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    CHOLANGIOCARCINOMA: CLINICAL AND LABORATORY TECHNIQUES WITH SPECIAL EMPHASIS ON IMAGING TECHNOLOGIES
    (Macedonian Association of Anatomists and Morphologists, 2026-02-23)
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    Bozhinovska, Biljana
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    Kostova, Masha
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    Bozhinovska Beaka, Gordana
    Cholangiocarcinoma is a rare and highly aggressive malignancy of the biliary epithelium, marked by considerable anatomical heterogeneity and a largely nonspecific clinical presentation, factors that frequently contribute to delayed diagnosis. The purpose of this study was to examine the demographic, clinical, laboratoryand imaging characteristics of patients with cholangiocarcinoma and to assess their relationship with imaging-based anatomical tumor classification.This retrospective study included 40 adult patients with histopathologically confirmed cholangiocarcinoma diagnosed in General Hospital “8th September” in Skopje, Republic of North Macedo-nia, between January 2022 and December 2025. Clinical presentation, hepatobiliary laboratory parameters, and imaging findings obtained using contrast-enhanced computed tomography, and most often magnetic res-onance imaging with magnetic resonance cholangiopancreatography were reviewed. Based on imaging find-ings, tumors were classified as intrahepatic, perihilar, or distal cholangiocarcinoma. The study population demonstrated a male predominance (62.5%), with a mean age at diagnosis of approximately 68 years. Perihilar cholangiocarcinoma was the most commonly identified type (55%), followed by distal (27.5%) and intrahepatic tumors (17.5%). Jaundice and pruritus occurred exclusively in patientswith extrahepatic disease, whereas all asymptomatic patients had intrahepatic tumors. Laboratory analysis revealed a marked cholestatic pattern in perihilar and distal cholangiocarcinoma, with substantially higher bilirubin, alkaline phosphatase, and gamma-glutamyl transferase levels compared with intrahepatic disease. Overall, these findings highlight the importance of anatomical tumor classification and support the integrated use of imaging(MR and MRCP), clinical assessment, and laboratory data in the diagnostic evalua-tion ofcholangiocarcinoma.
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    SPLENIC ABSCESS IN PATIENT WITH CHRONIC PANCREATITIS: A CASE REPORT
    (2019-06-05)
    Bozhinovska Beaka, Gordana
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    Noveska-Petrovska, Biljana
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    Bozinovska, Nadica
    <jats:p>The abscess of the spleen is a rare condition with diverse аetiologies and highly polymorphic clinical expression. It is more common in male than female patient, with a wide age range. Regarding varied and often unspecific symptomatology it poses a great problem for diagnostic and overall treatment with a very high mortality rate in untreated patients. Recent diagnosis and treatment are based on modern imaging techniques that enable precise and rapid diagnostics. The following is a presentation of a case that refers to a young male patient with splenic abscess. CASE REPORT. A 37-year-old patient with a history of hypertensive crisis and multiple previous admittances to the emergency room regarding acute attacks of pancreatitis and persistent reduction in body weight was admitted to the emergency room with nonspecific symptoms of abdominal pain, more prominent in the upper left quadrant. Laboratory findings revealed leukocytosis and elevated levels of CRP. Infective panel for hepatitis and HIV was negative. Additional ultrasound investigations were made which revealed hypoechogenic lesion in the spleen, clearly demarcated from the neighboring parenchyma and partially encapsulated, with near proximity to the tail of the pancreas. Hospitalization with additional MRI and surgical treatment was advised, but the patient refused and contrary to the advice of the doctor decided to leave the hospital. After 10 days he was again admitted to the emergency room with persistent leukocytosis and elevated CRP. Because of the worsening condition, he accepted the previously proposed treatment and was hospitalized. The conducted MRI investigation revealed three cystic lesions with dense content in the spleen, measuring from 5x3sm to 2sm in diameter with propagation towards the tail of the pancreas. Surgical splenectomy with partial pancreatectomy was performed, and the surgical specimen was forwarded for histopathological examination. The microscopic examination on the selected specimens revealed severe stasis in the splenic parenchyma with subcapsular abscess formation, and also confirmed the chronic pancreatitis condition. The postoperative course went well without any complications, as well as on the following regular checkups. DISCUSSION. Splenic abscess is very uncommon entity associated with versatile etiologies which covers primary immunocompromised patients, trauma or patients with infective endocarditis. As a potentially life-threatening condition it is essential to emphasize the need for fast detection and splenectomy as a choice of treatment. But also it is very important as a potential aetiology to have in mind other chronic conditions like pancreatitis, especially in young male patients, given that management of the underlying disease is of great importance.</jats:p>