Faculty of Medicine

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Gallbladder and gastric metastasis as initial presentation of an undiagnosed primary lobular breast carcinoma
(Oxford University Press (OUP), 2026-02-24)
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Ivkovska, Sanja
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Filipovski, Vanja
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Kubelka Sabit, Katerina
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Jasar, Dzengis
The most common sites for breast cancer metastases include the bones, lungs, liver, and brain. Metastases in the GI tract are rare and predominantly originate from lobular breast cancer. Gastric involvement by invasive lobular carcinoma (ILC) is rare and can mimic primary gastric malignancies, leading to diagnostic challenges. Metastasis of ILC to the gallbladder is exceedingly rare and often identified incidentally during cholecystectomy performed for presumed benign conditions. We present a case of a 62-year-old female patient with symptoms of weight loss and dysphagia. After CT and gastroscopy, gastrectomy and cholecystectomy were performed due to suspicion of gastric carcinoma. Histology and immunohistochemical profiling, with estrogen receptor (ER), progesterone receptor (PR), E-cadherin, GATA3, Mammaglobin, and GCDFP-15, favored the diagnosis of lobular breast carcinoma metastasis over primary gastric adenocarcinoma. Awareness of these atypical presentations is crucial for accurate diagnosis and effective management, as misdiagnosis can result in suboptimal treatment strategies.
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DETECTION OF LYNCH SYNDROME IN ENDOMETRIAL CANCER PATIENTS
(Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, 2023-12-27)
Kubelka Sabit, Katerina
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Petrova, Deva
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Jashar, Dzangis
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Filipovski, Vanja
Lynch syndrome (LS) is an autosomal dominant inherited disease defined by germline mutations in mismatch repair (MMR) genes, leading to a defective DNA MMR system. Patients with LS havepredisposition to a spectrum of cancers, primarily colorectal cancer, but LS-associated endometrial cancer (LS-EC) is the most common extraintestinal cancer and occurs in 2% of LS patients. The most frequently mutated MMR genes are MLH1, MSH2, MSH6 and PMS2. Clinico-pathologic features of LS-EC are: early age of onset, lower body mass index, endometrioid type of carcinoma and lower uterine segment involvement. Recent studies support LS screening in every EC patient since MMR status is also part of the molecular subclassification of endometrial cancers.Screening methods include traditional clinical criteria and molecular techniques, such as MMR-immunohistochemistry(MMR-IHC), microsatellite instability (MSI) testing, MLH1promoter methylation testing and gene sequencing. MSI can also be detected in sporadic tumors, through epigenetic events inactivating the MMR system. Patients with diagnosed LS and their affectedrelatives should be closely monitored in order to prevent the development of other types of cancer. Patients with advanced recurrent microsatellite instability-high (MSI-H)/mismatch repair-deficient (dMMR) endometrial cancer can also benefit from immunotherapy.We describe our 3-year experience in screening of Lynch syndrome in EC patients.
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Penile Strangulation: Two Case Reports and Review of the Literature
(Elsevier BV, 2007-11)
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Kuzmanoski, Marjan
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Banev, Saso
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Synovial sarcoma of the liver - a case report
(Scientific Foundation SPIROSKI, 2011-06-15)
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Filipovski, Vanja
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Banev, Saso
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Jovcevski, Alen
We report a case of synovial sarcoma of liver in a 44 year old man, presented as a tumor mass in left hepatic lobe. The patient was admitted at the hospital with clinical symptoms of acute abdomen and severe pain in the right upper quadrant. Imaging examinations showed a tumor mass in the left hepatic lobe and free liquid in the abdominal cavity, due to the rupture of the tumor. A resection of 2 segments of the left hepatic lobe, where the tumor was located, was performed. Morphological, immunohistochemical and FISH studies confirmed the diagnosis of monophasic synovial sarcoma. Additional clinical and imaging examinations, made after the surgery, did not confirm tumor mass in any other localization. The patient refused any therapy other than surgery, at that time. A relapsing tumor mass was found 6 months later and another surgical intervention was done. The patient received five monotherapy cycles of Doxorubicin, 75 mg/m2, after the second surgical intervention. He is still alive 11 months after the first operation receiving the same therapy and having second relapsing inoperable tumor mass filling the retroperitoneal space and a great fraction of the abdominal cavity.
