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    Girls with Turner's syndrome with spontaneous menarche have an increased risk of endometrial carcinoma: a case report and review from the literature
    (Elsevier BV, 2005-03)
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    A. Papazovska
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    R. Jankova
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    D. Toncheva
    Background. Patients with Turner's syndrome receiving unopposed estrogens for the induction of feminization have an increased risk of endometrial carcinoma. Only seven patients who were not treated with estrogen replacement therapy have been reported to have developed endometrial carcinoma at different age levels. Case. A young girl with Turner's syndrome phenotype, spontaneous puberty, and karyotype 45,X0/47,XXX from peripheral blood, after irregular menstrual cycles of 9 years, at the age of 21, was diagnosed with a non-invasive well-differentiated endometrial carcinoma confined to a hyperplastic endometrial polyp. Analysis of the ovarian tissue by FISH confirmed mosaicism: 45,X0/46,XX/47,XXX. Conclusion(s). The endogenous estrogen secretion from the ovaries might have caused malignancy in this case. Patients with Turner's syndrome with spontaneous menarche might carry a higher risk of endometrial carcinoma.
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    Comparison Between HPV DNA Testing and HPV E6/E7 MRNA Testing in Women with Squamous Cell Abnormalities of the Uterine Cervix
    (Walter de Gruyter GmbH / MANU, 2019-05-01)
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    Duvlis, Sotirija
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    The aim of the study was to compare the results of two human papillomavirus (HPV) diagnostic techniques: human papillomavirus deoxyribonucleic acid (HPV DNA) testing and human papillomavirus E6/E7 messenger ribonucleic acid (HPV E6/E7 mRNA) testing in women with squamous cell abnormalities of the uterine cervix.
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    A new familial mutation (R133G) in the SRY gene
    (Wiley Online Library, 2007-05)
    D Plaseska-Karanfilska
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    P Noveski
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    K Kuzevska
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    Correlation Between Microvessel Density and Morphological Features in Skin Squamous Cell Carcinoma
    (Walter de Gruyter GmbH/Macedonian Academy of Sciences and Arts, 2017-03-01)
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    Abnormal angiogenesis is described in tumor growth and it facilitates its metastatic spread. Tumors with high angiogenic activity belong to the category of aggressive tumors with poor prognosis for patients. The aim of this study was to determine the blood vessels density (BVD), i.e. neovascularization at the tumor invasive front in skin squamous cell carcinoma (SCC) in order to determine its possible role in the tumor progression, and to correlate it to the blood vessels density of healthy skin and with the prognostic parameters of the TNM classification: T status, depth of tumor invasion (DI) and tumor histological grade (G), which were also correlated between each other.
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    Benign granular cell tumor of the uterine corpus: A case report
    (The Arab Division of the International Academy of Pathology In Collaboration with the Jordanian Society of Pathologists, 2018-10)
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    Krstevska, Iskra
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    Ognenoska-Jankovska, Biljana
    Objective: Granular cell tumors (GCTs) are relatively uncommon soft tissue tumors that are usually benign (0.5-2.0% malignant). They have been described in many sites and organs, although cases with genital involvement have rarely been reported. We present the clinicopathological features of a case of a uterine corpus GST. Methods: A 37-year-old woman with secondary infertility was admitted at the University Clinic of Gynecology and Obstetrics for a hysteroscopic examination during which a polypoid isthmico-cervical lesion was detected. Results: The biopsy excision specimen consisted of one smaller fragment of the endometrium and two larger semispherical fragments measuring 0.7x0.5x0.4 and 0.8x0.6x0.4 cm. Upon microscopic examination of the larger fragments under the partly pseudodecidualized endometrial or isthmic type of surface mucosa, a benign mesenchymal neoplasm was found composed of nests of large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei lacking conspicuous nucleoli or mitotic figures. In addition to PAS positivity, upon immunohistochemical staining, the large cells also showed vimentin, S-100, neuron-specific enolase, CD56, CD57, calretinin and Wilms tumor 1 positivity. The proliferative index determined by Ki-67 staining was <5%. Based on the pathological and immunohistochemical examinations, the diagnosis of a benign GCT was established. Due to the fact that the neoplasm was incompletely excised a wide local excision was recommended along with a careful follow-up of the patient. The patient refused the excision and is being well and preparing for in vitro fertilization 24 months following biopsy. Conclusion: GCTs of the uterus and especially of the uterine corpus are extremely rare. To the best of our knowledge, this is a second reported case of uterine corpus GCT in the English-language literature. It is important for gynecologists as well as pathologists to be aware of the possibility of uterine corpus GCTs, for which accurate diagnosis, complete resection and long-term follow-up are crucial.
