Faculty of Medicine

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Gastric metastasis from high-grade soft tissue sarcoma: a rare occurrence with literature review
(Oxford University Press and JSCR Publishing Ltd, 2025-03-15)
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Angelovska, Tamara
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Adem, Xhem
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Todorova, Teodora
Metastasis of high-grade soft tissue sarcoma to the stomach is an extremely rare occurrence. While sarcomas can spread to distant organs,they most commonly metastasize to the lungs,liver,and bones.We report a unique case of gastric metastasis from a high-grade soft tissue sarcoma,occurring 4 years after the initial diagnosis of fibrosarcoma in the right femoral region.The patient did not undergo adjuvant chemotherapy and developed a large soft tissue metastasis in the left gluteal region 2 years later. After 4 years, he presented with a second soft tissue metastasis and suspected metastatic lung nodules. Symptoms of melena and severe anemia prompted a gastroscopic examination, which revealed gastric metastasis from a high-grade soft tissue sarcoma. Due to severe anemia, a palliative gastric resection was performed.A review of the literature indicates that metastatic leiomyosarcomas are the most frequently reported sarcoma subtype metastasizing to the stomach.
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Small intestine metastasis from endometrial carcinoma initially presented as enterocutaneous fistula: a case report and literature review
(Oxford University Press (OUP), 2024-05)
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Limani, Nimetula
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Ristova Tancheva, Aleksandra
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Manasievska Bogoevska, Antonela
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Although endometrial cancer is the fourth most common malignancy among women, it rarely metastasizes to the small intestine. Cases of endometrial recurrence to the intestine clinically present with secondary anemia, melena, abdominal cramps, and epigastric pain. Only a dozen cases are reported in the literature, but none presented with an enterocutaneous fistula. In this report, we present a case of an 88-year-old female patient previously treated for endometrial adenocarcinoma with surgery and adjuvant radiotherapy. Fourteen months after the surgery, the patient presented with an enterocutaneous fistula on the anterior abdominal wall, which was confirmed to be a metastasis from the primary tumor. To our knowledge, this is the first case of endometrial cancer metastasizing to the small intestine with involvement of the anterior abdominal wall and the occurrence of an enterocutaneous fistula, which was treated with radical surgery.
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Malignant diffuse peritoneal leiomyomatosis: A case report
(Expansion Scientifique Publications, 1998-10)
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Ivkovski, Ljube
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Yashar, Genghis
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Veljanovska, Slavica
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Vuzevski, Vojislav
Diffuse peritoneal leiomyomatosis (DPL) is a rare condition characterized by the presence of multiple abdominal smooth muscle nodules. Malignant transformation appears to be extremely rare. This report presents the eighth case with proven malignancy. The patient is a 43 year old, Caucasian, non-pregnant female, with no history of hormonal therapy, presented with a few months old history of intermittent and increasing right lower abdominal pain. In October 1996, explorative laparatomy was performed. Innumerable subperitoneal gray-white masses with firm to rubbery consistency, varying in size from 0.2 to 11.5 cm, were found scattered over the parietal peritoneum, omentum and mesentery. Several of these nodules were removed. Their microscopic appearance was variable. Most of the lesions appeared to consist of subperitonel nodules of benign-appearing smooth muscle cells. Nevertheless, some of them showed malignant characteristics, marked cellularity, and numerous mitoses. Immunohistochemical and ultrastuctural studies proved the smooth muscle origin of the tumors. During the next few months the abdominal tumors increased in size and the patient's condition progressively deteriorated. A second laparotomy was performed in March 1997. More than 40 nodules were removed together with a small bowel segment where inflammatory fistula was found. After receiving three courses of chemotherapy, the patient refused further treatment. In December 1997, the patient was admitted to the hospital with acute abdominal pain due to ileus, and the third laparotomy was performed. This additional case indicates that DPL has a low, but definite malignant potential, and suggests that meticulous examination of histologic material and careful follow up are required.
