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: Wilms tumor (WT) rupture is a serious complication that upstages the disease and requires treatment intensification. This study evaluates clinical characteristics, radiological-pathological concordance, and survival outcomes of ruptured versus non-ruptured WT at a major Middle Eastern tertiary center. Methods: We conducted a retrospective cohort study of 111 pediatric patients with unilateral WT treated at King Hussein Cancer Center, Jordan, between October 2014 and December 2023 (follow-up to December 2025). Tumor rupture was defined by preoperative CT findings (peritumoral effusion, hemorrhage, or peritoneal nodules), intraoperative capsular breach/spillage, or pathological confirmation. Event-free survival (EFS) and overall survival (OS) were estimated using Kaplan–Meier methods and compared with the log-rank test. Multivariable Cox regression identified independent prognostic factors. Results: Tumor rupture occurred in 17 patients (15.3%). Ruptured cases were older (median 4.2 vs. 3.5 years, p = 0.03), had larger tumors (13.7 vs. 11.7 cm, p = 0.01), and presented with lower hemoglobin (7.9 vs. 10.4 g/dL, p < 0.001). All ruptured cases were stage III/IV, with 41% having distant metastases at diagnosis. Five-year EFS was 44.1% vs. 75.8% (p = 0.025) and OS was 58.2% vs. 81.4% (p = 0.002) for ruptured vs. non-ruptured groups. On multivariable analysis, rupture independently predicted death (HR 17.62, 95% CI 2.69–115.48, p = 0.003) and relapse (HR 8.1, 95% CI 1.66–39.57, p = 0.01). Conclusion: WT rupture is associated with advanced disease at presentation and significantly inferior survival. Substantial discordance between preoperative radiological/intraoperative findings and post-chemotherapy pathology highlights the “masking effect” of neoadjuvant chemotherapy. A multidisciplinary approach integrating initial imaging, surgical notes, and histology is essential to avoid undertreatment in SIOP-based protocols.

Background: An inferior vena cava thrombus (IVCT) occurs in approximately 4–10% of Wilms tumor (WT) cases. The presence of an IVCT complicates surgical management and potentially affects patient outcomes. We reviewed all patients with a WT with and without an IVCT treated at our center, comparing their characteristics and outcome. Patients and Methods: We retrospectively reviewed pediatric patients with a WT treated between November 2014 and July 2023. Patients were categorized according to the presence or absence of an IVCT. Data on demographics, clinical presentation, imaging findings, treatment modalities, and outcomes were collected. Group comparisons for categorical data were carried out using Chi-square tests, Event-free survival (EFS) and overall survival (OS) were estimated using Kaplan–Meier curves, and differences between groups were assessed with the log-rank test. Results: Among 110 children with a unilateral WT, 17 (15.4%) had an IVCT at presentation. Their median age at diagnosis was 4.2 years. Females predominated (65%) and 11 (65%) had distant metastasis. Thrombus levels were infra-hepatic (52.9%), retro-hepatic (23.6%), supra-hepatic (5.9%), and intra-cardiac (17.6%). Thrombus resolution following neo-adjuvant chemotherapy was achieved in 41.2% of patients, most frequently in infra-hepatic thrombi. Local control followed neo-adjuvant chemotherapy that included doxorubicin. Favorable histology was observed in 70% of patients with an IVCT. Compared with patients without an IVCT, children with an IVCT tend to present at an older age, have hematuria, a larger tumor, positive lymph node (LN) involvement, and metastatic disease (p value, 0.019, 0.008, 0.01, 0.014, and 0.002, respectively). On univariable analysis, older age, the presence of metastatic disease, IVCT, LN involvement, and diffuse anaplasia were associated with inferior EFS and OS. Five-year EFS and OS were significantly lower in patients with IVCT compared to those without (51% ± 12.5% vs. 74.5% ± 4.6%, p = 0.021 and 53.8% ± 15.4% vs. 82% ± 4.9%, p = 0.012, respectively). Conclusions: We observed a higher proportion of IVCT than previously reported. Consistent with prior studies, an IVCT was associated with more aggressive disease features. Although survival was worse in patients with an IVCT, the mere presence of a thrombus as an independent prognostic factor requires evaluation in larger patient cohorts.

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.

Background: Tumor volume in Wilms tumor (WT) guides risk stratification under the International Society of Pediatric Oncology (SIOP) protocol. While the radiological ellipsoid formula is the current protocol-specified reference method, modalities such as planimetry, intraoperative specimen weight, and pathological volume are often used interchangeably in practice without systematic evaluation. Methods: We reviewed 60 pediatric WT patients. Three measurements were compared against the SIOP-standard radiological ellipsoid volume: radiological planimetry, intraoperative specimen weight, and pathological tumor volume. Pearson and Spearman correlations and Bland–Altman analysis were performed. Results: Radiological planimetry showed near-perfect correlation with the SIOP ellipsoid (Pearson r = 0.993, p < 0.001; mean bias +21.1 cm³, 95% limits of agreement −82.8 to +124.9 cm³, percentage bias +6.1%). Intraoperative specimen weight (r = 0.730) and pathological tumor volume (r = 0.594) showed moderate-to-good correlations but wide limits of agreement and systematic biases of +46.6% and −34.1%, respectively. At the critical 500 cm³ treatment threshold, ellipsoid and planimetry showed 100% concordance. However, using pathology volume would have produced discordant (lower) risk categorization for 47% of ellipsoid-defined high-risk patients, a discordance whose clinical treatment implications were not directly assessed in this study. Conversely, relying on intraoperative weight would have upstaged 9.1% of patients to a higher risk category, which could correspond to a more intensive treatment category, including doxorubicin, under the SIOP protocol; whether this would translate into unnecessary treatment in practice was not directly assessed in this study. Conclusions: Radiological planimetry is a highly reliable surrogate for the SIOP ellipsoid formula across all stages and histologies. Intraoperative weight and pathological volume exhibit significant systematic biases and should not be used to revise radiological risk groups. These findings support continued anchoring of SIOP risk stratification to preoperative radiological volumetry, consistent with the currently validated protocol threshold, to avoid unintended deviations in treatment intensity.