Judi Clinical Journal
type: channel
description: Judi Clinical Journal publishes high-quality clinical research, using a rigorous double-blind peer review process to ensure accuracy. The journal releases two issues per year, each featuring at least six peer-reviewed papers. Free and accessible, it promotes knowledge dissemination while upholding excellence through thorough peer review. The journal is published by Barw, which is owned by Smart Health Tower.
publisher: barw
language: en
publication name: Judi Clinical Journal
issn: 3105-4102
items: Preoperative Thyroglobulin and Thyroid Pathologies: A Single Center Experience
items: Late-Onset Alkaptonuria in an Elderly Male: A Case Report and Literature Review
items: Male Breast Cancer: A Single Center Case Series
items: Fregoli Syndrome: A Case Report and Literature Review
items: Atypical Presentations of Pilonidal Sinus Disease: A Case Series with Literature Review
items: Challenging Management of Postoperative Empyema: A Case Report with Literature Review
items: Clinicopathological Profile of Malignant Tumors at a Tertiary Center in Iraq: A Five-Year Analysis
items: Pembrolizumab and Sarcoma: A meta-analysis
items: Multiple Concurrent Pilonidal Sinuses: Case report and Literature review
items: Provocative Tests in Diagnosis of Thoracic Outlet Syndrome: A Narrative Review
items: Thyroid Hemiagenesis: A Single-Center Case Series
items: Hyalinizing Trabecular Tumor: A Case Series with Literature Review
items: Blunt Chest Trauma and Chylothorax: A Systematic Review
items: Pediatric Adrenal Hydatid Cyst: A Case Report and Literature Review
items: Current Perspectives on Cystic Echinococcosis: A Systematic Review
items: Complex Collision Tumors: A Systematic Review

Preoperative Thyroglobulin and Thyroid Pathologies: A Single Center Experience
type: item
description: Abstract Introduction: Thyroid nodules are frequently found in the general population, though malignancy is confirmed in only a minority of cases. Distinguishing between benign and malignant nodules before surgery is vital for appropriate clinical management. The utility of preoperative serum thyroglobulin (Tg) levels as a diagnostic marker in thyroid carcinomas remains controversial. This study aimed to provide a descriptive overview of patients with markedly elevated preoperative Tg levels (>500 ng/mL) and their corresponding histopathological outcomes. Methods: A retrospective, single-center study was conducted at Smart Health Tower, which included patients who underwent surgical interventions for thyroid disorders between 2019 and 2025, with preoperative serum Tg levels exceeding 500 ng/mL. Patients were excluded if they had incomplete medical records. Patient demographics, clinical features, preoperative findings, surgical details, and final histopathology were retrieved from electronic medical records. Results: A total of 260 patients were included, predominantly female (73.08%), with a median age of 49 years (QR: 38–61). Neck swelling was the most common symptom (63.08%). Ultrasonography showed follicular nodular disease in 60.0%. Fine-needle aspiration cytology revealed Bethesda II in 20.0%, IV in 13.85%, and VI in 11.15% of cases. Total thyroidectomy was performed in 74.62% of cases. Histopathology showed benign lesions in 70.77% and malignant lesions in 29.23% of the cases. Conclusion: Preoperative Tg levels may be elevated in both benign and malignant thyroid disorders; however, Tg may not possess adequate diagnostic precision to be used as a sole indicator of malignancy. Introduction Thyroid nodules are highly prevalent in the general population, with ultrasonography identifying them in up to 60% of individuals. Despite their frequency, approximately 5% are malignant [1, 2]. Primary thyroid carcinoma is the most common endocrine malignancy and is broadly…
subject: Original Article
  topic: section
subject: Thyroglobulin
  topic: keywords
subject: Thyroid nodules
  topic: keywords
subject: Thyroid cancer
  topic: keywords
subject: Papillary thyroid carcinoma
  topic: keywords
creator: Shaho F. Ahmed
creator: Rebaz M. Ali
creator: Rawa M. Ali
creator: Ari M. Abdullah
creator: Abdulwahid M. Salih
creator: Hiwa O. Baba
creator: Rebaz O. Mohammed
creator: Aso N. Qadir
creator: Shko H. Hassan
creator: Abdullah A. Qadir
creator: Harun A. Ahmed
creator: Hawkar A. Nasralla
creator: Berun A. Abdalla
creator: Fahmi H. Kakamad
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-12
publication date: 2025-11-12
starting page: 71
ending page: 75
doi: 10.70955/JCJ.2025.9

