Faculty of Medicine

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Outcomes of transbronchial and transthoracic biopsy in pulmonary diseases
(Turkish Respiratory Society; Respiratory Society of Serbia, 2017-04)
Bushev Jane
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Kochovska Kamchevska Nade
;
Smileska Snezana
;
Baloski Marjan
;
AIM: contribution of invasive methods- transbronchial (TBLB) and transthoracic biopsy (TTNA) in the diagnostics of certain chest X- ray infiltrations. MATERIAL-METHODS: 76 - aged 41 to 83 years, out/ inpatient 14/ 62, male/ female 64/12 with lung and/or mediastinal changes, were analyzed since January 2015 to 2017. Bronhoscopic examination (before TTNA) excluded abnormalities. RESULTS: 92 biopsies were made (30 TBLB, 62 TTNA, in 16 patients both methods). TBLB- 14 patients, TTNA- 46 patients, both- 16 patients. TBLB with histological confirmation was obtained in 8 (57%) of 14 cases (4 in the first and 4 in the repeated TBLB), and in 42 (91%) of 46 made of TTNA. In 16 patients in which both methods (TBLB and TTNA) were performed, defined histological diagnosis was obtained in 4 samples of TBLB (also confirmed with TTNA), and in 12 samples of the TTNA. Defined histological diagnosis was not obtained in 18 of 30 TBLB (12 of them clarified by TTNA) and in 8 of 62 TTNA. 62 patients (81.5%) had a histopathological confirmation: 34 Carcinoma planocellulare bronchogenes; 10 Carcinoma microcellulare bronchogenes; 14 Adenocarcinoma; 4 Sarcoidosis. CONCLUSION: TBLB and TTNA are safe and cost effective diagnostic methods for definitive diagnosis of the changes in chest wall, lung parenchyma and mediastinum. Strategy of treating bronchial carcinoma requires clear histopathological classification, and therefore at sufficiently defined histological forms indicated repeating both methods. Usage of both TBLB and TTNA, even though with congruent histopathologic findings, has strengthened definitive diagnosis, which was confirmed with our results.
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Solitary lung metastasis of malignant melanoma - Case report
(Turkish Respiratory Society; Respiratory Society of Serbia, 2017-04)
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Kochovska Kamchevska Nade
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Bushev Jane
;
Smileska Snezana
;
Baloski Marjan
Malignant melanoma is increasing last thirty years, one of the most common cancers in young adults (especially women). Primary localization on skin, mouth, intestines, eye. Survival in malignant melanoma stage IV is 10-15%, better prognosis have patients with normal lactate dehydrogenase (LDH). Lung metastases are usually asymptomatic, multiple, nodular. Desmoplastic (neurotropic, spindle cell) melanoma is rare form of infiltrating carcinoma, with diificult diagnosis due to similarity to un-melanocytic lesion as scar, fibroma, cyst. Female patient, 69 years of age, hospitalized for changes seen on chest X-ray. Symptoms: intermittent pain in left shoulder, dyspnea. Profession: housewife, non-smoker, comorbidity: arterial hypertension. Normal lung auscultatory finding. Laboratory: sedimentation 20, hemoglobin 11,9, LDH and tumor markers (CA19-9, CEA, CA 125, CA 15-3) normal. Chest X-ray: left apical, oval, soft-tissue shadowing. Bronchoscopy – without pathological findings. A computed tomographic chest scan showed: in left apicoposterior segment, solid formation with dimensions 18x13,6mm, close to the pleura, that accumulated contrast, two mediastinal lymph nodes 5,7mm and 8,5mm. CT guided transthoracic lung core biopsy was performed. Histopathological diagnosis - Metastatic process of Spindle cell melanoma malignum. Microscopic examination with accumulation of large, pleomorphic cells with deposits of melanin irregularly arranged. The origin and systemic dissemination of the melanoma was investigated. Abdominal ultrasound without abnormalities. Dermatological, ophthalomological, gastroenterohepatological examinationas were performed, but the primary lesion remained unknown. The patient denied to receive proposed oncological and surgical therapy. Two years after, control CT scan, the tumor was 47x43mm, in right lung secondary deposite 11x8mm, increased mediastinal lymph nodes to 18mm.
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Hodgkin lymphoma – lung metastasis - Case report
(Turkish Respiratory Society; Respiratory Society of Serbia, 2017-04)
Baloski Marjan
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Kochovska Kamchevska Nade
;
Bushev Jane
;
Smileska Snezana
;
Lymphoma is the most common blood cancer. Occurs when lymphocytes grow and multiply uncontrollably in the lymph nodes, spleen, bone marrow, or other organs. Approximately 9,000 new cases of Hodgkin Lyphoma are projected each year, commonly diagnosed in young adults between the ages of 20 and 34 years. Female patient, 33 years old, diagnosed with Hodgkin Lymphoma in 2010. Treated with several cycles of chemotherapy. 2-3 months before hospital admission, she felt shortness of breath, prolonged, dry cough, haemoptysis. On physical examination – swallen lymph nodes in right axilla and neck. Auscultatory normal finding. Other systems without pathological findings. Chest X-ray - right infraclavicular, massive, heterogenous shadowing, separated and connected to right hylus. CT lung scan – in right upper medial segment, stellate, 6sm, cavernous consolidaton. Mediastinal and hilar lymphaednopathy In right axilla enlarged lymph nodes. Bronchoscopy – edematous mucosa. Abdominal and pelvic CT scan – normal. Transthoracic CT guided lung biopsy with histopathological finding - MORBUS HODGKIN PULMONUM. Microscope finding of fragments showed accumulations of mature lymphocytes mixed with macrophages, plasma cells and eosinophilic leukocytes, rare cells with basophilic cytoplasm and hyperchromatic large cores. In several cells binuclearity, in a larger cell multinuclearity. The immunohistochemical analysis conducted further, obtained the following RESULTS: CD-15 (cell marker for Reed-Sternberg cells) positive +, CD-30 (a marker for cell mitosis in cells) is positive focal +, CD-20 (B-grade. marker) positive +, CD-3 (T marker) positive focal +. For further treatment the patient was referred to the Department of Hematology.
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Tracheal diverticulum – a possibility of intraoperative and postoperative complications
(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University Skopje, R.N.Macedonia, 2019-12)
Tusheva Ivana
;
Adjami Bekim
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Poposki Bozidar
During preoperative anesthesiology examination of a 39 year old female patient, it was noticed a suspected tracheal diverticula, as seen on the CT scan. Bronchoscopy was required to assess the risk of intubation, which did not confirm the presence of the tracheal diverticulum, but a demarcation of the posterior wall of the trachea was observed. Due to a diagnosed kidney tumor, the patient was intubated and operated without complications from the intubation. However postoperatively, in order to confirm the presence of a tracheal diverticulum, the Radiology Clinic was consulted, where a 3D reconstruction of a pre-made CT scan revealed a tracheal diverticulum with dimensions of 1.83 cm x 5.42 mm. Conclusion: Diagnosis of tracheal diverticulum is established with high resolution CT with 1 mm cross sections and 3D reconstruction. Bronchoscopy cannot exclude the presence of tracheal diverticulum. If we have evidence of the presence of a tracheal diverticulum during anesthesiology, it is desirable to determine the level of the tracheal diverticulum to avoid placing the cuff at that level. The airway pressure needs to be strictly controlled and the ventilation mode adequate

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