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    Presentation of the Molecular Subtypes of Breast Cancer Detected By Immunohistochemistry in Surgically Treated Patients
    (ID-Design/Scientific foundation SPIROSKI, 2018-06-20)
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    INTRODUCTION: The detection of estrogen, progesterone and HER-2 neu receptors on the surface of the tumour cell is a significant prognostic factor, alone or in combination. The presence or absence of receptors on the surface of the tumour cell is associated with the conditional gene expression in the tumour cell itself. Based on these genetically determined expressions of the tumour cell, five molecular subtypes of breast cancer have been classified on the St. Gallen International Expert Consensus in 2011 that can be immunohistochemically detected, with each subtype manifesting certain prognosis and aggression. AIM: Analyzing the presentation of molecular subtypes of breast cancer that are immunohistochemically detected in surgically treated patients at the Clinic for Thoracic and Vascular Surgery. MATERIAL AND METHODS: We used the international classification on molecular subtypes of breast cancer which divides them into: Luminal A (ER+ and/or PR+, HER-2 negative, Ki-67 < 14%), Luminal B with HER-2 negative (ER+ and/or PR+, HER-2 negative, Ki-67 ≥ 14%), Luminal B with HER-2 positive (ER+ and/or PR+, HER-2+, any Ki-67), HER-2 enriched (ER-, PR-, HER-2+), and basal-like (triple negative) (ER-, PR-, HER-2 negative, CK5/6+ and/or EGFR+). A total of 290 patients, surgically treated for breast cancer, were analysed during 2014. RESULTS: In our analysis, we found that Luminal A was present in 77 (26.55%) patients, Luminal B HER-2 negative was present in 91 (31.38%) patients, Luminal B HER-2 positive was present in 70 (24.14%) patients, HER-2 enriched was present in 25 (8.62%) patients and basal-like (or triple negative) was present in 27 (9.31%) patients. CONCLUSION: Detecting the subtype of breast cancer is important for evaluating the prognosis of the disease, but also for determining and providing an adequate therapy. Therefore, determining the subtype of breast cancer is necessary for the routine histopathological assay.
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    A new familial mutation in the SRY gene (Arg133Gly)
    (Macedonian Academy of Sciences and Arts, 2006-09)
    Plaseska-Karanfilska, Dijana
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    Noveski, Predrag
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    Kuzevska, Klementina
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    Mutations in the testis-determining gene SRY result in XY sex reversal with pure gonadal dysgenesis (PGD). Most of the SRY mutations affect the HMG domain of SRY which plays a central role in DNA binding and bending activity of SRY. The arginine at codon 133 is conserved in the SRY gene of all studied species. It is part of the basic C-terminal region of the HMG box, which was proposed to provide nuclear localization signal. A de novo Arg133Trp mutation was described in two unrelated patients with pure gonadal dysgenesis. Impaired nuclear localization of SRY was proposed as a cause of organogenesis failure for mutations affecting Arg133. Here we describe a novel mutation that affects codon 133 of the SRY gene, resulting in an arginine to glycine substitution in the protein. It was detected in a 17 years old girl with primary amenorrhea, non-mosaic 46,XY karyotype and bilateral gonadoblastoma. The Arg133Gly mutation in the SRY gene was also detected in patient’s father, who is a phenotipically normal male. However, the mutation was not found in the SRY gene of 90 other males, thus excluding the possibility of a common polymorphism. Our report of familial Arg133Gly mutation suggests that replacement of Arg 133 of the SRY is not sufficient for impaired organogenesis and emphasizes the importance of modifier genes in the sex determination pathway.