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Granular cell tumor of the breast: a case report and review of literature
(BioMed Central, 2009-08-10)
Filipovski, Vanja
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Banev, Saso
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A 22-year-old female patient presented with a breast mass lesion with a clinical suspicion of a fibroadenoma. Histological evaluation revealed a rare benign neoplasm - granular cell tumor. Granular cell tumor is rare neoplasm that may arise in virtually any body site, and in 5% it occurs in the breast. The histogenesis of this tumor is still rather controversial and currently the most acceptable theory is a Schwann cell origin. The main histological feature is granular cytoplasm of the tumor cells. From a clinical point of view there is a similarity between granular cell tumor and mammary carcinoma on mammography and ultrasound. Pathohistologically, sometimes, differential diagnostic difficulties exist concerning apocrine carcinoma, histiocytic lesions and metastatic neoplasms.
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Expression of p53 Protein Product in Triple Negative Breast Cancers and Relation with Clinical and Histopathological Parameters
(Walter de Gruyter GmbH/Macedonian Academy of Sciences and Arts, 2015-05-01)
Jasar, Dzengis
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Kubelka, Katerina
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Filipovski, Vanja
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<jats:title>Abstract</jats:title><jats:p>Introduction: "Triple" negative breast cancer is a subgroup of so-called basal-like breast cancer. They are represented with 15% of all breast cancers, characterized with lack of hormone receptor as well as with negative expression of HER2 test. These tumors are more frequent in Afro-Americans and Latin-Americans, in patients with BRCA1 mutations and in patients with recent delivery. The aim of this study is to present the immunohistochemical and clinico-pathological characteristics of the triple negative breast cancer and their correlation with expression of the protein product of the tumor suppressor gene p53.</jats:p><jats:p>Methods: A retrospective analyses of 24 patients with triple negative breast cancer was performed. All of the patients were evaluated in the Histopathological Laboratory of the Clinical Hospital Sistina, during the period from June 2009, until June 2011. The standard immunohistochemical procedures, including the hormone receptor status, HER2 status, proliferative index - Ki67 and p53 gene protein product were performed, as well as additional immunohistochemical staining for socalled basal keratins (Cytokeratin 5/6 and high molecular weight cytokeratin 34BE12).</jats:p><jats:p>Results: The age of the patients ranged from 29-77 years. Positive lymph nodes were found in 14 (59%) patients. The tumor was poorly differentiated in 19 patients (79%). Overexpression of the p53 protein product was evaluated in 19 (79%) of the cases. All p53 negative patients (5/5) had poorly differentiated tumors (G3), associated with positive regional lymph nodes. The p53 positive group expressed quite opposite correlation, only 9/19 (47%) were with positive lymph nodes (p = 0.03). The expression of p53 protein product was also associated with the nuclear grade (p = 0.005), the mitotic index (p = 0.001), lymph-vascular invasion (p = 0.005) and with the proliferation index Ki67 (p = 0.003). There was a trend for association with the tumor size - pT (p = 0.05).</jats:p><jats:p>Conclusion: According to the results, the triple negative breast cancers are subgroup of the poorly differentiated neoplasms frequently associated in the younger age groups. The majority of these have overexpression of the p53 protein product, which in other hand, are inversely correlated with lymph nodes metastases. Hence, the necessity of enriching the immunohistochemical protocol of these patients with new antibodies, in order to evaluate their expression, which would be helpful for prediction the outcome of different therapeutical modalities.</jats:p>

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