Malahova gjoreska, Iva

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Malahova gjoreska, Iva
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Malahova gjoreska, Iva

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    Struma Ovarii: A Rare Ovarian Teratoma and Follicular Adenoma of Thyroid Gland
    (Austin Publishing Group, 2022)
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    Stojanovska, MI
    Ovarian struma is a germ cell tumor in which thyroid tissue represents more than a half of the tumor and has incidence of 0,3-1% of all ovarian tumors. Most of the patients are asymptomatic and tumor is found incidentally during ultrasound, or with nonspecific symptoms, like pain or abdominal swelling. We report a case of 49-years old woman with no symptoms and an ovarian mass, which was incidentally found during a routine ultrasound examination. On ultrasound she had a tumorous mass on the left ovary with central cystic part filled with dense fluid. Color Doppler showed resistance index RI - 0.64, which did not indicate malignant nature of the tumor, and CA-125 was slightly elevated (38,4 U/ml). The result of the scoring system ROMI was 11 ponts, i.e. low risk for ovarian carcinoma. The patient underwent hysterectomy and bilateral adnexectomy. The final histopathologic report was struma ovarii with well-differentiated neoplasm of uncertain malignant potential.
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    COMPLICATIONS AFTER PLEATED COLPOSUSSPENSION
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
    Zlateska Gjurikj, Sofija
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    Zlateska Damjanovikj, Aleksandra
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    Ilkoski, Ana
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    The case is about a 60-year-old woman with abdominal swelling, lower abdominal cramps, and occasional urine leakage triggered by coughing, sneezing, or laughing. She had no nocturia or urgency symptoms but reported significant social discomfort. Her history included two vaginal deliveries. A pelvic exam revealed mild urethral hypermobility during Valsalva, no significant pelvic organ prolapse, and a highly positive Marshall test for stress urinary incontinence (SUI). Additionally, a firm, mobile mass was palpated in the right abdomen. Ultrasound identified a 13 cm cystic formation in the right ovary with thick edges and no solid components. To assess malignancy risk, we applied our original ROMI index, evaluating serum CA-125 levels, menopausal status, personal and familial history, and ultrasound features. The patient’s ROMI score was 6, indicating low malignancy risk. Laparotomy revealed a large retroperitoneal mass adhering to the right ureter, necessitating J-J stent placement. A successful tumor excision was performed, followed by an abdominal hysterectomy and our modified Pleated Colposuspension after Antovska for SUI correction.
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    Anastrozole is not Always Successful in Preventing Endometrial Hyperplasia in Patients with Estrogen (+) Breast Cancer – Case Report
    (Austin Publishing Group, 2023)
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    Islami, NS
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    Sehfulahi, S
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    Shabani, A
    Breast cancer is the most common malignancy among women. Anastrozole is the recommended therapeutic for long-term postoperative therapy in postmenopausal women with estrogen (+) breast cancer. Its advantage over Tamoxifen lies in the fact that it does not have a stimulating effect on the proliferation of the endometrium, and therefore does not represent a risk for the development of endometrial atypia and endometrial cancer. However, it is not always 100% effective in suppressing endometrial proliferation and anaplasia. Our case shows exactly the same situation. In our case, endometrial atypia was diagnosed despite Anastrazole therapy for estrogen (+) breast cancer. The lesson that can be drawn from our case is that cases that are on long-term hormonal therapy with Anastrazole due to previous estrogen (+) breast cancer should be vigilantly monitored for the possible development of premalignant and malignant endometrial changes, including ultrasound gynecological examination at least once/6 months and, if necessary, performance of fractional exploratory curettage.
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    Increased level of IL-8 in amniotic fluid in early second trimester linked with preterm pregnancies.
    (ID Design DOOEL Skopje, 2020-01-15)
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    Cytokines (IL-1, IL-6, IL-8, TNF- alfa) are of crucial importance during pregnancy; they are produced by the placenta in the amniotic fluid and they are elevated in case of intrauterine inflammation. The аim of the study was to prove the ratio between the increased IL-8 in the amniotic fluid in the beginning of the second trimester (16-22 g.w.) and premature birth (< 36.6 g.w.). Material and methods: This was a prospective study that included 150 pregnant patients that had clinical indication for amniocentesis (advanced mother’s age, abnormal test of PRISCA I, suspicious anomalies of the fetus, virus infection or mother’s wish). They all gave a signed consent on being informed about the aims of the study, and following the protocol, they were analyzed and examined i.e. all patients underwent ultrasound examination, vaginal cervicometry. Five ml. of amniotic fluid during the process of amniocentesis was taken for the purpose of the study. All patients were followed until they gave birth, and the exact week of gestation was noted and compered with the IL-8 level. Results: All 150 patients were in the period of 16th-22nd gestational weeks. Twenty of the total of 150 patients had preterm delivery. A total of 139 patients conceived naturally and 9 patients underwent in vitro fertilisation (IVF) and embryo transfer (ET). In those with IVF and ET, 3 had preterm birth. 80% of patients that had preterm birth had increased IL- 8 levels. Median cervical length in those who gave birth at term was 32.1 mm and in those who gave preterm birth was 30.7mm. Conclusion: The study has confirmed the reason for examining cytokines as a method of discovering asymptomatic changes in patients who would give a premature birth.
