Faculty of Medicine

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    VERRUCOUS MALFORMATIONS AS A RARE CASE IN THE GROUP OF VASCULAR ANOMALIES WITH SLOW BLOOD FLOW IN CHILDREN
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04-04)
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    Kamiloski, Marijan
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    Lumani Bakiji, Njomza
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    Racaj, Anila
    Verrucous venous malformations belong to the group of vascular anomalies. The International Society for the Study of Vascular Anomalies (ISSVA) classifies these changes into two major groups: vascular tumors and vascular malformations. The vascular malformations group includes lymphatic malformations, venous malformations, and their combinations (malformations with slow blood flow), as well as arteriovenous malformations (malformations with fast blood flow). Verrucous venous malformations (VVM) are a rare congenital vascular anomaly first described by Helwig in 1967. They are characterized by varying degrees of hyperkeratosis of the skin and subcutaneous tissue. Clinically, they manifest as dark red solitary or multiple hyperkeratotic plaques, most commonly localized on the extremities. Treatment is combined and includes surgical intervention, electrocoagulation, laser therapy, topical agents, and systemic medications. Materials and Methods: Between 2019 and 2024, two children with suspected verrucous venous malformations were admitted to the Public Healthcare Institution – University Clinic for Pediatric Surgery. The lesions were unilaterally located on the lower extremities. The gender distribution was 1:1 (male to female), with an average age of 10 years. The changes had been present since birth. There was no positive family history in either patient. Clinically, one of the patients presented with inflammation of the lesion, accompanied by pain and serous secretion. Results: Following appropriate preoperative preparation, both patients underwent surgical excision and autologous skin transplantation. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis. After excision, electrocoagulation was applied to residual lesions. A reduction of approximately 90% in lesion size was recorded. Conclusion: Verrucous venous malformations are a rare type of malformation within the group of vascular anomalies, requiring a multidisciplinary treatment approach.
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    Percutaneous Imaging-Guided versus Open Musculoskeletal Biopsy: Concepts and Controversies
    (Georg Thieme Verlag KG, 2020-12)
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    Ivanoski, Slavcho
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    Bone and soft tissue tumors are a largely heterogeneous group of tumors. Biopsy of musculoskeletal (MSK) tumors is sometimes a challenging procedure. Although the open biopsy is still considered the gold standard for the biopsy of MSK lesions, core needle biopsy can replace it in most cases, with similar accuracy and a low complication rate. The biopsy should be performed in a tertiary sarcoma center where the multidisciplinary team consists of at minimum a tumor surgeon, an MSK pathologist, and an MSK radiologist who can assess all steps of the procedure. Several factors can influence the success of the biopsy including the lesion characteristics, the equipment, and the method used for the procedure. This review highlights some of the important aspects regarding the biopsy of the MSK tumors, with special attention to imaging a guided core needle biopsy and highlighting some of the recent advancements and controversies in the field.
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    Ultrasound-guided Biopsy of Musculoskeletal Soft-tissue Tumors: Basic Principles, Usefulness and Limitations
    (Sciendo, 2022-04)
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    Ivanoski, Slavcho
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    The aim of this article is to provide a short review of the literature concerning the basic principles, usefulness and limitations of ultrasound-guided biopsy of musculoskeletal soft-tissue tumors, with particular focus on core needle biopsies. Musculoskeletal soft-tissue tumors represent a rare and complex group of heterogeneous lesions. Prompt diagnosis of these uncommon lesions can improve the outcome and increase the patient survival rate. A biopsy examination of soft-tissue tumors with imaging modalities is necessary in all cases of aggressive or undetermined lesions. Although fine needle aspiration can be helpful for the biopsy of certain tumor types, core needle biopsy is a standard procedure in most tertiary sarcoma centers. It has a high diagnostic accuracy, low complication rate and lower price in comparison to open biopsy, and can replace it in the majority of cases of soft-tissue tumor assessment. However, the examining physician has to be familiar with the technique, and the strengths and potential difficulties in performing ultrasound-guided biopsy, as well as possible solutions to obstacles. Several recently developed ultrasound techniques can be helpful and improve the outcome of imaging-guided biopsies of musculoskeletal lesions.
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    Fibrillary Nephropathy and Amyloidosis - Two Morphological Faces of the Myeloma Kidney
    (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020)
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    Myeloma-induced renal failure is associated with sig- nificant morbidity and mortality. Rapid intervention is critical to reverse kidney damage and improve renal function. We report two cases, one with fibrillary nephropathy and other one with kidney amyloidosis due to multiple myeloma, diagnosed by renal biopsy and treated in our department. Both patients had no other signs of multiple myeloma present, apart from acute renal failure and histological findings on renal biopsy. The renal biopsy was performed because of acute renal failure to exclude rapidly progressive glomerulo- nephritis. The histological analysis showed fibrillary glomerulopathy in one patient and kidney amyloidosis in the other, changes consistent with the diagnosis of multiple myeloma with kidney involvement. Further clinical investigation confirmed multiple myeloma and the patients treated accordingly.