Faculty of Medicine

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Multifocal Hurthle cell (oxyphilic) variant of papillary thyroid carcinoma associated with Hashimoto`s thyroiditis: A case report
(Macedonian Association of Pathology, 2016-09)
Qerimi, Adelina
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Ognenoska-Jankovska, Biljana
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Stojkoska, Elena
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Objective: Oxyphilic (Hurthle cell) variant of papillary thyroid carcinoma (OVPTC) is a rare subtype accounting for 1-11% of all cases of papillary thyroid carcinomas (PTCs). The clinicopathological features and biological behavior of OVPTC have not yet been thoroughly characterized. We present a case of multifocal OVPTC with concurrent Hashimoto`s thyroiditis. Material and Methods: A 51-year-old female patient with multinodular goiter underwent a fine-needle aspiration biopsy which was reported as negative, followed by a subtotal thyroidectomy procedure. Results: The surgically obtained material consisted of two oval fragments designated as right and left thyroid lobe with the largest diameter of 5 cm and 4.5 cm, respectively. Grossly, on the cut section of the left lobe two well-circumscribed, white to grey-tanned foci with the largest diameter of 1.3 cm and 0.6 cm, respectively, were found. Microscopically, in a background of Hashimoto`s thyroiditis, the two foci revealed a neoplasm with predominantly insular growth pattern and focally follicular or papillary structures composed of large polygonal cells with abundant eosinophilic granular cytoplasm and optically clear nuclei with the characteristic intranuclear pseudoinclusions and nuclear grooves. Psammoma bodies and areas of calcification were also present. Mitoses were rare and no vascular or capsular invasion was encountered. Immunohistochemically, tumor cells showed diffuse positivity for low-molecular-weight cytokeratin and cytokeratin 19 and focal positivity for thyroid transcription factor-1. Conclusions: This case confirms that although OVPTC remains controversial, it usually displays the morphological and immunohistochemical features of the classical type of PTC, which can aid in avoiding the diagnostic pitfalls in distinguishing this subtype of PTC from other benign or malignant Hurthle cell lesions.
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Warthin-like papillary carcinoma of the thyroid: A case report
(Macedonian Association of Pathology, 2016-09)
Stojkoska, Elena
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Qerimi, Adelina
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Ognenoska-Jankovska, Biljana
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Objective: Warthin-like variant of papillary carcinoma (WLPCT) is an uncommon variant, first described in 1995, with a clinical presentation and prognosis similar to the classic papillary thyroid carcinoma (PTC). We report a case of WLPCT focusing on the histopathological and immunohistochemical features. Material and Methods: A 60-year old female, with no remarkable past medical history, underwent surgical treatment of an enlarged multinodal goiter with previous negative fine-needle aspiration biopsy findings. A left total and right subtotal thyroidectomy was performed. The patient is alive and well 4 months after the surgery. Results: On gross examination, the right lobe of the thyroid gland measured 4.5x1.5x1 cm, and the left lobe with adjoined isthmic lobe measured 5x3.5x2 cm. In the right lobe an oval, firm, grey, 0.8 cm large nodule was found, while in the left lobe another well-circumscribed, pale-brown, 2.5 cm large nodule was present. The left lobe nodule was diagnosed as an atypical follicular adenoma with no capsular or vascular invasion. Histology of the right lobe nodule showed an encapsulated tumor composed of papillary structures lined by oncocytic cells and rich lymphoid stroma, with germinal centers in the papillary stalks, typical for WLPCT. Immunohistochemically, tumor cells of WLPCT showed positive expression for cytokeratin 19, thyroid transcription factor-1 and thyroglobulin. Conclusions: Warthin-like variant is one of the rarest variants of PTC (less than 100 reported cases in the literature) with as favorable prognosis as the classic PTC. Morphology and immunohistochemistry are of decisive significance in differentiating these neoplasms from benign lymphoepithelial lesions, Hurthle cell carcinoma and tall cell variant of PTC.