Late-Onset Alkaptonuria in an Elderly Male: A Case Report and Literature Review
type: item
description: Abstract Introduction: Alkaptonuria (AKU) is a rare autosomal recessive metabolic disorder caused by homogentisate 1,2-dioxygenase deficiency, leading to homogentisic acid accumulation. While AKU typically presents in children and young adults, this report aims to present an unusual late-onset presentation of AKU in an elderly male. Case presentation: A 65-year-old male presented with 20 years of black skin discoloration and chronic knee and pelvic pain. Despite early signs, including dark-colored urine, the condition was repeatedly misdiagnosed as melasma and primary osteoarthritis. Computed tomography scan revealed vertebral ankylosis and sacroiliac arthritis, and histopathological examination confirmed ochronotic pigment deposition. Due to financial constraints, the patient declined joint replacement surgery and was managed with diclofenac 100 mg twice daily and dietary restrictions. Literature review: Among six case reports of AKU reviewed in the literature, selected with a focus on misdiagnosis or delayed diagnosis, the majority of cases (3/6, 50%) occurred in the 8th–9th decades of life. Although AKU affects both sexes equally, five of the six reviewed cases (83.3%) were male. Conclusion: This case highlights the unusual late-onset alkaptonuria and the risk of prolonged misdiagnosis, emphasizing the importance of early recognition and multidisciplinary management. Introduction Alkaptonuria (AKU) is a rare, autosomal recessive metabolic disorder, with an estimated prevalence ranging from 1 in 200,000-1,000,000 live births worldwide [1,2]. The primary risk factor for AKU is having two copies of the affected homogentisate 1,2-dioxygenase (HGD) gene, which requires both parents to be carriers of mutations in the HGD gene. Consanguineous marriages significantly increase the risk of AKU due to the higher probability of both parents carrying the same recessive gene inherited from a common ancestor. This is particularly evident in certain populations where consanguini…
subject: Case Reports
  topic: section
subject: Alkaptonuria
  topic: keywords
subject: Ochronosis
  topic: keywords
subject: Homogentisic acid
  topic: keywords
subject: Metabolic disorder
  topic: keywords
subject: Osteoarthritis
  topic: keywords
creator: Ronak S. Ahmed
creator: Shvan O. Siddiq
creator: Lawen J. Mustafa
creator: Rawa M. Ali
creator: Razan B. Jalal
creator: Omed M. Hussein
creator: Saywan K. Asaad
creator: Abdullah K. Ghafour
creator: Lawand A. Sharif
creator: Sasan M. Ahmed
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-24
publication date: 2025-11-24
starting page: 118
ending page: 121
doi: 10.70955/JCJ.2025.14

Male Breast Cancer: A Single Center Case Series
type: item
description: Abstract Introduction: Male breast cancer is a rare malignancy, and despite increasing its prevalence, little is known about its prognosis, and management continues to rely largely on guidelines developed for female breast cancer. This study presents a single-center experience focusing on the diagnosis, therapeutic strategies, and prognostic outcomes associated with male breast cancer. Methods: The study was carried out between May 2020 and January 2025. All the male patients diagnosed with breast cancer were identified from the center's database. The study included those with complete medical records, encompassing demographics, clinical presentation, imaging findings, outcome, and follow-up data. Results: Fifteen male breast cancer cases were analyzed (mean age 59.47 ± 12.97 years). The left breast was affected in 60%, and 80% presented with a painless lump. Tumor size ranged 0.6–5.4 cm (mean 2.53 ± 1.50 cm). Modified radical mastectomy was performed in 86.66%. Invasive ductal carcinoma predominated (93.33%), with lymph node involvement in 40% and bone metastasis in 6.67%. Immunohistochemistry results were available for 5 patients (33.33%); all of them were estrogen receptor and progesterone receptor positive and human epidermal growth factor receptor 2 negative. Adjuvant chemotherapy and radiotherapy were used in 33.33%, while 20% received triple modality therapy. Mean follow-up was 2.8 ± 1.52 years (range 1–5), with one recurrence. Conclusion: Male breast cancer may present as a breast mass and is often diagnosed as invasive ductal carcinoma. Modified radical mastectomy accompanied by adjuvant therapy might offer favorable outcomes. Introduction Male breast cancer (MBC) is a rare condition, representing about 1% of all malignancies in men and of all breast cancer cases globally. Moreover, MBC accounts for less than 0.2% of cancer-related mortality among men. Breast cancer occurs less frequently in males, with a male-to-female ratio of approximately 1:100. This lo…
subject: Original Article
  topic: section
subject: Male breast cancer
  topic: keywords
subject: Invasive ductal carcinoma
  topic: keywords
subject: Mastectomy
  topic: keywords
subject: Wide local excision
  topic: keywords
subject: Chemotherapy
  topic: keywords
creator: Abdulwahid M. Salih
creator: Lana RA. Pshtiwan
creator: Fattah H. Fattah
creator: Ari M. Abdullah
creator: Rebaz M. Ali
creator: Rebaz O. Mohammed
creator: Hiwa O. Baba
creator: Ahmed H. Ahmed
creator: Sakar O. Arif
creator: Nasren S. Sabr
creator: Shko H. Hassan
creator: Harzal H. Fatih
creator: Masty K. Ahmed
creator: Meer M. Abdulkarim
creator: Hiwa O. Abdullah
creator: Fahmi H. Kakamad
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-15
publication date: 2025-11-15
starting page: 83
ending page: 88
doi: 10.70955/JCJ.2025.11

