Faculty of Medicine

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A CASE OF A POSTMENOPAUSAL WOMEN WITH DIFFERENTIATED VULVAR INTRAEPITHELIAL NEOPLASIA (dVIN) – HPV INDEPENDANT
(Македонско лекарско друштво = Macedonian medical association, 2025-09)
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Bashkim Ismaili
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Julija Kostadinoska
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Bobi Kirkovski
Introduction: Human papillomavirus (HPV) independent vulvar intraepithelial neoplasia is the precursor lesion of HPV independent vulvar squamous cell carcinoma (SCC). Differentiated vulvar intraepithelial neoplasia (dVIN) is an aggressive lesion with higher potential to become invasive than HPV associated VIN (usual type). It is most common in older women ~60-80 years of age, who have a history of chronic inflammatory dermatoses, lichen sclerosus, lichen simplex chronicus. Case report: A 67 years old woman was referred to the Specialized hospital for gynecology and obstetrics “Mother Teresa” due to the presence of a dark red change of the vulva and itching. On inspection, there was fusion of the anterior commissure and an effaced clitoris. With acetic acid, a vinegar-positive sector was observed at the junction of the commissures with dimensions of 2-3 cm. An indication for a biopsy was established. A pathohistological analysis of a biopsy fragment with a diameter of 0.5 cm was performed. It was partially lined with keratotic stratified squamous epithelium and partially with squamous epithelium showing dyskeratosis and parakeratosis, and the epithelial cells contained prominent nucleoli and showed pathological mitoses in the basal layers. A lympho-plasmacytic inflammatory infiltrate was found subepidermally. Immunohistochemically, the cells showed negative staining for p16 protein and positive for p53 protein. The proliferative marker Ki-67 showed nuclear positivity in the distal two-thirds of the epithelium. The morphological and immunohistochemical characteristics corresponded to a differentiated type of vulvar intraepithelial neoplasia that was HPV independent. The patient was referred to a tertiary healthcare facility where an indication for vulvectomy was established due to the size and location of the change. Conclusion: We like to emphasize the need of performing biopsy of any suspicious lesion of the vulva, especially in older women, because inflammatory changes can be precursors to intraepithelial neoplasia, which can further develop into invasive SCC.
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Effectivness And Safety Of Minimally Invasive Gynaecological Surgery Procedures
(Shoqata Shqiptare Endoskopise Gjinekologjike (SSEG), 2025)
Bashkim Ismaili
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Shqipe Saracini Hajdari
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Marijana Filipovska Rafajlovska
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A case report of serous carcinoma of the uterine corpus
(2022-09)
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Emil Bajalski
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Bashkim Ismaili
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Dimitar Georgiev
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In the Republic of North Macedonia, in 2020, there were 369 new cases of cancer of the uterine body, which were 10.9% of all new cases of malignancies and was the third most common in women, after breast cancer and colorectal cancer. Endometrial polyps are common pathological findings and their prevalence is between 16% to 34%. The prevalence of malignant and premalignant lesions found in the endometrial polyps ranges from 0.8% to 4.8%. Uterine serous carcinoma is an aggressive variant of EC that accounts for only 5-10% of all EC, but is related with 80% of endometrial cancer–related deaths. It is not related with increased estrogen levels and atypical endometrial hyperplasia. They arise in a background of atrophic endometrium or endometrial polyps in postmenopausal women. We present a case of 72 years old patient with serous carcinoma of the uterine corpus that arises on endometrial polyp. She was 20 years postmenopausal and bleeding was present. The transvaginal ultrasound examination showed that heterogeneous and irregular endometrial thickening was present. We performed fractionated explorative curettage. The histopathological report showed the presence of the parts of an endometrial polyp with surface that is coated with atrophic endometrium, and in parts it was coated with malignantly altered endometrium. The morphology of serous endometrial carcinoma with complex papillary and glandular architecture was present. Pathological mitoses have been verified. Lymphovascular invasion or infiltration of the cervical stroma were not found. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathological analysis of the operative material showed the absence of lymphovascular infiltration but present infiltration of the cervical stroma (pTNM= pT2 pNx pMx R0 L0 V0 Stage II). The patient was referred for further treatment to an oncologist.
