The optimal time sequences for chemotherapy and radiation therapy after breast surgery for patients with breast cancer remains unknown. Most of published studies were done for early breast cancer patients. However, in Egypt advanced stages were the common presentation. This retrospective analysis aimed to assess the optimum sequence for our population.

Background: Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life. Materials and Methods: This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test. Results: Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1%) and 18 women (43.9%), with a median age of 56 years (16 to 70 years). There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ), 17 patients underwent telescoping pancreatico jejunostomy (PJ) and 15 patients pancreaticogastrostomy (PG). The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors that predisposed to development of pancreatic leakage included male gender, preoperative albumin < 30g/dl, pre-operative hemoglobin < 10g/dl and non PJ-duct to mucosa type of reconstruction. The ampullary cancers presented at an earlier stage and had a better prognosis than pancreatic cancer and cholangiocarcinoma. Early stage (I and II), negative surgical margin, well and moderate differentiation and absence of lymph node involvement significantly predicted for longer survival. Conclusions: PJ duct-to-mucosa anastomosis was safe, caused least pancreatic leakage and least blood loss compared with the other methods of reconstruction and was associated with early return back to home and prolonged disease free and overall survival.

Objective: This study aimed to investigate the predictive diagnostic role of thyroglobulin (Tg) as a preoperative tumor marker among patients at the National Cancer Center in Yemen. Analysis of 323 cases (141 malignant, 182 benign) demonstrated high diagnostic accuracy with an area under the curve (AUC) of 0.913 (95% CI: 0.879–0.946, P < 0.001). Various threshold values were evaluated, with optimal diagnostic performance observed at different cutoff points, suggesting Tg’s potential as a valuable preoperative screening tool. Method: A prospective study of 323 patients of thyroid nodule was conducted between January 2013 and March 2025. A diagnostic accuracy study was performed to analyzing the high level of preoperative Tg in 323 patients presenting with thyroid nodules in comparison with post total thyroidectomy histopathological results, where 141 patients subsequently confirmed had malignant nodule and 182 cases confirmed as benign nodule Results: Of all results of preoperative Tg level of 323 cases, we were performed the receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic accuracy Tg. Multiple cutoff points were analyzed to determine optimal threshold values for clinical application. Statistical significance was set at P < 0.001. The result of The ROC curve analysis revealed excellent discriminatory power with an AUC of 0.913 (95% CI: 0.879–0.946, SE: 0.017, P < 0.001). This indicates strong diagnostic capability of Tg as a preoperative marker. Conclusion: This study demonstrates that preoperative serum Tg is a highly effective biomarker for differentiating malignant from benign thyroid nodules, supported by an AUC of 0.913 in 323 histopathological confirmed cases. While Tg’s adaptability across cutoff thresholds enhances its diagnostic utility, optimal values require context specific validation. The findings advocate integrating Tg into preoperative screening to improve risk stratification and reduce unnecessary interventions. However, broader multicenter studies are needed to confirm generalizability and establish standardized thresholds, particularly beyond the studied Yemeni cohort, to refine thyroid cancer management globally.

This case report describes a rare occurrence of a single isolated sacral metastasis in a 59‐year‐old male with clear cell renal cell carcinoma (ccRCC). The patient presented with progressive lower back pain and sacral numbness following a fall. Initial imaging revealed a destructive lytic lesion in the S1–S2 region and a left renal mass. A CT‐guided biopsy of the sacral lesion confirmed metastatic ccRCC. PET‐CT confirmed no additional metastases. Multidisciplinary management included partial left nephrectomy for the primary renal tumor, stereotactic body radiotherapy (SBRT; 45 Gy/15 fractions) targeting the sacral metastasis, and immunotherapy with sunitinib. The patient experienced significant pain relief within 1‐week post radiotherapy and demonstrated stable disease with near‐resolution of the sacral lesion at 3‐month follow‐up. At 12 months, imaging confirmed sustained disease stability. This case highlights the importance of considering metastatic RCC in patients with isolated sacral lesions, even in the absence of disseminated disease, and underscores the efficacy of combining localized ablation, radiotherapy, and targeted systemic therapy. Early diagnosis and a tailored multidisciplinary approach are critical for optimizing outcomes in such rare presentations.