Fregoli Syndrome: A Case Report and Literature Review
type: item
description: Abstract Introduction: Fregoli syndrome is a rare misidentification disorder that can disrupt behavior, endanger safety, and impair quality of life. Its occurrence in young adults is exceptionally uncommon. This report presents a case of Fregoli delusion in a young adult without the usual underlying causes, such as schizophrenia. Case presentation: A 25-year-old male presented with a two-month history of persecutory delusions, believing that strangers, friends, and professors were disguising themselves to follow and harass him. His psychiatric history was unremarkable, and there was no family history of mental illness. The patient was diagnosed with Fregoli delusion and prescribed Risperidone 2 mg/day, alongside cognitive-behavioral therapy to challenge his delusions. After three months of treatment, he showed gradual improvement, with reduced intensity of delusions but occasional paranoid thoughts. Literature review: Seven cases of Fregoli delusion were reviewed. Patient ages ranged from 43 to 77 years, with predominant female prevalence (71.4%). Psychiatric histories included delusional schizophrenia, paranoid schizophrenia, and unspecified psychiatric conditions. Medical histories included hypertension, myocardial infarction, Parkinson’s, and diabetes mellitus. Presenting symptoms varied with delusional misidentification, auditory/visual hallucinations, suicidal ideations, delirium, and paranoia. Treatment approaches included risperidone alone or in combination with electroconvulsive therapy, aripiprazole & promazine, and more. Symptom improvement was seen in four cases, and one case achieved full resolution of symptoms. Conclusion: Fregoli syndrome is a rare condition of multiple etiologies that can present in young patients. Risperidone, combined with cognitive behavioral therapy, may yield fruitful results. Introduction Delusional Misidentification Syndrome (DMS) is typically classified into three main types: Capgras syndrome, Fregoli syndrome, and intermetamo…
subject: Case Reports
  topic: section
subject: Fregoli delusion
  topic: keywords
subject: Schizophrenia
  topic: keywords
subject: Delusional misidentification syndrome
  topic: keywords
subject: Antipsychotic
  topic: keywords
subject: Cognitive behavioral therapy
  topic: keywords
creator: Yadgar N. Abbas
creator: Fattah H. Fattah
creator: Hemin S. Mohammed
creator: Meer M. Abdulkarim
creator: Jihad I. Hama
creator: Amr M. Mahmood
creator: Hussein M. Hamasalih
creator: Shvan H. Mohammed
creator: Berun A. Abdalla
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-25
publication date: 2025-11-25
starting page: 122
ending page: 125
doi: 10.70955/JCJ.2025.15

Atypical Presentations of Pilonidal Sinus Disease: A Case Series with Literature Review
type: item
description: Abstract Introduction: Pilonidal sinus (PNS) typically arises in the sacrococcygeal region but can occasionally present in atypical locations, including the axilla, intermammary region, umbilicus, interdigital web, and neck, often leading to delayed diagnosis and suboptimal management. This study aims to examine clinical features, surgical management, and outcomes of PNS in these uncommon sites. Methods: This retrospective case series was conducted at a single center over eight years and examined patients with extra-sacrococcygeal PNS confirmed by histopathology. Clinical, surgical, and follow-up data were retrieved from patient records. Data were analyzed using SPSS 25.0 and presented as descriptive statistics (frequencies, percentages, means, and ranges). Results: This study included 4 patients, with an equal sex distribution (2 females, 50%; 2 males, 50%) and a mean age of 24 years (range: 16–31). Presenting symptoms included discharge, itching, pain, redness, and mass formation. None had significant past medical history, and one patient (25%) had prior surgery at the same site. Affected sites were equally distributed: breast (25%), axilla (25%), penile (25%), and scalp (25%). All patients underwent surgical intervention, and histopathology revealed tracts lined with epidermis, surrounded by mixed inflammatory cells, foreign body giant cells, and hair shafts in granulation tissue. During the follow-up period (mean follow-up: 13.5 months), no recurrence was observed. Conclusion: Atypical presentations of PNS, although rare, can occur in diverse anatomical regions. Surgical excision with primary closure might be an effective treatment approach, potentially leading to favorable clinical outcomes and a low recurrence rate. Introduction Pilonidal sinus (PNS) is a common inflammatory disorder that typically occurs in the natal cleft, resulting from hair penetration into the skin, forming a tract lined with granulation tissue, which may develop into a pus-filled cavity …
subject: Original Article
  topic: section
subject: Pilonidal sinus
  topic: keywords
subject: Discharge
  topic: keywords
subject: Atypical presentation
  topic: keywords
subject: Histopathological examination
  topic: keywords
creator: Shaban Latif
creator: Hemn H. Kaka Ali
creator: Deari A. Ismaeil
creator: Karzan M. Salih
creator: Ayman M. Mustafa
creator: Shko H. Hassan
creator: Kayhan A. Najar
creator: Harun A. Ahmed
creator: Abdullah A. Qadir
creator: Bushra O. Hussein
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-13
publication date: 2025-11-13
starting page: 76
ending page: 82
doi: 10.70955/JCJ.2025.10

Challenging Management of Postoperative Empyema: A Case Report with Literature Review
type: item
description: Abstract Introduction: Pleural empyema is the collection of pus within the pleural cavity, typically arising as a complication of pneumonia, chest trauma, thoracic surgery, or bacterial invasion of the pleural space. This report presents a case of post-surgical pleural empyema caused by Pseudomonas aeruginosa, successfully managed with a targeted combination of fosfomycin and colistin, with intrapleural lavage. Case presentation: A 37-year-old male developed epigastric pain 12 days after a laparoscopic near-total gastrectomy. A chest computed tomography scan revealed a right-sided pleural empyema. Ultrasound-guided drainage was performed, followed by the intrapleural instillation of alteplase to facilitate breakdown of the loculated empyema. Pseudomonas aeruginosa was identified as the causative agent. Based on antimicrobial susceptibility, the patient received intravenous fosfomycin and colistin, along with daily pleural lavage using colistin. Inflammatory markers declined, and the patient showed notable clinical improvement. Literature review: A review of five cases of Pseudomonas aeruginosa pleural empyema was conducted, including two carbapenem-resistant and one extensively drug-resistant case. The mean patient age was 53.8 years, and 60% (3/5) were female. Four of the five cases (80%) were confirmed using computed tomography, and all patients received antimicrobial therapy, most frequently ceftolozane/tazobactam (60%), ciprofloxacin (60%), and colistin (40%). Surgical management was required in 60% of cases, whereas bacteriophage therapy was utilized in 20%. During follow-up, 60% of patients remained stable, 20% experienced repeated hospital admissions during which antibacterial therapy was withheld, and 20% died due to infectious disease. Conclusion: Pleural lavage combined with antibiotics such as fosfomycin and colistin may provide an effective treatment for postoperative pleural empyema, with early intervention being critical to prevent clinical deteriorati…
subject: Case Reports
  topic: section
subject: Pleural empyema
  topic: keywords
subject: Pseudomonas aeruginosa
  topic: keywords
subject: Intrapleural lavage
  topic: keywords
subject: Colistin
  topic: keywords
subject: Antibiotic
  topic: keywords
subject: Antibiotic resistance
  topic: keywords
creator: Hemn H. Kaka Ali
creator: Abeer K. Abass
creator: Ali H. Hasan
creator: Ahmed H. Ahmed
creator: Naser A. Mohammed
creator: Twana O. Saeed
creator: Marwan N. Hassan
creator: Yadgar H. Hamakarim
creator: Deari A. Ismaeil
creator: Shvan H. Mohammed
creator: Hussein M. Hamasalih
creator: Fahmi H. Kakamad
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-27
publication date: 2025-11-27
starting page: 126
ending page: 130
doi: 10.70955/JCJ.2025.16