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    High-risk HPV E6/E7 messenger RNA testing versus HPV DNA testing in women with squamous cell abnormalities of the uterine cervix
    (BMJ Publishing Group Ltd, International Gynecologic Cancer Society & European Society of Gynaecological Oncology, 2017-11)
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    Duvlis, Sotirija
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    Micevska, Megi
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    Dabeski, Ana
    Aims The study is performed in order to compare the results of two HPV screening methods: High-risk HPV E6/E7 mRNA and HPV DNA. Method Comparative prospective study, conducted in the period for April 2016 to March 2017 at the University Clinics for Gynecology and Obstetrics and Radiotherapy and Oncology in Skopje and Institute of Public Health of Republic of Macedonia of 98 sexually active women, age groups of 20 to 60 years, with squamous cell abnormalities on the cervical cytology. In all 98 women were done: HPV DNA testing, High-risk HPV E6/E7 mRNA testing and colposcopy and directed biopsy with endocervical curettage for histopathological analysis. Results Histopathologically, there were: 36.7% non-neoplastic lesions, 20.4% LGSIL cases, 29.6% HGSIL cases and 13.3% invasive squamous cell carcinomas. HPV DNA was found 78.6% of the cases; E6 and E7 transcripts were found in 58.2%. The rates of detection of HPV DNA and E6 and E7 transcripts were 83.3% and 22.2% for cases with non-neoplastic finding; 65.0% and 45.0% for cases with LGSIL; 75.9% and 93.1% for cases with HGSIL and 92.3% and 100% for cases with invasive squamous cell carcinoma. High-risk HPV E6/E7 mRNA testing showed a higher sensitivity than the HPV DNA testing (79.0% and 75.8%), higher specificity (77.8% and 16.7%) and a higher positive predictive value for HGSIL ( 93.1% and 75.9%) and invasive squamous cell carcinoma (100% and 92.3%). Conclusion High-risk HPV E6/E7 mRNA testing could be more powerful than HPV DNA testing for screening and investigation of HGSIL and invasive squamous cell carcinoma.
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    The depth of the stromal invasion of cutaneous squamous cell carcinoma in correlation with tumor size and tumor differentiation
    (Macedonian Association of Pathology, 2016-09)
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    Objective: The aim of this study was to determine the correlations between stromal invasion and the grade of differentiation as well as tumor’s size in squamous cell carcinoma of the skin (SCC). Material and Methods: Surgically resected skin specimens from 30 patients with cutaneous SCC, were included in the study. The hematoxylin-eosin stained histological sections containing the tumor tissue and the surrounding normal skin prepared from routinely processed paraffin blocks were analyzed by light microscopy. In each analyzed SCC, the degree of histological differentiation (G) and the postoperative tumor status (pT) of the neoplasm according to TNM classification (AJCC) were determined. The depth of stromal invasion in each case was measured on low power field (x40) using morphometry software. The distance from the basement membrane of the epidermis to the deepest invasive neoplastic focus of the tumor and the obtained values are presented in absolute numbers expressed in micrometers. Results: The SCC in 21 (70%) cases was classified as pT1 and in 9 (30%) cases as pT2 category tumor. Twelve tumors (40%) were classified as well (G1), 13 (43.3%) as moderately (G2), and 5 (16.7%) as poorly (G3) differentiated tumors. The depth of stromal invasion was ranging from 1561.2 μm to 13000.1 μm. A statistically significant difference was found between the depth of invasion in tumors belonging to different pT category (Mann-Whitney U test, p=0.003034 for pT1 and pT2), and different grade (Kruskal-Wallis test, p=0.00008 for G1, G2, G3). Conclusions: The depth of stromal invasion was higher in larger SCCs with a maximal diameter greater than 2 cm (pT2) and in poorly differentiated (G3) tumors.
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    Multimodality treatment of brain metastases from ovarian cancer
    (Macedonian Association of Pathology, 2016-09)
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    Veljanoska, Slavica
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    Objective: Brain metastases from ovarian cancer are uncommon and usually associated with mean survival less than 12 months. In some cases, multimodality treatment may achieve an improved outcome in these patients. Material and Methods: Two cases of multiple brain metastases from ovarian cancer are presented. A combination of whole-brainradiotherapy (WBRT) and chemotherapy (Topotecan) was used. Results: Case 1: A 62-year-old patient was diagnosed and treated for primary ovarian cancer in 2012. She underwent optimal surgical resection and adjuvant platinum-based chemotherapy (Carboplatin/Paclitaxel, 6 cycles). Eleven months after the initial treatment the patient developed right hemiparesis. Brain CT documented multiple brain metastases in the left frontal and parietal lobe. She proceeded to WBRT and subsequent 4 cycles of Topotecan. At a follow-up of 24 months, there is no evidence of recurrent disease. Case 2: A 63-year-old patient was diagnosed with primary ovarian cancer in 2012. Initially, she received neoadjuvant chemotherapy (Carboplatin/Paclitaxel, 6 cycles and Doxorubicin/Carboplatin, 3 cycles) followed by surgical treatment. After 1-year follow-up, multiple brain metastases in the right temporoparietal and occipital lobe were detected by brain MRI. She underwent WBRT followed by 4 cycles of Topotecan. Better motor performance was achieved and the MRI scan evaluation showed volume reductions of brain metastases. Nine months later, CT scan revealed a progression of the metastatic disease and re-WBRT was performed. At a follow-up of 18 months, she is in good clinical condition. Conclusions: In ovarian cancer patients with multiple brain metastases, multimodal therapeutic approach including radiotherapy followed by chemotherapy may lead to prolonged survival.