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Follicular variant of papillary thyroid carcinoma arising in struma ovarii: A case report
(Macedonian Association of Pathology, 2016-09)
Stojkoska, Elena
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Qerimi, Adelina
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Ognenoska-Jankovska, Biljana
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Objective: Struma ovarii is a rare form of ovarian mature teratoma and is the most common type of monodermal teratoma (3% of all ovarian teratomas). 5-10% of such tumors are malignant with papillary carcinoma as the most common type (70%) while 26% of them are a follicular variant of papillary thyroid carcinoma (FVOPTC). We report a case of FVOPTC arising in struma ovarii focusing on the clinical, histopathological and immunohistochemical features. Material and Methods: A 29-year old nulliparous female underwent laparoscopic surgery of a 7 cm a large right ovarian cyst, diagnosed by ultrasound. Clinically and biochemically she was euthyroid with normal serum TSH level, and without previous significant medical or gynecological history. Results: Grossly, a laparoscopically obtained material consisted of 8x3 cm fragment of cyst wall measuring 0.2 to 0.6 cm in thickness with a focus of 5 mm large grayish-white tumor. Histology of the cyst wall showed thyroid tissue characteristic of cystic struma ovarii while the tumor showed typical nuclear features of papillary thyroid carcinoma with follicle formation and minimal presence of papillary structures typical for FVOPTC arising in thyroid tissue. Immunohistochemical staining showed positive expression for thyroglobulin, TTF-1, and cytokeratin-19 in the tumor cells. Conclusions: FVOPTC arising in struma ovarii is difficult to assess because it is a rare tumor with about 60 published cases and lacking standard criteria for diagnosis. Thus, the morphological criteria for the diagnosis of this tumor are based on classical criteria for primary thyroid carcinoma. Prognostically, FVOPTCs measuring less than 2 cm arising in struma ovarii are considered as low-risk lesions with a low rate of recurrence and metastasis.
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Superficial leiomyoma of the gastrointestinal tract with interstitial Cajal-like cells
(Springer, 2015-09)
Qerimi, Adelina
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Stojkoska, Elena
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Ognenoska-Jankovska, Biljana
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Objective: Some authors suggest common origin of all gastrointestinal stromal tumours from stem cells, which may show diverse differentiation. There are reports in which cells with a morphology of interstitial Cajal-like cells are found in deep leiomyomas. The aim of this study was to demonstrate CD117 positive cells in superficial gastrointestinal (GI) leiomyomas and to find other cells that would suggest diverse differentiation in histologically typical leiomyoma. Method: We have analyzed 9 cases of superficial leiomyomas, received in our institutions as endoscopically or surgically obtained material. The tumour sections were immunohistochemically stained with CD117, CD34, NSE, S 100, α-S MA and desmin. Results: There were one esophageal and 8 colonic superficial leiomyomas, 2 of which rectal. Histological analysis showed presence of stellate cells morphologically similar to the interstitial cells of Cajal. Immunohistochemical analysis showed that in addition to diffuse positivity for -SMA and desmin, all leiomyomas showed presence of CD117, CD34 and NSE positive cells between smooth muscle cells, while six of them showed presence of S-100 positive cells. The cells were found in different quantity, usually were scarce and diffusely scattered through the tumours without predilection site. Conclusion: The presence of CD177, CD 34, S-100 and NSE positive cells in superficial leiomyomas may suggest a common origin of GI stromal tumours.
