Faculty of Medicine

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    A CASE OF A POSTMENOPAUSAL WOMEN WITH DIFFERENTIATED VULVAR INTRAEPITHELIAL NEOPLASIA (dVIN) – HPV INDEPENDANT
    (Македонско лекарско друштво = Macedonian medical association, 2025-09)
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    Bashkim Ismaili
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    Julija Kostadinoska
    ;
    Bobi Kirkovski
    Introduction: Human papillomavirus (HPV) independent vulvar intraepithelial neoplasia is the precursor lesion of HPV independent vulvar squamous cell carcinoma (SCC). Differentiated vulvar intraepithelial neoplasia (dVIN) is an aggressive lesion with higher potential to become invasive than HPV associated VIN (usual type). It is most common in older women ~60-80 years of age, who have a history of chronic inflammatory dermatoses, lichen sclerosus, lichen simplex chronicus. Case report: A 67 years old woman was referred to the Specialized hospital for gynecology and obstetrics “Mother Teresa” due to the presence of a dark red change of the vulva and itching. On inspection, there was fusion of the anterior commissure and an effaced clitoris. With acetic acid, a vinegar-positive sector was observed at the junction of the commissures with dimensions of 2-3 cm. An indication for a biopsy was established. A pathohistological analysis of a biopsy fragment with a diameter of 0.5 cm was performed. It was partially lined with keratotic stratified squamous epithelium and partially with squamous epithelium showing dyskeratosis and parakeratosis, and the epithelial cells contained prominent nucleoli and showed pathological mitoses in the basal layers. A lympho-plasmacytic inflammatory infiltrate was found subepidermally. Immunohistochemically, the cells showed negative staining for p16 protein and positive for p53 protein. The proliferative marker Ki-67 showed nuclear positivity in the distal two-thirds of the epithelium. The morphological and immunohistochemical characteristics corresponded to a differentiated type of vulvar intraepithelial neoplasia that was HPV independent. The patient was referred to a tertiary healthcare facility where an indication for vulvectomy was established due to the size and location of the change. Conclusion: We like to emphasize the need of performing biopsy of any suspicious lesion of the vulva, especially in older women, because inflammatory changes can be precursors to intraepithelial neoplasia, which can further develop into invasive SCC.
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    Clinicopathological analysis of incidentally detected blue nevi of the uterine cervix in biopsy and curettage specimens. A report of 7 cases.
    (Springer, 2019-09)
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    Ognenoska-Jankovska, Biljana
    Background & Objectives: Blue nevi (BN) of the uterine cervix (UC) are rare incidental lesions; they are often found in hysterectomy specimens from middle-aged women, or rarely in specimens obtained during more conservative diagnostic procedures (e.g. biopsy, curettage). The objective of our study was to analyse the clinicopathological features of 7 incidentally detected cases of the BN of the UC in biopsy or curettage specimens. Methods: Among a total of 60 BN of the UC diagnosed on operative and biopsy specimens in our Department between 2000-2019, in 7 (7/60, 11.7%) cases BN were found in biopsy or curettage specimens that had been taken for an examination of a clinically or cytologically suspicious cervical lesion (3/7, 42.9%) or a dysfunctional uterine bleeding (4/7, 57.1%), respectively. The mean age of the patients was 44 years (range, 29-57 years). In addition to routine hematoxylin&eosin, histochemical and immunohistochemical stainings were also performed. Results: Histologically, all cases showed loose aggregates of pigmented, spindle-shaped, dendritic or nevoid, epithelioid cells in the superficial stroma in one (4/7, 57.1%) or >2 fragments of cervical mucosa (3/7, 42.9%). The lesions ranged in size from 0.5 to 6mm (mean, 2.4mm), while their thickness ranged between 0.5-4mm (mean, 1.5mm). In one case the BN was presenting as an endocervical polyp. The pigmented cells in all tested cases were positive for melanin (Fontana-Masson), S100, Melan-A, as well as for HMB45 in 3 cases. Conclusion: Although the BN of the UC seem to be lesions of low clinical significance, they require careful differential diagnosis with other pigmented lesions including malignant melanoma, especially because they are rarely detected and might easily be missed or misinterpreted in scanty endocervical curettage or cervical biopsy specimens due to their small size, more frequent endocervical localization and occasional discrete findings.
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    METASTATIC CUTANEUS MELANOMA OF THE GALLBLADDER-CASE REPORT
    (Association of medical doctors "Sanamed" Novi Pazar, 2019-08-04)
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    Nancheva Bogoevska, Andrea
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    Bozinovska Beaka, Gordana
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    Gjoreski, Aleksandar
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    Melanoma is an aggressive malignant tumor that originates from melanocytes and most com- monly occurs on the skin. Dominantly metastasize to regional lymph nodes, in the brain and lungs and rarely in the gastrointestinal (GI) system. The aim of this re- port is to present a rare case of metastasis of cutaneous malignant melanoma in the gallbladder, discovered 10 months after excision of the primary melanoma of the skin. A 45-year-old patient was hospitalized in our hos- pital due to abdominal pain in right upper quadrant and nausea lasting for 7 days. An intraluminal substrate was found in the gallbladder with computed tomogra- phy and later a CT guied biopsy was performed on it, thus proving a metastatic deposit of primary malignant melanoma. Metastatic deposits in the gallbladder are extre- mely rare finding, and 238 cases have been described in the literature.
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    Breast cancer in pregnancy - case report
    (SHMSHM / AAMD, 2013)
    Jovanova Daniela
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    Selami A
    Breast cancer in pregnancy (BCP) is relatively rare with an incidence of 1:3000 to 1:10 000 births. Breast cancer in pregnancy is second most frequent among malignancies in pregnancy, right behind cervical cancer. The diagnosis of BCP is made if the condition appears during the pregnancy, or during the first year after delivery, with some variations in duration of the postnatal period that is taken into consideration, varying from 6 months to 2 years. Most of the tumors are adenocarcinomas, scirus, colloid or anaplastic. As in all cases of breast cancer outside pregnancy, biopsy is a "gold standard" in the diagnosis of this condition during pregnancy. Imaging diagnostic techniques have limited application either because of the increased false positive rate or lower sensitivity. Pregnancy termination does not represent an efficient therapeutic alternative. Surgical treatment is a supreme therapeutic procedure in the treatment of BCP. In patients that have been diagnosed during the late second trimester, optimal treatment comprises of dissection of the tumor mass and axillar lymph nodes, followed by delivery and radiation therapy. We are presenting a case of 34 years old patient with poorly differentiated breast carcinoma, Stage IIIC, during the late second trimester. After the surgery the delivery was postponed until 37th week. Through presentation of this case we've tried to show that there is an open possibility to postpone the delivery in patients in which the diagnosis was made in the late second trimester, for until the late third trimester or even until the EDD, and yet not to compromise overall prognosis of the patient.