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A case report of fetal spinal meningomyelocella
(2022-09)
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Bashkim Ismaili
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Dimitar Georgiev
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Neural tube defects are congenital malformations of the CNS resulting from defective closure of the neural tube during early embryogenesis between 3rd and 4th week of intrauterine life. It involves defect in the skull, vertebral column, the spinal cord and other portion of CNS. It occurs about 1 to 5 per 1000 live births. Myelomeningocele is most common and severe form of spina bifida cystica, characterised by protrusion of spinal cord through the open vertebrae into the amniotic fluid. We present a case of a 25-year-old pregnant woman who came into our hospital in the 17th week of pregnancy with characteristic ultrasound signs for the presence of fetal spina bifida. Lumbosacral meningomyelocella was present. The anterior part of the head started to develop ‘‘the lemon sign’’ and cerebellum showed ‘‘the banana sign’’. Dilated lateral ventricle was also present. There was anamnesis for folic acid supplementation starting at 6 weeks of gestation. We performed induction of labour with oxytocine and termination of this pregnancy. The autopsy report showed the presence of spina bifida in the lumbosacral region, with a defect of the skin and the vertebral arches, measuring 1.7 × 1 cm, with protrusion of meninges and the spinal cord.
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Ultrasound assessment of endometrial thickness in women with endometrial bleeding
(2022-09)
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Bashkim Ismaili
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Dimitar Georgiev
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Mladen Risteski
Objectives: Dysfunctional endometrial bleeding is often during the menopausal transition as a result of hormonal changes during this period. In postmenopaus, there should be no uterine bleeding. Postmenopausal bleeding occurs in approximately 90% of patients with endometrial cancer, but only 9% of women with postmenopausal bleeding have endometrial cancer. The aim of this study is to determine the histopathological changes of the endometrium that occur in women with perimenopausal and postmenopausal bleeding and the association with endometrial thickness and anteroposterior diameter of the uterus. Methods: This study involved 120 patients with fractionated explorative curettage due to abnormal uterine bleeding. The examined group was divided in two subgroups: 60 women in perimenopausis and 60 women in postmenopausis. Anamnestic data were taken from all respondents. Ultrasound measurement of anteroposterior diameter of uterus and endometrial thickness were made with endovaginal ultrasound probe. Results: The most common pathological change of the endometrium was an endometrial polyp (in 45% of the respondents). 26.7% of perimenopausal women had dysfunctional uterine bleeding. Endometrial adenocarcinoma was present in 3% of perimenopausal and in 5% of postmenopausal women. The average value of the anteroposterior diameter of the uterus was 50.7 mm in perimenopausal, 37.3 mm in postmenopausal group, and the difference of 13.4 mm was statistically significant (p < 0.0001). The average thickness of the endometrium was 13.6 mm in perimenopausal, 10.3 mm in postmenopausal group, and the difference of 3.3 mm was statistically significant (p = 0.00011). Conclusions: Fractionated explorative curettage is an effective method for timely and effective diagnosis of pathological changes of the endometrium in women with abnormal uterine bleeding Perimenopausal patients had significantly higher anteroposterior diameter of the uterus and thicker endometrium than those in the postmenopausal period.