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Atypical polypoid adenomyoma of the uterus: A clinicopathological analysis of 28 cases
(Springer, 2015-09)
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Ognenoska-Jankovska, Biljana
Objective: To investigate the clinicopathological characteristics of uterine atypical polypoid adenomyoma (APAM), including the cases with coexistent endometroid endometrial adenocarcinoma (EEA). Method: A retrospective analysis of the clinical data, morphologic features, and immunohistochemistry of 28 consecutive cases of uterine APAM diagnosed in our Department between January 2001 and December 2014 was done. Results: The mean age of the patients was 41 (range, 26–61). Only five patients were postmenopausal, and seven were undergoing evaluation for infertility. Microscopic examination disclosed endometrial glands with varying degrees of hyperplasia and cytological atypia within a myofibromatous stroma. Squamous metaplasia was present in 25(89 %), and foci of well-differentiated EEA coexisted in 5 (17.9 %) cases. In 4 (14,3 %) other patients moderately differentiated EEA was present both in APAM and endometrial fragments. Nine patients were initially treated with hysterectomy and the remaining 19 with curettage, polypectomy, or hysteroscopic transcervical resection, followed by hormonal therapy in 10 cases. There was one recurrence documented, while in 3 (13.6 %) of these patients the APAMs persisted up to 2 years. All patients except the one with advanced stage EEA (FIGO stage IIIC) were well and alive 16–147 (mean, 71) months after primary treatment. Conclusion: Although the clinical behavior of APAM is benign in most cases, it can be associated with sterility and rarely with endometrial carcinoma. Therefore a meticulous pathological evaluation of specimen of APAM is necessary for the detection of the coexistence of EEA.
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Primary osteosarcoma of the thyroid gland
(Springer, 2015-09)
Stojkoska, Elena
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Qerimi, Adelina
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Ognenoska-Jankovska, Biljana
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Objective: Primary mesenchymal tumours of the thyroid gland are extremely rare. One percent of the thyroid tumours are reported to be sarcomas, and the infrequency of these lesions is a reason for the difficulties in achieving right diagnosis. Method: We report a case of primary thyroid osteosarcoma (PTO) in 54-years old female who underwent surgery of the thyroid left lobe, with an unexpected final diagnosis, focusing on the histopathological and immunohistochemical features, which helped in differential diagnosis. Results: The surgical specimen was a thyroid lobe measuring 10 × 9 × 8,5 cm. The cut surface showed gritty, grayish-white tumour with areas of hemorrhage which almost entirely infiltrate the left lobe, measuring 9 cm. The microscopic examination showed a high-grade malignant neoplasm with necrotic areas composed of polygonal and fusiform cells, numerous osteoclast-like giant cells and focal osteoid deposition. Immunohistochemical staining showed positive expression for vimentin and osteopontin, and negative immunostaing for cytokeratin 19, epithelial membrane antigen, thyroid transcription factor-1, calcitonin and thyroglobulin, with a high mitotic index (60 %) of the tumour cell nuclei, determinate by Ki-67 antibody. Thus, the diagnosis of PTO of a predominantly teleangiectatic variant was established, that was confirmed with additional CD34 immunohistochemistry. Conclusion: PTO is extremely rare tumour that should be considered in thyroid pathology and immunohistochemistry is of decisive significance.
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Clinicopathological and immunohistochemical analysis of 23 cases of ovarian cellular fibroma
(Springer, 2013-09)
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Ognenoska-Jankovska, Biljana
Objective: To define clinicopathological characteristics and immunohistochemical markers helpful in differentiating between cellular fibroma (CF) and mitotically active cellular fibroma (MACF). Method: Patient records and archival pathology specimens of 23 ovarian cellular fibromas diagnosed and followed between 2000 and 2012, were reviewed and immunohistochemistry was performed. Results: The mean age of patients with CF (n=15) and MACF (n=8) was 55 and 37 years, respectively. All tumours were unilateral, with a mean tumour size of 8.6 cm for CFs and 12.9 cm for MACFs. In all tumours, most of the cells showed mild or moderate nuclear atypia. The mean highest mitotic count was 2.0 MFs/10 HPFs for CF, and 7.2 MFs/10 HPFs for MACFs. The majority of the tumours were immunoreactive for vimentin, alpha-SMA, WT-1, inhibin-alpha, calretinin, CD56, melan-A, PR, and bcl-2, and negative for pan-cytokeratin, EMA, CD117, ER, and p53. A few tumours were also positive for S100, desmin, CD10, and CD99. In addition, the MIB-1 labeling index (LI) in MACFs was higher (mean 16.9 %, range 12–25 %), than that in CFs (mean 5.9 %, range 3–9 %). Conclusion: Our results confirm the clinicopathological differences and the immunophenotypic similarity between ovarian fibromas and cellular fibromas, and suggest that the use of MIB-1 LI may help in differentiating between CF and MAFC.

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