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Oncologic and pregnancy outcomes of fertility-sparing treatment with medroxyprogesteron acetate in women with premalignant and malignant endometrial lesions: A case series
(Elsevier B.V., 2025-04)
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Introduction Current trends of delaying childbearing and the increasing incidence of endometrial cancer in nulliparous woman necessitate research and development of fertility sparing treatments. Hormonal therapy with progestins offers an alternative to surgical treatment for a select group of patients of reproductive-age, who wish to preserve their reproductive potential. Materials and methods The study evaluates the effectiveness of medroxyprogesterone acetate therapy in patients with early-stage endometrial cancer, atypical endometrial hyperplasia or atypical polypoid adenomyoma, seeking to preserve fertility. This prospective case series encompasses nine patients (6 with endometrial cancer, 2 with atypical endometrial hyperplasia and 1 with atypical polypoid adenomyoma) treated in the period between 2015 and 2022 with high-dose medroxyprogesterone acetate therapy. Treatment and monitoring were conducted at the University Clinic for Gynecology and Obstetrics in Skopje, R. Macedonia, with clinical assessments carried out every three to six months via hysteroscopy with endometrial biopsy or exploratory curettage. Results Primary response was achieved in 4 patients (44.4 %). Secondary response was achieved in the remaining 5 cases (55.6 %). Therefore, all 9 patients (100 %) showed complete response to progestin treatment in the time interval 3–9 months. Recurrence occurred in 3 cases (33.3 %) after follow-up of 15, 33 and 84 months, respectively. During the study period, 2 patients (22.2 %) underwent definitive surgery with hysterectomy because of disease recurrence (both with endometrial cancer, stage IA). Fertility was achieved in 1 patient (11.1 %), who had a full-term delivery with caesarean section. Conclusion Conservative treatment approach to patients with endometrial cancer aiming to preserve fertility can be safe and have acceptable outcomes in terms of oncologic response as well as pregnancy results, with high-dose medroxyprogesterone acetate therapy being an effective option. The selection of endometrial cancer patients, for whom fertility-sparing progestin therapy is appropriate, is of great importance to achieve the best outcomes. Continuous and careful monitoring of patients undergoing conservative treatment is essential, due to the risk of disease recurrence and progression.
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DIAGNOSTIC CHALLENGE IN DISTINGUISHING BENIGN FROM RARE MALIGNANT UTERINE PATHOLOGY – A CASE REPORT OF A MYXOID LEIOMYOSARCOMA
(SHMSHM - AAMD, 2023)
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Gjoreski, Josif
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Biljan, Aleksandra
Leiomyosarcomas are rare aggressive soft tissue tumors, which account for 1 to 2% of all uterine malignancies. Due to their infrequency, as well as the difficulty to distinguish them from leiomyomas, the diagnosis is often made postoperatively. We report a case of a 38-year-old patient who was treated at the University Clinic for Obstetrics and Gynecology – Skopje for an enlarging uterine fibroid, for which she had undergone a myomectomy. The histopathology report showed that it was a case of a myxoid leiomyosarcoma, FIGO Stage IB, involving margins. She was admitted for a reoperation which consisted of a total hysterectomy, bilateral adnexectomy, selective lymphadenectomy and staging. The final postoperative clinical stage was FIGO IB. Leiomyosarcomas are generally less responsive to chemotherapy or radiation, most often have a poor prognosis and a high risk of recurrence. Surgery is the most significant treatment modality. The prognosis primarily depends on the FIGO stage, as the most important independent variable associated with survival.
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DEPRESSION AND ANXIETY FOLLOWING EARLY PREGNANCY LOSS – OCCURRENCE AND RISK FACTORS
(Macedonian Association of Anatomists and Morphologists, 2023)
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Ilkoski, Ana
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Biljan, Aleksandra
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Drogrishki, Marta
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Simonovska, Biljana
Early pregnancy loss is associated with various psychological symptoms shortly after the miscarriage which, in some patients, can persist a longer period of time. The main goal of our study is to establish the occurrence-rate and risk factors for development of these symptoms. Patients with early pregnancy lose, who came in hospital were enrolled in the study. The HADS (Hospital Anxiety and Depression Scale) was used to measure symptoms of depression and/or anxiety of these patients. Chi-square test was used for statistical analysis. Out of total 70 patients, 60% reported symptoms of depression and/or anxiety at some point during the study. Half of them, i.e. 54.2% display the symptoms on the day of admission to the hospital, while 9.5% of the patients demonstrated onset of symptoms of depression and/or anxiety one month after the incident. The symptoms persisted at least one month following the miscarriage, in 64.3% of the patients. Regarding the studied variables (nationality, level of education, employment and marital status as well as number of previous pregnancy loss and the number of children), none of them shows statistically significant difference for developing symptoms of depression and/or anxiety. 60% of women display symptoms of anxiety or/and depression following early pregnancy loss, majority of them immediate after the incident, so every hospital should be well-staffed by professionals and able to provide an adequate care and psychological support for these patients. The study failed to reveal any risk factor (among selected) significantly associated with development of symptoms of depression and anxiety. Hence, every woman with such diagnosis can potentially develop psychological stress, and should be monitored carefully.

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