Faculty of Medicine

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Author: search.filters.author.Ognenoska-Jankovska, BiljanaSubject: search.filters.subject.ovary

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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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    Ovarian Leydig cell tumor (hilus cell tumor): A case report
    (Macedonian Association of Pathology, 2016-09)
    Qerimi, Adelina
    ;
    Stojkoska, Elena
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    Ognenoska-Jankovska, Biljana
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    Trajanova, Milka
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    Objective: Leydig cell tumor is a rare ovarian tumor that belongs to the group of sex-cord stromal tumors. They produce testosterone leading to hyperandrogenism. As a subtype of steroid cell tumors of the ovary characterized by the presence of Reinke crystals, it comprises 19% and affects mainly young women. Material and Methods: A 24-year old nulliparous patient clinically presented with hirsutism, oligomenorrhea, and infertility. Ultrasonography showed a left ovarian tumor mass with the greatest diameter of 4.3 cm. The patient underwent a laparoscopic tumorectomy followed by gradual withdrawal of the symptoms at the first check-up after 6 months follow-up. Results: The laparoscopically obtained material consisted of 15 yellow to orange-tanned, soft and solid fragments with a diameter ranging from 0.5 to 5.5cm. Microscopically, the tumor was solid, relatively well-circumscribed, and composed of cellular areas with clustering of nuclei separated by eosinophilic anuclear zones. Some of the tumor cells had scant and others abundant eosinophilic or clear cytoplasm with lipid-rich, oil Red O-positive vacuoles and oval, hyperchromatic or bizarre nuclei. Mitotic figures were scarce, while Reinke crystals were found after a prolonged search. Immunohistochemically, tumor cells showed diffuse positivity for vimentin, focal for cytokeratin AE1/AE3, alfa-smooth muscle actin, S100, CD99, calretinin, inhibin-alpha, melan A, CD56 and were steroid hormone receptor negative. Conclusions: Although idiopathic hirsutism and other benign androgen excess disorders like polycystic ovarian syndrome are common, the presence of an ovarian mass in younger patients should raise suspicion of Leydig cell tumor or other steroid cell tumors. This case confirms that Reinke crystal quest should always be tenacious.
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    Ovarian clear cell adenocarcinoma arising in association with endometriosis: a clinicopathological study of 20 cases
    (Springer, 2014-09)
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    Ognenoska-Jankovska, Biljana
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    Veljanoska-Petreska, Slavica
    Objective: The objective of the study was to determine clinicopathological features of the ovarian clear cell adenocarcinomas (OCCA) arising in association with endometriosis. Method: We retrospectively compared 20 cases of endometriosis-associated clear cell adenocarcinoma (EACCA) with 35 cases of clear cell adenocarcinoma without endometriosis (CCAWE) diagnosed at our department between 2000 and 2013, using Student’s t-test and chi-square test to analyze the data. Results: The median age in EACCA group was 50 versus 58 years in CCAWEgroup (P=0.0007), and the prevalence of postmenopausal status was significantly higher in EACCA cases (55 % vs. 17.1 %; P=0.0035). Grossly, in the EACCA group the tumours were predominantly unilocular cysts containing solitary or multiple nodules in the inner surfaces (80 % vs. 31.4 %), while CCAWE were more frequently multilocular cystic tumours (P=0.0005). The EACCA patients tended to have smaller (median size 11 vs. 13 cm) and early-stage tumours (FIGO stage I and II combined; 85 % vs. 68.6 %), although the differences were not statistically significant. In 17 patients EACCA were arising within endometriosis, with atypical endometriosis present in 6 cases, while in the remaining 3 OCCA were adjacent to endometriosis on the same ovary. Conclusion: Patients with EACCA are typically premenopausal and younger, with a tendency to have smaller in size, early-stage tumours usually presenting as unilocular cysts.
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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.