Faculty of Medicine

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Author: search.filters.author.Qerimi, AdelinaSubject: search.filters.subject.histology

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    Ovarian Leydig cell tumor (hilus cell tumor): A case report
    (Macedonian Association of Pathology, 2016-09)
    Qerimi, Adelina
    ;
    Stojkoska, Elena
    ;
    Ognenoska-Jankovska, Biljana
    ;
    Trajanova, Milka
    ;
    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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    Apocrine carcinoma in situ with microinvasion – A case report
    (Macedonian Association of Pathology, 2016-09)
    Ognenoska-Jankovska, Biljana
    ;
    Qerimi, Adelina
    ;
    Stojkoska, Elena
    ;
    Objective: Invasive apocrine carcinoma is a very rare type of breast malignancy, with an incidence of 0.5-4%, which presumably develops from apocrine precancerous lesions. We report a case of microinvasive apocrine carcinoma which was diagnosed by fine needle aspiration cytology (FNAC) and confirmed by histopathology. Material and Methods: A 45-year-old woman following a routine mammography that showed irregular spiculated mass measuring approximately 2.5cm in the upper outer quadrant of the left breast was referred to our Department for FNAC. The patient subsequently underwent left-sided quadrantectomy and axillary lymph node dissection, followed by postoperative adjuvant chemotherapy and radiotherapy. After 3 years of follow-up, no local recurrence or metastases were found. Results: FNAC yielded moderately cellular smears composed of loosely cohesive clusters of large, polygonal cells with abundant, basophilic and granular cytoplasm suggestive of malignant neoplasm with apocrine features. On gross examination of the quadrantectomy specimen, a grayish-white, solid growth with pushing borders measuring 2.5x1.7x1.5 cm was identified. Twenty-one lymph nodes measuring from 0.3 to 1.3 cm were dissected. Histologically atypical apocrine adenosis, low- and high-grade apocrine ductal carcinoma in situ (ADCIS) and 9 foci of microinvasive apocrine carcinoma (0.1-0.5mm) were found. Apocrine metaplasia was identified in the surrounding ducts. No nodal involvement was observed and the surgical margins were tumor free. Immunohistochemistry revealed that malignant cells (ADCIS and microinvasive carcinoma) were strongly positive for gross cystic disease fluid protein-15, Her2, and androgen receptor, and negative for estrogen and progesterone receptors. Ki67 proliferative index was approximately 15-20%, while 20-25% of the tumor cells were immunoreactive for p53. Conclusions: Here we report a case in which all of the stages involved in apocrine carcinoma progression were identified, from benign metaplasia to hyperplasia, atypia, ADCIS, to microinvasive cancer.