Introduction: Inflammatory myofibroblastic tumor is a very rare benign tumor in children that mimics malignant tumors in its aggressiveness locally and by the possibility of recurrence after surgical resection, and causing anemia of chronic disease, which is a decrease in hemoglobin 1 to 2 g/dL below normal level in a patient with chronic illness. Case presentation: A 32-month-old boy from Libya presented with microcytic hypochromic anemia. He had been treated in three countries and five centers without response to medical therapy. He was investigated at our center and found to have a mass in the colon causing intermittent intussusception and bleeding. He was treated surgically, and his condition improved dramatically. The pathology report proved a diagnosis of inflammatory myofibroblastic tumor. Conclusion: We report a case of an unusual tumor of the gastrointestinal tract causing chronic anemia not responding to medical treatment, and discuss the characteristics of inflammatory myofibroblastic tumor. In our case, we stress the involvement of a multidisciplinary team in treating such a patient who presents with common symptoms and signs but in whom there has been no response to any of the measures and treatment protocols.

Background: H. pylori antimicrobial resistance causes increasing treatment failure rates among H. pylori gastritis in children. This study investigates the molecular mechanisms of H. pylori antimicrobial resistance among Jordanian children. Methods: Demographic, clinical, and laboratory data were recorded for children referred to Prince Hamzah Hospital. Clarithromycin, Metronidazole, and Levofloxacin susceptibility were tested via E-test. Clarithromycin-related mutations were investigated using Real-Time (RT)-PCR and Levofloxacin resistance was analyzed with DNA sequencing of the gyrA gene. Results: 116 children were recruited, including 55.2% females and 55.2% in the age range of 10.1 to 14 years. A total of 82.7% were naïve to eradication therapy. H. pylori positivity was 93.9%, 89.6%, 61.7%, and 84.3% according to Rapid Urease Test, histology, culture, and RT-PCR, respectively. Resistance rates were 25.9% for Clarithromycin, 50% for Metronidazole, and 6.9% for Levofloxacin via E-test. A2142G or A2143G or a combination of both mutations concerning Clarithromycin resistance were documented in 26.1% of samples, while mutations in gyrA gen-related to Levofloxacin resistance were reported in 5.3% of samples. Antibiotic resistance was significantly affected by abdominal pain, anemia, hematemesis, and histological findings (p < 0.05). Conclusion: H. pylori resistance was documented for Metronidazole and Clarithromycin. RT-PCR for H. pylori identification and microbial resistance determination are valuable alternatives for cultures in determining antimicrobial susceptibility.

Cancer is one of the leading causes of global morbidity and mortality and one of the most challenging global health conditions, impacting the lives of millions every year. The Eastern Mediterranean Region (EMR) is not on track to achieve the sustainable development goal (SDG) target 3.4 which aims to reduce premature mortality (i.e., before the age of 70 years) for non-communicable diseases (NCDs), including cancer, by a third by year 2030; instead, it is projected that the EMR will experience the least progress towards achieving this target. This review therefore highlights the importance of context-specific cancer management, with a focus on nutritional, lifestyle and supportive care, in the EMR. A comprehensive literature search was conducted using electronic databases, including PubMed, Scopus and Google Scholar, as well as the Academy of Nutrition and Dietetics and key oncology institutes. Nutritional and lifestyle management is a fundamental aspect of cancer care which should be context-specific, achievable and individualized to minimize symptoms and side effects, while maximizing benefits and better addressing the needs of the patients with cancer. A multidisciplinary approach that integrates medical, nutritional, psychological and palliative care is essential to address this growing issue effectively. Cancer care and management requires coordinated efforts from policymakers, healthcare providers and communities to implement evidence-based interventions and promote cancer awareness.

Vasoactive intestinal peptide (VIP)-secreting neuroblastic tumors are rare pediatric neoplasms that may present with chronic secretory diarrhea prior to tumor detection, posing significant diagnostic and therapeutic challenges. VIP-induced diarrhea is typically profuse, watery, and refractory to standard management, often resulting in dehydration, electrolyte imbalance, weight loss, and failure to thrive. Herein, we report two pediatric patients with neuroblastoma who presented with chronic secretory diarrhea as the initial and predominant symptom. In both cases, the persistent diarrhea remained unexplained by common etiologies and was unresponsive to conventional therapies. After approximately three months of ongoing symptoms accompanied by progressive abdominal distension, radiologic evaluation revealed intra-abdominal masses in both cases. The diagnosis of neuroblastoma was confirmed by tumor biopsy in one patient and bone marrow biopsy in the other. Serum VIP levels were not available in either case; however, the clinical presentation was consistent with VIP-mediated secretory diarrhea. Although surgical resection of VIP-secreting neuroblastic tumors in localized disease is typically associated with resolution of diarrhea and favorable outcomes, delayed diagnosis could result in advanced, metastatic, and inoperable disease. Both of our cases had metastatic, inoperable disease at the time of diagnosis, and proved fatal in one. These cases underscore the importance of considering VIP-secreting neuroblastic tumors in the differential diagnosis of children presenting with unexplained, treatment-resistant secretory diarrhea. Early recognition may facilitate timely diagnosis and improve clinical outcomes.