Clinicopathological Profile of Malignant Tumors at a Tertiary Center in Iraq: A Five-Year Analysis
type: item
description: Abstract Introduction: Cancer incidence and mortality are increasing worldwide, disproportionately affecting low- and middle-income countries due to limited healthcare access. This study aims to analyze the prevalence and clinicopathological characteristics of cancers diagnosed at a tertiary care center, offering crucial data to inform regional cancer control efforts. Methods: This retrospective study was conducted at a single tertiary center, analyzing histopathological reports from January 2020 to January 2025. Data were collected from digital and physical archives by a trained team, including only confirmed malignant diagnoses. Variables extracted included patient demographics, cancer types, tumor characteristics, and procedure details. Data integrity was ensured through double-entry and expert review. Statistical analysis using SPSS 27.0 summarized categorical variables as frequencies, percentages and continuous variables as means or medians. Results: A total of 9,375 cases were analyzed (median age 48 years), with females comprising 75.74% (7,101 cases). The age-standardized incidence rate was 82.20 per 100,000. Head and neck cancers accounted for 2,903 cases (30.97%), primarily thyroid (2,208 cases), followed by thoracic malignant tumors with 2,556 cases (27.26%). Invasive ductal carcinoma was most frequent cancer type (2,392 cases, 25.5%). Larger tumors correlated significantly with positive margins and lymph node involvement (p < 0.05). Conclusion: The study highlights a unique cancer profile, with younger age at diagnosis and higher rates of head, neck, and thyroid cancers. These findings underscore the need for targeted screening and prevention strategies adapted to regional healthcare systems. Introduction Cancer remains one of the foremost causes of morbidity and mortality globally, representing a growing public health challenge of increasing magnitude and complexity. According to the International Agency for Research on Cancer, an estimated 20 million n…
subject: Original Article
  topic: section
subject: Cancer epidemiology
  topic: keywords
subject: Histopathology
  topic: keywords
subject: Thyroid cancer
  topic: keywords
subject: Breast cancer
  topic: keywords
creator: Fahmi H. Kakamad
creator: Berun A. Abdalla
creator: Dahat A. Hussein
creator: Fakher Abdullah
creator: Ayman M. Mustafa
creator: Sabah J. Hasan
creator: Mohammed S. Ezzat
creator: Harem S. Amin
creator: Lanya Q. Rashid
creator: Muhammad A. Khdir
creator: Danyar G. HamaSaeed
creator: Hussein H. Rasul
creator: Akam R. Ahmed
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-18
publication date: 2025-11-18
starting page: 89
ending page: 98
doi: 10.70955/JCJ.2025.12

Pembrolizumab and Sarcoma: A meta-analysis
type: item
description: Abstract Introduction: Pembrolizumab is a monoclonal antibody that promotes antitumor immunity. This study presents a systematic review and meta-analysis of the efficacy and safety profile of this treatment as monotherapy or in combination with other drugs for the treatment of sarcomas. Methods: A literature search was conducted across Google Scholar, PubMed/MEDLINE, and EMBASE from February 15th to April 15th. Eligible studies were clinical trials that reported efficacy or outcomes of pembrolizumab in sarcoma patients, either alone or in combination with other drugs. In contrast, those lacking sufficient data or not meeting trial criteria were excluded. Results: Ten clinical trials met the eligibility criteria, including 419 sarcoma patients (53.7% male; median age 55.4). Pembrolizumab was administered either as monotherapy in 23% of cases or in combination with other agents in 77% of cases. The progressive disease rate was 83% with monotherapy and 36% with combination therapy. Objective response rates varied, with the highest observed in the pembrolizumab plus talimogene laherparepvec combination (35%) and the lowest in pembrolizumab monotherapy (ranging from 0% to 11.2%). Median progression-free survival ranged from 1.4 (Pembrolizumab + Cyclophosphamide) to 7.8 months (Pembrolizumab + Lenvatinib in undifferentiated pleomorphic sarcoma). Combination therapy was associated with significantly better tumor response (<0.001). However, rates of endocrine, gastrointestinal, some hepatic, and dermatological adverse events were significantly associated with combination therapy compared to monotherapy (p < 0.05). Conclusion: Pembrolizumab-based combination therapies have the potential to enhance treatment efficacy in sarcoma, although they may be associated with an increased risk of adverse events. Introduction Sarcomas are rare tumors that develop from mesenchymal tissue and are known for their diverse histological subtypes. Although they are uncommon, they carry particul…
subject: Review Articles
  topic: section
subject: Pembrolizumab
  topic: keywords
subject: Immunotherapy
  topic: keywords
subject: Chemotherapy
  topic: keywords
subject: Sarcoma
  topic: keywords
subject: Programmed cell death protein
  topic: keywords
subject: Monoclonal antibody
  topic: keywords
creator: Rebaz M. Ali
creator: Sami S. Omar
creator: Shalaw H. Abdalla
creator: Fattah H. Fattah
creator: Shnya R. Hamalaw
creator: Hussein M. Hamasalih
creator: Ayman M. Mustafa
creator: Sanaa O. Karim
creator: Yousif M. Mahmood
creator: Meer M. Abdulkarim
creator: Ahmed G. Hamasaeed
creator: Dana O. Karim
creator: Abdullah D. Ahmad
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-06-29
publication date: 2025-06-29
starting page: 51
ending page: 62
doi: 10.70955/JCJ.2025.6