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Epithelioid trophoblastic tumor initially misinterpreted as uterine smooth muscle tumor with vaginal and sigmoid colon metastases
(Macedonian Association of Anatomists and Morphologists, 2005)
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Prodanova, Irina
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Veljanoska-Petreska, Slavica
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Kubelka-Sabit, Katerina
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Jashar, Dzengis
The epithelioid trophoblastic tumor (ETT) is a rare trophoblastic neoplasm with a wide spectrum of differential diagnoses and unpredictable clinical behaviour. A 43-year-old woman underwent hysterectomy for an intramural uterine nodule initially misinterpreted as smooth muscle tumor. Subsequently, 91 and 113 months later, two recurrences were discovered: at the vaginal stump and in the sigmoid colon. The histological and immunohistochemical findings of the primary and the metastatic tumors were consistent with the diagnosis of ETT. Therefore, immunohistochemistry could help in confirming the diagnosis of ETT. In these patients, subsequent to primary surgical treatment, a careful and prolonged follow-up is warranted.
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Malignant melanoma metastatic to the ovaries: a clinicopathological and immunohistochemical study of four cases
(Wiley-Blackwell, 2012-10)
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Veljanoska-Petreska, Slavica
Introduction: Ovarian involvement with malignant melanoma (MM) is extremely rare often leading to a misdiagnosis of ovarian cancer. We present the clinicopathological and immunohistochemical features of four cases of ovarian metastatic MM diagnosed at our Department over a 23-year period (1989–2011). Materials and Methods: The patients’ age ranged from 28 to 72 (mean 49.5) years. All presented with a pelvic mass and a past history of MM (three cutaneous, one anorectal), although at the time of the histopathological evaluation it was known in only two cases. The interval between the primary and ovarian MM ranged from 3 to 72 months. The initial treatment was surgery, followed by chemoimmunotherapy in three of them. One patient died of an unrelated cause 29 months following surgery with metastatic disease, while the other three died from metastatic disease within 41 days, 15 months, and 10 years, respectively. Two of these patients had lymph node metastases previously and all three had synchronous metastases at other sites at the time of the surgery. Results: The ovarian tumors were unilateral, varied in size from 14 to 25 cm, and only two were grossly pigmented. Histologically, they were composed of large epithelioid cells with eosinophilic cytoplasm, small cells, spindle-shaped cells, or a combination. The predominant architectural patterns were nodular in one, and diffuse in the other three tumors. Immunostains for S-100, HMB-45, and melan-A were positive in all tumors tested. Conclusion: The presented cases illustrate the clinical variability and unpredictable biologic behavior of ovarian metastatic MM and emphasize the value of immunohistochemistry in establishing the diagnosis.
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Solitary lung metastasis of malignant melanoma - Case report
(Turkish Respiratory Society; Respiratory Society of Serbia, 2017-04)
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Kochovska Kamchevska Nade
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Bushev Jane
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Smileska Snezana
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Baloski Marjan
Malignant melanoma is increasing last thirty years, one of the most common cancers in young adults (especially women). Primary localization on skin, mouth, intestines, eye. Survival in malignant melanoma stage IV is 10-15%, better prognosis have patients with normal lactate dehydrogenase (LDH). Lung metastases are usually asymptomatic, multiple, nodular. Desmoplastic (neurotropic, spindle cell) melanoma is rare form of infiltrating carcinoma, with diificult diagnosis due to similarity to un-melanocytic lesion as scar, fibroma, cyst. Female patient, 69 years of age, hospitalized for changes seen on chest X-ray. Symptoms: intermittent pain in left shoulder, dyspnea. Profession: housewife, non-smoker, comorbidity: arterial hypertension. Normal lung auscultatory finding. Laboratory: sedimentation 20, hemoglobin 11,9, LDH and tumor markers (CA19-9, CEA, CA 125, CA 15-3) normal. Chest X-ray: left apical, oval, soft-tissue shadowing. Bronchoscopy – without pathological findings. A computed tomographic chest scan showed: in left apicoposterior segment, solid formation with dimensions 18x13,6mm, close to the pleura, that accumulated contrast, two mediastinal lymph nodes 5,7mm and 8,5mm. CT guided transthoracic lung core biopsy was performed. Histopathological diagnosis - Metastatic process of Spindle cell melanoma malignum. Microscopic examination with accumulation of large, pleomorphic cells with deposits of melanin irregularly arranged. The origin and systemic dissemination of the melanoma was investigated. Abdominal ultrasound without abnormalities. Dermatological, ophthalomological, gastroenterohepatological examinationas were performed, but the primary lesion remained unknown. The patient denied to receive proposed oncological and surgical therapy. Two years after, control CT scan, the tumor was 47x43mm, in right lung secondary deposite 11x8mm, increased mediastinal lymph nodes to 18mm.
