Khan, Allahdad

Abstract Background: Chronic Lymphocytic Leukemia (CLL) is the most prevalent leukemia among adults in Western populations, disproportionately affecting the elderly, with a median age at diagnosis of approximately 70 years. Over the past two decades, significant advancements in therapeutic options, including Bruton tyrosine kinase (BTK) inhibitors, BCL-2 antagonists, and monoclonal antibodies, have improved clinical outcomes. However, despite these advances, limited data exist on long-term mortality trends and disparities in CLL outcomes among older adults in the United States. Understanding such patterns is critical to guiding geriatric oncology care, identifying gaps in healthcare delivery, and informing public health strategies. Methods: We conducted a population-based analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause-of-Death database. We identified all deaths among individuals aged ≥65 years from 1999 to 2020 in which CLL (ICD-10 code C91.1) was listed as the underlying cause. Mortality data were stratified by sex, age group (65–74, 75–84, ≥85), U.S. Census region, urban-rural classification, state, and place of death. We calculated crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 persons, standardized to the U.S. 2000 population. Joinpoint regression analysis was used to assess temporal trends in AAMRs and compute annual percent changes (APCs) and average annual percent changes (AAPCs), with statistical significance set at p<0.05. Results: Between 1999 and 2020, a total of 85,371 CLL-related deaths occurred among U.S. adults aged ≥65 years. The overall AAMR declined from 11.18 per 100,000 in 1999 to 7.75 in 2020, reflecting a significant downward trend (AAPC: -1.86%; 95% CI: -2.18 to -1.54; p<0.0001). Men consistently exhibited higher mortality rates (AAMR: 13.48) than women (AAMR: 6.45), though the mortality decline was more pronounced among women (AAPC: -2.10% vs. -1.65%, respectively; both p<0.0001). Regional disparities were evident, with the Midwest reporting the highest AAMR (10.63), and the West the lowest (8.71). Urbanization analysis revealed higher mortality in non-metropolitan areas (AAMR: 10.33) than metropolitan ones (AAMR: 9.08), though both experienced significant declines over time. Age-stratified analysis showed the steepest declines in the 65–74 age group (AAPC: -3.91%; p<0.0001), followed by those aged 75–84 years (AAPC: -1.96%) and ≥85 years (AAPC: -0.25%). States with the highest mortality included Minnesota, Iowa, and South Dakota, while Hawaii, Nevada, and New Mexico had the lowest. Most deaths occurred in medical facilities (43.8%), followed by home (26.7%), nursing homes/long-term care (19.5%), and hospice (5.6%). Conclusion: CLL-related mortality among the U.S. geriatric population declined significantly between 1999 and 2020, likely reflecting the impact of therapeutic innovations and improved disease management. However, substantial disparities persist across sex, age, region, urbanization, and state-level subgroups. These findings underscore the importance of equitable access to modern CLL treatments and the need for targeted interventions to reduce mortality in high-risk, underserved older populations. Efforts to close these gaps will be essential in optimizing outcomes in the era of personalized cancer care for aging Americans.

Abstract Disclosure: A. Riaz: None. R. Haider: None. F. Naseer: None. S. Fatima: None. A. Khan: None. M. Mal: None. A. Qadeer: None. INTRODUCTION: Giant mastauxe is a rare neonatal condition characterized by excessive breast enlargement, with a breast bud diameter exceeding 3 cm. It is an exaggerated form of common neonatal breast enlargement (1 to 2 cm) that typically resolves within six months. This condition results from maternal estrogen withdrawal, which triggers prolactin release and breast tissue proliferation. Its pronounced presentation raises parental concern and requires clinical evaluation to exclude pathological causes. Very few reports exist in literature on it. Here we report a rare case of giant mastauxe, highlighting its presentation and management. CASE PRESENTATION: A 1-month-20-day-old male infant came with bilateral breast enlargement and milky discharge since birth. There was no history of trauma or redness. He was born at 39 weeks via vaginal delivery, weighing 3100g, with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Mother had no history of antenatal infections or drug intake, except for iron, calcium, and folic acid supplements during antenatal visits.On examination, the respiratory rate was 54 breaths/min, heart rate 140 beats/min, temperature 98.5°F, and oxygen saturation 99%. Bilateral, non-tender, non-erythematous breast swelling with soft consistency and milky discharge was noted (right: 5.1×3.2 cm; left: 3.8×3.0 cm), with retracted nipples and no skin changes.Laboratory tests showed normal leukocytes and CRP. Ultrasonography revealed enlarged breasts with dilated ducts/cysts. Diagnosed as Giant mastauxe, malignancy and inflammation were ruled out. Treatment included Miconazole gel, Miconazole nitrate, Hydrocortisone cream, Iron polymaltose complex, Vitamin B complex, Vitamin C, and Lysine.After 3 weeks, follow-up showed reduced breast size with retracted nipples and no infection. DISCUSSION: Giant Mastauxe is breast bud enlargement more than 3 cm. Postnatally, falling maternal estrogen triggers prolactin secretion in the newborn’s pituitary, leading to breast stimulation and milk secretion in 5-20% of infants. The breast's engorgement correlates with plasma prolactin, implying the infant’s prolactin drives the response. The cause of exaggerated hormonal response in neonatal mastauxe is unclear but may involve heightened sensitivity to estrogen or prolactin. increasing the risk of malignancy later. Ultrasound typically shows hypoechoic tissue for diagnosis. The condition resolves on its own, and requires simple follow-up every two months. Presentation: Saturday, July 12, 2025

Introduction and importance: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, often presenting with nodal or extranodal masses. However, involvement of the chin region is extremely rare and underreported in literature. This case highlights an unusual extranodal manifestation of germinal center B-cell-like (GCB) DLBCL. Case presentation: A 56-year-old man with a history of hypertension and type II diabetes presented with an 8-month history of a painless, progressively enlarging chin mass. Prior antibiotic therapy failed to resolve the lesion. Examination revealed a firm, 4 × 3 cm subcutaneous swelling involving skin and mucosa. Computed tomography (CT) and positron emission tomography/CT imaging revealed hypermetabolic soft tissue lesions in the chin and right buccogingival region. Histopathology and immunohistochemistry confirmed GCB-type DLBCL. The patient received six cycles of rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisolone chemotherapy, resulting in a significant reduction in lesion size and metabolic activity. Follow-up showed no recurrence. Clinical discussion: This case highlights the diagnostic challenges posed by extranodal DLBCL in atypical locations. Misdiagnosis as an infection led to a delayed diagnosis. Immunophenotyping revealed expression of both B- and T-cell markers, which complicated the classification of the lymphoma. A prior history of spontaneously resolving axillary masses suggested an indolent precursor phase that later transformed into aggressive DLBCL. Conclusion: DLBCL may present in rare extranodal sites such as the chin, mimicking benign conditions. Persistent lesions unresponsive to antibiotics should prompt a malignancy workup. Comprehensive evaluation, including imaging and immunohistochemistry, is critical for timely diagnosis and effective treatment. Further research is needed to understand unusual immunophenotypes and progression pathways in DLBCL.