the risk of undertreating aggressive BRAF-driven disease and provides a rapid, economical quality control step to ensure adherence to the WHO 2022 criteria.

Background: A conservative surgical method called marsupialization is used to treat large odontogenic cysts. A novel cyst tube (Grommet tube) was utilized to improve the drainage following marsupialization.
Objectives: To evaluate the efficacy of the Grommet tube by measuring the rate of reduction in cyst size, assessing patients' satisfaction, and evaluating the occurrence of complications.
Materials and methods: Marsupialization was performed under local anesthesia in 10 patients. Cone-beam computed tomography and a semi-automated segmentation method in the 3D Slicer 5.8.1 software were used to measure the cyst volume at baseline and six months after marsupialization, and a comparison between them was made to measure the percentage of reduction in cyst size. To evaluate variations in the rate of reduction of cystic lesions in accordance with different parameters, a volumetric analysis was used.
Results: Ten patients (2 female, 8 males; mean age 37 years, range: 18-51 years) with preoperative and postoperative cyst volumes of 6254 ± 4889.52 mm³ and 4145.5 ± 3385.3 mm³, respectively (P-value < 0.05), were handled. The volume reduction percentage was 33.71% after 6-months period. Overall, patient satisfaction was moderate. Significant results (P-value < 0.05) were obtained for sex, age, pathological diagnosis, and reduction rate. All patients showed soft tissue overgrowth, and 50% of cases revealed tube displacement.
Conclusion: the Grommet tube was effective in reducing cyst size. The patients were satisfied with the tube. Tube displacement and soft tissue overgrowth were observed in a significant number of cases.