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
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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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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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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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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.

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