Multiple Concurrent Pilonidal Sinuses: Case report and Literature review
type: item
description: Abstract Introduction: Concurrent pilonidal sinuses (PNSs) at distinct locations are extremely rare. This report highlights an exceptional case of a young female presenting with three PNSs in distinct locations. Case presentation: A 19-year-old female with a family history of PNS presented with a chronic, discharging sinus tract in the intermammary region that had persisted for two years. Physical examination revealed an erythematous lesion with intermittent purulent and bloody discharge, leading to a diagnosis of intermammary PNS (IMPNS). Surgical excision was performed, and histopathology confirmed the diagnosis. Six weeks postoperatively, the patient’s wound had completely healed; however, she mentioned symptoms in the umbilical and sacrococcyx regions that had been intermittent for the past year. Further evaluation led to diagnoses of natal cleft PNS (NCPNS) and umbilical PNS (UPNS). NCPNS was scheduled for surgical treatment, while UPNS was managed conservatively. Histopathology confirmed chronic sinus tract formation in both cases. Literatue review: Nine cases of PNS were reviewed, six of which were males. Two of them had recurrent discharging sinuses, and no family history of PNS was reported. Locations included gluteal, auricular, mammary, cheeks, and umbilical regions. Discharge was present in all of the cases, accompanied by pain in two. Sinus excision was performed for all the cases, accompanied by laser epilation in one. Healing modalities included secondary intention and various dressings. Conclusion: It is extremely rare for NCPNS, UPNS, and IMPNS to occur concurrently. Surgical management for NCPNS and IMPNS, combined with conservative treatment for UPNS, may lead to favorable outcomes. Introduction The term "pilonidal sinus" (PNS) was first introduced by Hodges in 1880. However, the condition was initially described by Anderson in 1847 as "hair extracted from an ulcer" [1]. PNS is an inflammatory disorder that occurs when hair penetrates the epidermi…
subject: Case Reports
  topic: section
subject: Pilonidal sinus
  topic: keywords
subject: Intermammary
  topic: keywords
subject: Umbilical
  topic: keywords
subject: Non-sacrococcygeal
  topic: keywords
subject: Sinus tract
  topic: keywords
creator: Emad S. Siddiq
creator: Shko H. Hassan
creator: Abdullah A. Qadir
creator: Meer M. Abdulkarim
creator: Ibrahim H. Qader
creator: Khalis Z. Hamad
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-06-30
publication date: 2025-06-30
starting page: 67
ending page: 70
doi: 10.70955/JCJ.2025.8

Provocative Tests in Diagnosis of Thoracic Outlet Syndrome: A Narrative Review
type: item
description: Abstract Thoracic outlet syndrome (TOS) is a group of conditions caused by the compression of the neurovascular bundle within the thoracic outlet. It is classified into three main types based on the affected structure: neurogenic, arterial, and venous TOS. Diagnosis remains challenging due to symptom overlap with other conditions and a lack of universally accepted criteria. Provocative tests are integral to clinical evaluation, aiming to reproduce symptoms by stressing anatomical structures prone to compression. This review evaluates the commonly used provocative tests for TOS, analyzing their diagnostic performance, limitations, and clinical utility. Individual provocative tests vary widely in diagnostic performance. The Roos test demonstrates high sensitivity but poor specificity, while tests like the Cyriax Release and Wright’s hyperabduction offer better specificity at the cost of sensitivity. Most tests show significant overlap in symptom reproduction with other upper limb or cervical pathologies, contributing to high false-positive rates. Combining multiple tests improves diagnostic accuracy but still falls short of a definitive standard. While provocative tests are valuable for screening and clinical assessment of TOS, their standalone diagnostic reliability is limited. A multimodal approach integrating clinical examination, imaging, and electrodiagnostic studies is essential for improving diagnostic confidence and patient outcomes. Future research should aim to standardize testing protocols and validate findings through large-scale, population-based studies. Introduction Thoracic outlet syndrome (TOS) is a group of conditions characterized by the compression of the neurovascular bundle within the thoracic outlet [1]. Based on the affected structure, TOS is categorized into three primary types: neurogenic (nTOS), arterial (aTOS), and venous (vTOS) [2]. The most common subtype is nTOS, representing more than 90% of cases, and is more frequently observed in fem…
subject: Review Articles
  topic: section
subject: Neurogenic TOS
  topic: keywords
subject: Neurovascular compression
  topic: keywords
subject: Upper limb
  topic: keywords
subject: Clinical examination
  topic: keywords
subject: Thoracic outlet
  topic: keywords
creator: Fahmi H. Kakamad
creator: Berun A. Abdalla
creator: Saywan K. Asaad
creator: Hawkar A. Nasralla
creator: Abdullah K. Ghafour
creator: Hiwa S. Namiq
creator: Nasren S. Sabr
creator: Yadgar N. Abbas
creator: Lawen J. Mustafa
creator: Omed M. Hussein
creator: Azad S. Hattam
creator: Choman S. Omer
creator: Sakar O. Arif
creator: Ahmed H. Ahmed
creator: Ali D. Sadullah
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-06-22
publication date: 2025-06-22
starting page: 46
ending page: 50
doi: 10.70955/JCJ.2025.5