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Hodgkin lymphoma – lung metastasis - Case report
(Turkish Respiratory Society; Respiratory Society of Serbia, 2017-04)
Baloski Marjan
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Kochovska Kamchevska Nade
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Bushev Jane
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Smileska Snezana
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Lymphoma is the most common blood cancer. Occurs when lymphocytes grow and multiply uncontrollably in the lymph nodes, spleen, bone marrow, or other organs. Approximately 9,000 new cases of Hodgkin Lyphoma are projected each year, commonly diagnosed in young adults between the ages of 20 and 34 years. Female patient, 33 years old, diagnosed with Hodgkin Lymphoma in 2010. Treated with several cycles of chemotherapy. 2-3 months before hospital admission, she felt shortness of breath, prolonged, dry cough, haemoptysis. On physical examination – swallen lymph nodes in right axilla and neck. Auscultatory normal finding. Other systems without pathological findings. Chest X-ray - right infraclavicular, massive, heterogenous shadowing, separated and connected to right hylus. CT lung scan – in right upper medial segment, stellate, 6sm, cavernous consolidaton. Mediastinal and hilar lymphaednopathy In right axilla enlarged lymph nodes. Bronchoscopy – edematous mucosa. Abdominal and pelvic CT scan – normal. Transthoracic CT guided lung biopsy with histopathological finding - MORBUS HODGKIN PULMONUM. Microscope finding of fragments showed accumulations of mature lymphocytes mixed with macrophages, plasma cells and eosinophilic leukocytes, rare cells with basophilic cytoplasm and hyperchromatic large cores. In several cells binuclearity, in a larger cell multinuclearity. The immunohistochemical analysis conducted further, obtained the following RESULTS: CD-15 (cell marker for Reed-Sternberg cells) positive +, CD-30 (a marker for cell mitosis in cells) is positive focal +, CD-20 (B-grade. marker) positive +, CD-3 (T marker) positive focal +. For further treatment the patient was referred to the Department of Hematology.
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Predictive Factors in Malignant Melanoma
(Macedonian Association of Anatomists and Morphologists, 2012)
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The vertical melanoma thickness according to Breslow, the anatomical level of the tumor skin invasion according to Clark, mitotic activity in the tumor cells, the type and the phase of growth of the tumor, the localization, the local inflammatory response to the tumor cells and the presence of the tumor infiltrating lymfocytes as well as the age and the sex of the patient are considered as factors which could influence the prognosis of the melanoma. The aim of this study was to define the correlation between the predicting factors of malignant melanoma (vertical melanoma thickness according to Breslow, the presence of the ulceration and the presence of tumor infiltrating lymphocytes), and the presence of metastasis in the sentinel lymph nodes, and, to determine the predicting value of these factors in patients with malignant melanoma of the skin. Thirty patients with malignant melanoma who had undergone surgery at the University Clinic for Plastic and Reconstructive Surgery in Skopje in the period from 2005 until 2009, were retrospectively evaluated. The following parameters were analyzed: primary tumor thickness according to Breslow, presence of ulcerations, lymphocytic infiltration and their relation with onset of metastases in the sentinel lymph node. The results showed that there was a statistically significant correlation of the vertical thickness of the tumor according to Breslow and the presence of the lymphocytic infiltration with the sentinel node positivity for metastasis. Higher value of Breslow indicates higher possibility for metastasis in the sentinel nodes. A more intense tumor lymphocytic infiltration is related to the lower possibility for metastasis in the sentinel nodes. The correlation between the ulceration of the melanoma lesion and the positivity for metastasis of the sentinel node was statistically insignificant.

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