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    Case of an Low Grade Appendical Mucinous Neoplasia (LAMNS) Presenting as a Right Ovarian Mass
    (Austin Publishing Group, 2022)
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    Appendiceal carcinoma has an incidence of 0.12 cases per 1,000,000 people per year [1]. Of all intestinal tumors, malignant tumors of appendix are less than 0.5%. They are classified into three groups: carcinoid tumors, mucinous cystadenocarcinomas and adenocarcinomas, based on architectural and cytologic features [2]. Appendiceal carcinoma present with acute right abdominal pain, and can also present as a palpable abdominal mass, acute intestinal obstruction or ascites. Most of them are diagnosed unexpectedly from histopathologycal analysis after a simple appendectomy. That is why it is important for gynecologists and general surgeons to consider appendiceal mucinous cystadenomas in their differential diagnosis for a pelvic mass, because early recognition can prevent iatrogenic rupture and subsequent spilling of potentially malignant mucin-producing cells in a peritoneal cavity. In our case report, we present a low grade mucinous appendiceal tumor, diagnosed during surgery in an operating room.
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    ROLE OF CYTOKINES AND THEIR PRESENCE IN THE AMNIOTIC LIQUID AS A SIGN OF EARLY DETECTION OF PREMATURE BIRTH IN PREGNANT WOMEN
    (Македонско лекарско друштво = Macedonian medical association, 2019)
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    Introduction. Cytokines play a significant role in the pregnancy. They are very powerful and important me-diators of the cell growth as well as regulators of the immune and inflammatory reactions. Several cytokines (IL-1, IL-6, IL-8, TNF- alfa) are of crucial importance during the pregnancy since they are produced by the placentain the amniotic fluid, in case there is intraute-rine inflammation. Inpatients with premature birth, the intrauterine inflammation and infection is often present and leads to inflammatory syndrome of the human fetus. The intrauterine infection of the choriodecidual space and the amniotic fluid are the most common reasons for this obstetric complication, hence the most commonly examined etiologic factor. Aim. The study was conducted in order to prove the ratiobetween the increased level ofIL-6in the amniotic liquid at the beginning of the second trimester (16-22 g.w.) and the premature birth (< 36 g.w.). Methods. This is a case control study that has included 36 patientsso far.The pregnant women wererecruited fromthe Clinic of Gynaecology and Obstetrics. They all gave a signed consent on being informed about the aims of the study, and following the protocol, they were analyzed and examinedi. e. all patients under went ultra-sound examination, vaginal cervicometry; cervical and vaginal swabs were taken and 5 ml. amniotic fluid du-ring the process of amniocentesis. The study was performed at the Clinic ofGynaecology and Obstetrics, the Institute of Microbiology and Para-sitologyas well as the Institute ofImmunology and Hu-man Genetics. Results. The results obtained inthisstudy have confirmed the role of the cytokines i.e. they have shown an in-crease when there is inflammation in the intrauterine cavity which could lead in future to premature birth. There was an association between the risk of premature birth and positive cervical and vaginal swabs, length of cer-vix, and not a single case showed positive amnio-culture.