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ENDOMETRIAL PATHOLOGICAL CHANGES IN PERIMENOPAUSE AND POSTMENOPAUSE - ASSOCIATION WITH SOME ANAMNESTIC AND ULTRASONOGRAPHIC PARAMETERS
(Macedonian Association of Anatomists, 2022-05)
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Bashkim Ismaili
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Atypical endometrial hyperplasia is preneoplastic condition that precedes endometrioid adenocarcinoma. Postmenopausal women should not have bleeding; the thickness of the endometrium is normally below 5 mm and if it is above, the presence of a polyp, hyperplasia or cancer is suspected. To determine the histopathological changes of the endometrium, the prevalence of functional and organic changes and their association with history of previous childbirths and abortions, presence of bleeding, intensity of bleeding, anteroposterior uterine diameter and endometrial thickness. The study was performed in the Specialized Hospital for Gynecology and Obstetrics "Mother Teresa" - Skopje and involved a total of 120 respondents who underwent fractionated explorative curettage due to a medical indication. They were divided into 2 groups: with functional and organic changes of the endometrium. Ultrasonographic measurement of anteroposterior diameter of uterus and endometrial thickness was performed. The prevalence of functional changes was 30% and of organic changes 70%. The most common histopathological diagnosis was an endometrial polyp (45% of women). The mean value of endometrial thickness was 7.9 mm in the functional changes group and 13.6 mm in the organic changes group; this difference was statistically significant (p <0.0001). Perimenopausal patients had a significantly longer duration of bleeding than those in postmenopause (p = 0.0009). Endometrial adenocarcinoma was present in 3% of perimenopausal and in 5% of postmenopausal patients. Endometrium was significantly thicker in women with organic changes than in those with functional changes. Perimenopausal patients had a significantly longer duration of bleeding, more intensive bleeding, thicker endometrium and greater anteroposterior uterine diameter than those in postmenopause.
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A CASE OF CORNUAL ECTOPIC PREGNANCY SUCCESSFULLY TREATED BY LAPAROSCOPY
(Macedonian Association of Anatomists, 2022)
Dimitar Georgiev
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Bashkim Ismaili
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Cornual pregnancy is a rare type of ectopic pregnancy where the embryo implants in the junction between the fallopian tube and the uterus. Only 2% to 3% of all tubal pregnancies are cornual. Uterine rupture may occur in up to 20% of the cases of cornual pregnancy that progress beyond 12 weeks of amenorrhea, resulting in massive hemorrhage due to high vascularity in this region through the branches of the uterine artery. Despite the availability of modern diagnostic modalities including transvaginal ultrasonography, there is difficulty in the early diagnosis because of its location. We present a case of unruptured cornual ectopic pregnancy in a 40-year- old woman with amenorrhea of 7 weeks. In our case, the diagnosis was made early and laparoscopic cornuostomy with removal of the gestational sac and ipsilateral salpingectomy were performed, followed by laparoscopic repair of the cornuostomy incision. Hemostasis was achieved with electrocoagulation. This caused minimal hemorrhage without intraoperative and postoperative complications.
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Hormonal changes in women with abnormal endometrial bleeding in peri and postmenopause
(European Society of Endocrinology, 2022-05)
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Bashkim Ismaili
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Dimitar Georgiev
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SHpishikj Pushevska, Anamarija
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LARGE FIBROEPITHELIAL VAGINAL POLYP WITH VAGINAL INTRAEPITHELIAL NEOPLASIA (VAIN1) – CASE REPORT
(2022-05)
Dimitar Georgiev
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Bashkim Ismaili
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Bekim Dika
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A RARE CASE OF SEROUS CARCINOMA OF THE UTERINE CORPUS THAT ARISES IN POLYP
(Macedonian Association of Anatomists, 2022)
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Emil Bajalski
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Dimitar Georgiev
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Bashkim Ismaili
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Endometrial polyps (EPs) are common pathological findings and their prevalence range is between 16% to 34% depending on characteristics of the examined population and detecting methods. Clinically, these lesions cause thickening of the endometrium and abnormal uterine bleeding. Asymptomatic EPs can be detected by routine ultrasound examination or infertility investigations. Most EPs are benign. Their malignant potential is highest in postmenopausal women with uterine bleeding (2.3%). Serous carcinoma is the prototype of type-II endometrial cancer (nonendometrioid) and accounts for <10% of all endometrial carcinomas. It is a very aggressive tumor, unrelated to estrogen stimulation, arising occasionally in endometrial polyps or from precancerous lesions developing in atrophic endometrium that mainly occur in older women. We present a case of 72-years-old patient with uterine bleeding, with thick and heterogenous endometrium detected on ultrasound. Fractionated explorative curretage was performed and serous carcinoma that arises in polyp was diagnosed. After operative treatment, histopathological analysis of the operative material showed stage II of the disease.

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