Background: Asparaginase-associated hypertriglyceridemia (AAHTG) is a recognized metabolic complication of asparaginase therapy in pediatric acute lymphoblastic leukemia (ALL). However, data on its incidence, clinical presentation, and optimal management remain limited. Methods: We performed a retrospective analysis of 12 pediatric patients (≤18 years) with ALL treated at King Hussein Cancer Center (KHCC) between January 2021 and February 2026 who developed severe AAHTG, defined as triglyceride levels >1,000 mg/dL following asparaginase administration. Clinical characteristics, management strategies, and outcomes were systematically reviewed and analyzed. Results: Among 598 patients with pediatric ALL treated at KHCC, 12 developed severe AAHTG (incidence 2%). Most cases (83%) were asymptomatic and identified incidentally through observation of lipemic serum on routine laboratory testing; only two patients were symptomatic—one with acute pancreatitis and one with hyperviscosity syndrome. The median age was 9.5 years, with a male predominance (83%). Most patients had B-cell ALL (75%) and high-risk disease (66%). AAHTG occurred predominantly during the maintenance phase (66%), with a median onset of 12 days after the last asparaginase dose. The median peak triglyceride level was 2,645 mg/dL (range, 2,052–6,687 mg/dL). All patients received intravenous fluids, omega-3 fatty acids, and fibrates. Continuous insulin infusion was administered in 11 patients over a median of 3 days until triglyceride levels fell below 1,000 mg/dL. Plasmapheresis was utilized in three patients—two presenting with triglycerides exceeding 6,000 mg/dL and one with hyperviscosity syndrome—with all three achieving a reduction below 1,000 mg/dL after a single treatment session. Asparaginase was resumed per protocol in eight patients; recurrence occurred in one. Permanent discontinuation was required in four patients: two with symptomatic disease, one with refractory hypertriglyceridemia, and one who developed AAHTG after the final scheduled dose. Conclusion: Severe AAHTG is frequently asymptomatic and most often identified incidentally through lipemic serum; however, it carries a risk of serious complications. Early identification and prompt intervention were associated with favorable outcomes in this cohort. Resumption of asparaginase following an AAHTG episode appears feasible, provided triglyceride levels are confirmed below 1,000 mg/dL before each subsequent dose.

Background: Pediatric gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are exceedingly rare. Data from Jordanian and Arab world populations are absent from international registries, with only limited data available from Türkiye, leaving management strategies largely extrapolated from adult and Western literature. This study documents the clinical features, management, and outcomes at a tertiary oncology center in Jordan. Methods: We conducted a retrospective, single-center cohort study of patients 18 years or younger diagnosed with GEP-NETs at the King Hussein Cancer Center (January 2006 to May 2025). We analyzed demographics, presentation, tumor characteristics, treatment, and survival. Results: Ten patients were identified (8 male, median age 13 y). Primary sites were the appendix (8/10) and pancreatic head (2/10). Nine patients presented with abdominal pain; one with a pancreatic primary presented with obstructive jaundice. Histologically, 9 were low- or intermediate-grade (grade 1 to 2) and 9 were localized. Nine patients underwent surgery (8 appendectomy±hemicolectomy; 1 Whipple procedure). One patient with metastatic pancreatic NET was managed nonsurgically. Two patients with advanced/metastatic pancreatic NETs received systemic therapy. Appendiceal tumors were universally indolent with excellent outcomes postsurgery, whereas pancreatic tumors exhibited aggressive clinical behavior, including nodal involvement and distant metastasis. After a median follow-up of 46.6 months, 1 patient died of metastatic disease and 1 developed recurrence; both had pancreatic primaries. Conclusions: Pediatric appendiceal NETs carry excellent prognoses following conservative surgery. Pancreatic NETs represent a high-risk subgroup with aggressive behavior. As the first documented GEP-NET from Jordan and the Arab world, these findings align with international patterns and support site-specific, risk-adapted management while highlighting the need for multicenter collaboration across the region.