Thyroid Hemiagenesis: A Single-Center Case Series
type: item
description: Abstract Introduction: Thyroid hemiagenesis (TH) is a rare congenital anomaly characterized by the complete absence of one thyroid lobe, with or without absence of the isthmus. Its etiology remains unclear, and epidemiological data are limited. Although TH is often asymptomatic and discovered incidentally, it may pose clinical challenges when accompanied by thyroid dysfunction or structural abnormalities. This study reviews a single-center experience in diagnosing this condition and highlights its clinical significance.. Methods: This single-center case series was conducted from July 2021–July 2024, analyzing TH cases confirmed via ultrasonography. Eligible patients had complete medical records, including demographics, clinical presentation, radiological findings, and thyroid function status. Data were retrieved from electronic records and analyzed using SPSS 27.0, employing descriptive statistics to summarize means, ranges, frequencies, and percentages, ensuring a comprehensive assessment of TH’s clinical and epidemiological characteristics.. Results: This study analyzed 11 patients with TH (mean age: 28.12 ± 18.14 years; range: <1–55 years), seven of whom were females (63.6%). The diagnosis was incidental in six cases (54.5%), while three (27.3%) presented with neck swelling and two (18.2%) with neck pain. Thyroid function was euthyroid in seven (63.6%), hyperthyroid in two (18.2%), and hypothyroid in two (18.2%). Ultrasound examination confirmed left lobe and isthmus agenesis in eight cases (72.7%). Follow-up ranged from 4 to 48 months. Conclusion: This study confirms the female predominance of TH, with left-lobe absence being the most common. Congenital anomalies suggest embryological links. While thyroid function is typically preserved, those with hypo- and hyperthyroidism highlight the need for individualized endocrine assessment and monitoring. Introduction Thyroid hemiagenesis (TH), first described in 1852, is characterized by the absence of one thyroid lobe…
subject: Original Article
  topic: section
subject: Thyroid dysgenesis
  topic: keywords
subject: One lobe thyroid
  topic: keywords
subject: Congenital thyroid anomaly
  topic: keywords
subject: Hemi agenesis
  topic: keywords
subject: Ultrasonography
  topic: keywords
creator: Abdulwahid M. Salih
creator: Hiwa O. Baba
creator: Shaho F. Ahmed
creator: Karzan M. Salih
creator: Abdullah A. Qadir
creator: Ayman M. Mustafa
creator: Shko H. Hassan
creator: Harun A. Ahmed
creator: Aras J. Qaradakhy
creator: Rebaz O. Mohammed
creator: Aso N. Qadir
creator: Ahmed H. Ahmed
creator: Dindar H. Hama
creator: Rawand R. Rafiq
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-06-10
publication date: 2025-06-10
starting page: 7
ending page: 11
doi: 10.70955/JCJ.2025.3

Hyalinizing Trabecular Tumor: A Case Series with Literature Review
type: item
description: Abstract Introduction: Hyalinizing trabecular tumor (HTT) is a rare thyroid neoplasm originating from follicular cells and poses diagnostic challenges due to its cytologic and histologic overlap with other thyroid malignancies. This study aims to present the clinical features and management of HTT cases treated at a single center. Methods: This was a single-center retrospective case series. The patients were included from January 2019 to November 2024. Data collection took place over one month, from November 15, 2024, to December 15, 2024. The study included patients with HTT whose diagnoses were confirmed histopathologically. Results: The case series included 11 patients, predominantly female, 10 (90.9%), with a mean age of 50.7±19.01 years. The most common presenting symptom was anterior neck swelling, recorded in 5 (45.5%), while one case (9.1%) was discovered incidentally. Hyperthyroidism was present in 6 (54.5%). The tumors were distributed within the thyroid gland as follows: left lobe in 5 (45.5%) cases, right lobe in 4 (36.4%) cases, and isthmus in 2 (18.1%) cases. Total thyroidectomy was performed in 7 patients (63.6%), with tumor sizes ranging from 0.5 to 5.5 cm and a mean diameter of 2.6 ± 2.05 cm. All diagnoses were confirmed postoperatively through histopathological examination. Conclusion: A rare benign tumor, HTT remains challenging to diagnose accurately. Both total thyroidectomy and lobectomy may result in good outcomes. Introduction Thyroid neoplasms include a wide range of lesions with varying behavior and prognosis [1]. They are generally classified as benign, low-grade malignant, or malignant. Benign tumors, such as adenomas, are common and usually do not cause symptoms. Low-grade malignant neoplasms, like follicular thyroid carcinoma, tend to be more aggressive but often have a good prognosis [2]. Hyalinizing trabecular tumor (HTT) of the thyroid was first identified in 1987. It accounts for approximately 1% of all thyroid tumors, occurs six ti…
subject: Original Article
  topic: section
subject: Hyalinizing trabecular adenoma
  topic: keywords
subject: Hyalinizing trabecular tumor
  topic: keywords
subject: Lobectomy
  topic: keywords
subject: Thyroid neoplasm
  topic: keywords
subject: Thyroidectomy
  topic: keywords
creator: Abdulwahid M. Salih
creator: Rebaz O. Mohammed
creator: Hiwa O. Baba
creator: Shko H. Hassan
creator: Muhammed Bag A. Ali
creator: Imad J. Habibullah
creator: Imad S. Sedeeq
creator: Dyari Q. Hamad
creator: Karokh K. Mohammed
creator: Marwan N. Hassan
creator: Abdullah A. Qadir
creator: Harun A. Ahmed
creator: Meer M. Abdulkareem
creator: Fahmi H. Kakamad
creator: Hero KH. Mala
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-05-24
publication date: 2025-05-24
starting page: 1
ending page: 6
doi: 10.70955/JCJ.2025.2

