Faculty of Medicine

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Author: search.filters.author.Stepanovski, AleksandarLanguage: search.filters.language.English

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    Appendiceal neuroendocrine tumor in a pediatric patient – A case report
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2026-02)
    Jovcheski, Lazo
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    Andonovska Dokovska, Biljana
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    Stepanovski, Aleksandar
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    Gjorik, Sanja
    Appendiceal neuroendocrine tumors (NETs) are the most common appendiceal neoplasms but remain rare in the pediatric population. They often present with clinical features mimicking acute appendicitis and are therefore usually diagnosed incidentally on histopathological examination after appendectomy. Prompt identification is crucial, as tumor characteristics determine management and prognosis. We report a case of a 13-year-old girl presenting with clinical and radiological signs of acute appendicitis due to fecalith obstruction and a right ovary cyst. Laparoscopic appendectomy and ovarian cystectomy were performed without intraoperative suspicion of malignancy. Histopathological analysis revealed a well-differentiated neuroendocrine tumor measuring 1.5 cm localized near the tip of the appendix. The lesion infiltrated all the layers of the appendix wall and penetrated the serosa, without lymphovascular invasion or mesoappendiceal extension. Immunohistochemical staining confirmed the diagnosis. Multidisciplinary tumor board decision guided further management and the patient remains disease-free at twelve-month follow-up. Outcome was promising with no recurrence, metastasis, complications, or need for additional therapy observed during follow-up. The discussion section emphasizes the critical role of histopathological analysis of appendectomy specimens and gives further recommendations for efficient management of appendiceal NETs in children, depending on tumor size and histological risk features. Appendectomy alone is usually sufficient for tumors less than 2 cm without invasion. This case underscores the critical role of histopathological vigilance and multidisciplinary care in pediatric surgical oncology.
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    TREATMENT OF VENOUS MALFORMATIONS IN PEDIATRIC POPULATION – THREE- YEAR EXPERIENCE
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2022-12-30)
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    Lumani-Bakiji, Njomza
    Venous malformations (VMs) are a type of vascular malformations that result in abnormal development of veins that become extensible over time due to an error in vascular morphogenesis. They usually appear in newborns or in early adulthood as a bluish, soft, swollen and eventually painful skin formation. Treatment includes conservative therapy, sclerotherapy, and surgical excision. Aim of the paper is to evaluate the therapeutic effect of sclerotherapy in pediatric patients with venous malformations. Material and methods: In a three-year period, from 2019 to 2021, venous malformations were found in 33 patients aged 4 to 14 years (average age: 8 years). Pain as a symptom occurred in 8 patients. Two patients had lesions measuring up to 5 cm and 5 cm, respectively, while in the remaining subjects the lesion was over 5 cm. Ultrasound was performed routinely in all subjects, and MRI in two patients. Conservative treatment was instituted in 13 patients with venous malformations of the extremities; surgical excision with local reconstruction was performed in 11 patients, and sclerotherapy with bleomycin under general anesthesia was performed in 8 patients. Combined treatment was used in one patient that presented with venous malformation of the upper arm that underwent partial sclerotherapy with subsequent operative excision due to a phlebolith. Follow-up examinations revealed regression of the change not only from functional but from aesthetic aspect as well. Conclusion: Sclerotherapy is the established golden standard, first-line treatment for venous malformations. Excellent results were achieved as the reduction of the lesions was below 50% of the initial size. However, the modality of treatment should be individualized to each patient as it can sometimes require a combination of more than one treatment option. Venous malformations are best treated early, but they usually recur over time. Treatment helps relieve symptoms and control the growth of vascular malformations.