Libyan International Journal of Oncology

Hypercalcemia of Malignancy and Malignancy-Associated Kidney Damage: A Comprehensive Narrative Review with Clinical Relevance

Elmukhtar Habas — 2026-06-15

Hypercalcemia of malignancy (HCM) is a common paraneoplastic syndrome occurring in 10–30% of patients with advanced cancer. It is associated with significant morbidity and poor prognosis. This narrative review examines the mechanisms of HCM, its clinical presentation, diagnostic approach, and current management strategies, with particular emphasis on the interplay with kidney damage. Renal impairment both results from and exacerbates hypercalcemia, creating a vicious cycle that complicates therapy. Evidence-based recommendations, including those from the 2023 Endocrine Society Clinical Practice Guideline, highlight the role of hydration, antiresorptive agents (bisphosphonates and denosumab), and treatment of the underlying malignancy. Multidisciplinary collaboration between oncologists and nephrologists is essential for optimizing outcomes in patients with concurrent acute kidney injury or chronic kidney disease. Early recognition and mechanism-specific therapy can reverse renal dysfunction in many cases and improve quality of life.

Brain Tumor-Related Epilepsy: A Comprehensive Review of Pathophysiology, Molecular Biomarkers, Surgical Outcome, and What is the New Frontier in Clinical Management

Einass Ragab — 2026-06-15

Brain Tumor-Related Epilepsy (BTRE) is a complex clinical challenge at the intersection of oncology and neurology, significantly impacting patients' quality of life. Seizure prevalence is estimated between 30% and 50% in adults with brain tumors, reaching up to 80% in specific tumor types. This comprehensive literature review aims to synthesize and analyze the current knowledge on BTRE, focusing on its epidemiology and clinical correlations, molecular and pathophysiological mechanisms, and therapeutic strategies. The analysis revealed that Low-Grade Gliomas (LGGs) and Long-Term Epilepsy-Associated Tumors (LEATs), such as Ganglioglioma (GG) and Dysembryoplastic Neuroepithelial Tumor (DNT), are the most epileptogenic, particularly when localized in the temporal or frontal lobes. The review also underscored the pivotal role of modern molecular classification (WHO 2021), where genetic mutations like BRAF V600E and IDH play a direct role in epileptogenesis. Pathophysiologically, an "Epileptogenic Niche" forms in the peritumoral microenvironment, characterized by neurotransmitter imbalance (glutamate excess and GABA deficiency), neuroinflammation, and Blood-Brain Barrier (BBB) disruption. Shared molecular pathways, including PI3K/AKT/mTOR and RAS-RAF-MAPK, contribute to both tumor growth and neuronal hyperexcitability. In clinical management, drug-drug interactions between Antiseizure Medications (ASMs) and chemotherapy pose a major challenge. Enzyme-Inducing ASMs (EIAEDs) are discouraged in favor of Non-Enzyme-Inducing ASMs (NEIAEDs) like Levetiracetam. Surgical resection of the tumor remains the most effective treatment for seizure control, especially for LEATs, often requiring extended resection to achieve long-term seizure freedom. This review emphasizes the necessity of a multidisciplinary and personalized therapeutic approach to improve outcomes for patients with BTRE.

Pleural Schwannoma: An Uncommon Cause of Intrathoracic Mass — A rare Case Report

Theeb Sulaiman — 2026-06-15

A woman in her 40s was incidentally found to have a right-sided pleural-based mass on imaging. Further evaluation with contrast-enhanced computed tomography (CT) of the chest, followed by CT-guided percutaneous biopsy, was undertaken. Histopathological analysis confirmed the diagnosis of a schwannoma, a rare, slow-growing benign tumor arising from Schwann cells—the principal glial cells of the peripheral nervous system responsible for supporting nerve fibers. Primary pleural schwannomas are uncommon, accounting for approximately 1–2% of all thoracic tumors, and are thought to originate from the autonomic nerve sheath within the pleura. The patient was referred to thoracic surgery, where definitive surgical resection was recommended and is currently pending.

Unusual Initial Presentation of Primary Lung Adenocarcinoma as a Metastatic Sigmoid Colon Lesion: A Rare Case Report

Theeb Sulaiman — 2026-06-15

Metastatic spread of primary lung adenocarcinoma to the colon is rare, with initial presentation as a colonic lesion being exceptionally uncommon. Differentiating primary colorectal adenocarcinoma from metastatic pulmonary adenocarcinoma poses a diagnostic challenge due to overlapping clinical and histopathological features. We describe the case of a 60-year-old man who presented with nonspecific abdominal symptoms and was found to have a sigmoid colon mass on colonoscopic evaluation. Histopathological analysis revealed adenocarcinoma, and immunohistochemical profiling supported a pulmonary origin. Subsequent thoracic imaging identified a spiculated lung mass, which on biopsy confirmed primary lung adenocarcinoma with metastatic involvement of the colon.

The Role of Progesterone (PR), Estrogen Receptors (ER), and Human Growth Factor 2 (HER2) As Early Diagnostic Markers in Women with Breast Cancer

Fathia Jaat — 2026-06-15

Breast cancer is one of the leading causes of death among women worldwide. Expression of three receptors, including estrogen receptor (ER), progesterone receptor, and human epidermal growth factor receptor 2 (HER2), plays an important role in the prognosis and treatment of breast cancer. This study aims to analyze the demographic profile of BC patients and evaluate the steroid receptor status and its association with the grading of breast cancer. A total of 124 women diagnosed with breast cancer attended the Department of the National Cancer Institute, Sabratha (NCI) from November 2024 to March 2025. Demographic and clinical data were obtained from these patients. A significant association was found in age group, marital status, family history, and body mass index. Positive expression of ER and PR was significantly higher among patients. Furthermore, an inverse relationship was revealed between positive expression of ER and PR status and HER2. Furthermore, tumor grade II was more common among the patients in our study, followed by grades III and I, and there was a significant association between grade II and positive expression of PR (P = 0.002); however, HER2 expression did not show a significant association with tumor grade. Analysis of ER, PR, and HER2 receptors has clinical importance in breast cancer prognosis and treatment response