Blunt Chest Trauma and Chylothorax: A Systematic Review
type: item
description: Abstract Introduction: Although traumatic chylothorax is predominantly associated with penetrating injuries, instances following blunt trauma, as a rare and challenging condition, are being increasingly documented. This study aims to systematically review the reported cases of blunt chest traumatic chylothorax (BCTC) and provide comprehensive insights into the condition. Methods: Related studies published until December 11, 2024, were identified through Google Scholar. All studies documenting instances of BCTC, without restriction on cause or patient demographics, were included. Studies were excluded if they focused on chylothorax caused by penetrating injuries, their content was unretrievable, they were review articles, or they were published in blacklisted journals. Results: Sixty-five eligible studies, encompassing 69 cases of BCTC, were included in the review. It predominantly affected males (73.91%), with patient ages ranging from 11 months to 84 years old. The most common clinical findings were dyspnea (47.83%) and abnormal auscultation or percussion (34.78%), with road traffic accidents as the primary cause (59.42%). Unilateral chylothorax was found in 72.46% of cases, bilateral chylothorax occurred in 27.54%, and pleural effusion was the most frequent radiological finding (55.07% in X-ray and 33.33% in computed tomography). Treatment typically included drainage (94.20%), parenteral nutrition (50.72%), and thoracic duct closure (39.13%). Most patients achieved complete recovery (89.85%), and six cases (8.70%) died. Conclusion: The condition is rare and complex, underscored by the wide variability in patient demographics, clinical presentations, chylothorax onset, and management approaches. Given the challenges posed by limited evidence, the findings emphasize the need for early recognition and individualized management strategies. Introduction Chylothorax is a rare condition characterized by the accumulation of chyle in the pleural cavity caused by a disrupti…
subject: Review Articles
  topic: section
subject: Blunt trauma
  topic: keywords
subject: Chyle
  topic: keywords
subject: Chylothorax
  topic: keywords
subject: Chest trauma
  topic: keywords
subject: Thoracic duct
  topic: keywords
subject: Road traffic accident
  topic: keywords
creator: Hiwa O. Abdullah
creator: Fahmi H. Kakamad
creator: Harem K. Ahmed
creator: Bnar J. Hama Amin
creator: Hadi M. Abdullah
creator: Shvan H. Mohammed
creator: Berun A. Abdalla
creator: Sasan M. Ahmed
creator: Marwan N. Hassan
creator: Sarhang S. Abdalla
creator: Yousif M. Mahmood
creator: Kayhan N. Najar
creator: Suhaib H. Kakamad
creator: Bander A. Abdalla
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-06-10
publication date: 2025-06-10
starting page: 27
ending page: 45
doi: 10.70955/JCJ.2025.4

Pediatric Adrenal Hydatid Cyst: A Case Report and Literature Review
type: item
description: Abstract Introduction: Echinococcosis is a zoonotic disease that can affect various organs and tissues in the human body. However, primary adrenal hydatid cyst (AHC) is rare and may be overlooked, making its early detection crucial. This report presents a case of an incidentally diagnosed primary AHC. Methods: A 5-year-old female with an unremarkable medical history underwent abdominal ultrasonography for assessment of an inguinal hernia, and a right adrenal lesion was incidentally discovered. Intraoperatively, the lesion was suspected to be AHC, which was later confirmed by histopathology. Results: The 10 cases of AHC that were reviewed had a mean age of 46.2 ± 12.2 years; six patients were male. Three cases had a history of contact with animals. No laterality differences were observed, and the mean cyst size was 7.45 ± 2.7 cm. Flank pain was the most common symptom (3 of 10), and surgery was performed for all the cases, accompanied by antiparasitic drugs in five cases. No cases of recurrence were reported. Conclusion: Primary AHC can be easily overlooked or misdiagnosed as an adrenal mass, often being identified incidentally during investigations for unrelated health concerns. Surgical excision of the cyst without rupture may yield favorable results. Introduction Echinococcosis is a widely recognized zoonotic disease caused by the larval form of the tapeworm Echinococcus granulosus [1]. Although the disease can occur globally, it is considered endemic in several regions, including the Middle East, the Mediterranean basin, parts of South America, South Africa, and Australia [1]. Humans serve as accidental intermediate hosts for the parasite, acquiring the infection through direct contact with definitive hosts (such as dogs) or via ingestion of food or water contaminated with feces that contain parasitic eggs, often originating from livestock environments involving sheep, goats, or cattle [2]. Major risk factors include close contact with dogs, involvement in livest…
subject: Case Reports
  topic: section
subject: Echinococcus
  topic: keywords
subject: Echinococcosis
  topic: keywords
subject: Hydatid cyst
  topic: keywords
subject: Adrenal
  topic: keywords
subject: Suprarenal cyst
  topic: keywords
subject: hydatidosis
  topic: keywords
creator: Wirya N. Sabir
creator: Hadeel A. Yasseen
creator: Shwan F. Abdulaziz
creator: Paiwand A. Nadr
creator: Shaho F. Ahmed
creator: Meer M. Abdulkarim
creator: Hiwa O. Abdullah
creator: Sasan M. Ahmed
creator: Sarhang S. Abdalla
creator: Kayhan A. Najar
creator: Berun A. Abdalla
creator: Fahmi H. Kakamad
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-06-30
publication date: 2025-06-30
starting page: 63
ending page: 66
doi: 10.70955/JCJ.2025.7

Current Perspectives on Cystic Echinococcosis: A Systematic Review
type: item
description: Abstract Introduction: Hydatidosis, a zoonotic disease caused by the larval stage of Echinococcus granulosus, is a significant public health concern with notable economic impact. It leads to morbidity and mortality worldwide, particularly in endemic regions. This study systematically reviews recent literature on cystic echinococcosis (CE) to provide updated insights into its prevalence, impact, and management. Methods: A systematic review was conducted using PubMed to find original articles on hydatid cysts published between September 1, 2019, and September 1, 2024. Data extracted included the first author's name, country, publication year, study type, number of cases, clinical presentation, diagnostic methods, cyst location and quantity, cyst status, treatment type and medications, follow-up details, recurrence, and mortality rates. Data were organized and qualitatively analyzed. Results: A total of 398 articles were identified, of which 229 articles with 1,002 patients met the inclusion criteria. Spain reported the highest number of CE cases at 362 (36.13%). Asia accounted for 487 cases (48.60%), and Europe contributed 460 cases (45.91%). The liver was the most frequently affected organ, accounting for 731 cases (72.95%), followed by the lungs with 110 cases (10.98%), and the kidney with 43 cases (4.29%). The age distribution of the cases showed that 63 (6.29%) were aged between 3 and 18 years. Conclusion: Hydatidosis remains a significant global public health concern, impacting developing and developed countries. The liver and lungs remain the primary sites of infection. Preventive strategies, including regular animal screening and enhanced public health education, are essential for controlling the spread of the disease. Introduction Cystic echinococcosis (CE), also known as hydatid disease (HD) or hydatidosis, is a well-known zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus. Humans usually act as intermediate hosts, contracting…
subject: Review Articles
  topic: section
subject: Echinococcosis
  topic: keywords
subject: Hydatidosis
  topic: keywords
subject: Hydatid cyst
  topic: keywords
subject: Echinococcus granulosus
  topic: keywords
subject: Endemic regions
  topic: keywords
creator: Hawkar A. Nasralla
creator: Berun A. Abdalla
creator: Hiwa O. Abdullah
creator: Sasan M. Ahmed
creator: Fahmi H. Kakamad
creator: Shvan H. Mohammed
creator: Rawezh Q. Salih
creator: Dahat A. Hussein
creator: Tomas M. Mikael
creator: Marwan N. Hassan
creator: Hunar A. Hassan
creator: Suhaib H. Kakamad
creator: Kayhan A. Najar
creator: Karukh K. Mohammed
creator: Diyar A. Omar
creator: Shadi H. Sidiq
creator: Fakher Abdullah
creator: Yousif M. Mahmood
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-02-02
publication date: 2025-02-02
starting page: 12
ending page: 26
doi: 10.70955/JCJ.2025.1

Complex Collision Tumors: A Systematic Review
type: item
description: Abstract Introduction: A collision tumor consists of two distinct neoplastic components located within the same organ, separated by stromal tissue, without histological intermixing. These rare tumors are usually identified incidentally in surgical specimens. This study systematically reviews complex collision tumors (those with three or more distinct histological types) to explore their features and clinical behavior. Methods: A comprehensive literature search was conducted using Google Scholar, Consensus AI, and Perplexity AI to identify all articles that describe collision tumors comprising more than two distinct pathologies. Studies lacking full texts, reviews, or those from predatory journals were excluded. Data extracted included publication details, patient demographics, clinical and diagnostic findings, tumor characteristics, treatments, outcomes, and follow-up. Findings were analyzed qualitatively and summarized using frequencies, percentages, and means with standard deviations. Results: A total of 2,798 articles were identified, and 26 studies (28 cases) met the inclusion criteria. Female patients accounted for 17 cases (60.72%), with a mean age of 63.46 ± 14.00 years. Surgery was performed in 26 cases (92.86%). Triple collision tumors were reported in 26 cases (92.86%), and quadruple collision tumors in 2 cases (7.14%). The thyroid gland was affected in 7 cases (25.00%), and papillary thyroid carcinoma was identified in 9 cases (32.14%). At the last follow-up, 22 patients (78.57%) were alive. Conclusion: Complex collision tumors represent rare and histologically diverse entities with significant diagnostic and therapeutic implications. They are most frequently found in the thyroid and skin. Accurate diagnosis typically requires comprehensive histopathological and immunohistochemical analysis of the entire lesion. Introduction A collision tumor is defined by the presence of two histologically distinct neoplastic components situated adjacent to each other wi…
subject: Review Articles
  topic: section
subject: Collision tumors
  topic: keywords
subject: Complex neoplasia
  topic: keywords
subject: Multicomponent malignancy
  topic: keywords
subject: Triple tumors
  topic: keywords
subject: Quadruple neoplasms
  topic: keywords
creator: Dua Abuquteish
creator: Mohammad A. Al-Qudah
rights: Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/
date: 2025-11-22
publication date: 2025-11-22
starting page: 99
ending page: 117
doi: 10.70955/JCJ.2025.13