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    ДЕТЕКЦИЈА НА ПЛАЦЕНТА АКРЕТА СПЕКТАР (ПАС) СО ПОМОШ НА МАЈЧИНИ ПЛАЗМАТСКИ БИОМАРКЕРИ: ПЛАЗМИНОГЕН АКТИВАТОР ИНХИБИТОР 1, РАСТВОРЛИВ ТИЕ 2 И ВАСКУЛАРЕН ЕНДОТЕЛИЈАЛЕН ФАКТОР НА РАСТ РЕЦЕПТОР 2
    (2023-12)
    Резиме: Плацента акрета спектрум (ПАС) представува абнормално адхерентна плацента за лежиштето на утерусниот ѕид и неможност за нејзино спонтано одлепување по породувањето на плодот или во текот на царскиот рез. Плацента превија е плацента која во третото тромесечие достигнува до внатрешното маткино устие ОУИ и притоа делумно или целосно го препокрива. Златен стандард во дијагостиката на ПАС сеуште представува ултразвукот, но постојат и одредени биомаркери кои покажуваат променети вредности во плазмата кај пациентките со дијагноза за ПАС. Цел: Да се одреди вредноста на биомаркерите во мајчината плазма во зависност од степенот на трофобластна инвазија во утериниот ѕид (акрета, инкрета, перкрета) еднократно од крвта на трудниците во третото тромесечје од бременоста (28-37гн) Материјали и методи: Во оваа проспективна, кохортна, опсервациона лонгитудинална студија беа вклучени 113 пациентки со единечна бременост, дијагноза на предходен еден или повеќе царски резови со сомнение за ПАС, со или без плацента превија, предходни интервенции на матката (миомектомии, метропластики) на возраст од 18-40 години во третото тромесечје од бременоста. Испитувана група беа пациентки, амбулантски или хоспитализирани на Клиниката за Гинекологија и акушерство на одделите за Патолошка и високоризична бременост и Перипартална интензивна нега со предходно утврдени ултразвучни знаци за ПАС. Оваа студија се изведуваше на Клиниката за Гинекологија и акушерство и Институтот за имунологија и хумана генетика – Скопје, Р. Северна Македонија во текот на две години, во периодот од 02.2021година до 01.2023година. При влез во студијата и потпишување на согласност за учество во истата се вршеше ултразвучен преглед и венепункција на пациентките, во две епрувети, една за 4 рутинска диференцијална крвна слика а другата ЕДТА епрувета 2мл крв за испитување на биомаркери (плазминоген активатор инхибитор-1, васкуларен ендотелијален фактор на раст рецептор-2, растворлив Тие2). Сите пациентки се следеа до датумот на нивното породување, интраоперативниот тек и исходот. Резултати: Во истражувањето партиципираа 113 испитанички, 26 пациенки беа во групата со инвазивна плацента, 57 со неинвазивна плацента, во контролната група беа 30 пациентки со прва бременост без сомнение за ПАС и без други пропратни коморбидитети. Плоштината под ROC кривата за ПАИ 1 во одредување на ПАС имаше вредност од 0.69 (AUC=0.696, CI 95% 0.548-0.831), што укажува дека овој плазматски биомаркер има доволна дискриминаторска способност во разграничување на пациенти со и без плацента акреата спектрум. Најдобрата гранична вредност (cut off) oд која почнува детекција на пациенти со ПАС е 41.18 ng, со сензитивност од 61.5%, специфичност од 63.3%. Плоштината под ROC кривата за ВЕГФР 2 во одредувањна ПАС имаше вредност од 0.71 (AUC=0.71, CI 95% 0.573- 0.847). Тоа ни укажува дека овој плазматски биомаркер е добар тест, со добра дискриминаторска способност во разграничување на пациенти со и без плацента акреата спектрум. Најдобрата гранична вредност (cut off) oд која почнува детекција на пациенти со ПАС е 7.26 ng, со сензитивност од 80.8%, специфичност од 60%. Плоштината под ROC кривата за рТие- 2 во одредување наПАС имаше вредност од 0.742 (AUC=0.742, CI 95% 0.612-0.872).На овој начин укажавме дека овој плазматски биомаркер е добар тест, со добра дискриминаторска способност во разграничување на пациенти со и без плацента акреата спектрум.Најдобрата гранична вредност (cut off ) oд која почнува детекција на пациенти со ПАС е вредноста на рТие-2= 6 ng, со сензитивност од 73.1%, специфичност од 63.3%. Ова е прва студија во нашата држава од ваков тип која ја истражува поврзаноста помеѓу концентрациите биомаркерите ПАИ-1, ВЕГФР-2 и рТие-2 со исходот на пациентката со ПАС. Ние добивме поврзаност на концентрацијата на овие биомаркери и исходот од бременоста.
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    Enormous Unilateral Primary Ovarian Leiomyoma Mimicking Ovarian Cancer with High Levels of Serum CA-125 and Ascites
    (Austin Publishing Group, 2022)
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    Primary ovarian leiomyoma is a very rare benign tumor. We report a case of 61-year-old woman presenting with a large solid abdominal tumor and moderate ascites, as well as highly elevated serum CA-125. The patient was highly suspected for ovarian malignancy. This enormous ovarian tumor which was clinically diagnosed as a malignant ovarian mass, at surgery was presented as large ovarian fibroma, but on histology it was diagnosed as ovarian leiomyoma.
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    MATERNAL PLASMA BIOMARKERS (ANTITHROMBIN 3, PLASMOINOGEN ACTIVATOR INHIBITOR 1, SOLUBLE TIE 2, VASCULАR ENDOTHELIAL GROWTH FACTOR RECEPTOR2) AS INDICATORS FOR PLACENTA ACCRETA SPECTRUM (PAS) IN THE THIRD TRIMESTER OF PREGNANCY
    (SHMSHM - AAMD, 2022-04)
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    Gjoreski, Josif
    Introduction: Placenta accreta spectrum (PAS)- an abnormally adherent placenta into the uterine wall with the inability to properly detach after the birth of the fetus. Factors that increase the risk of PAS are: regions of poorly developed decidua, previous caesarean section/s, etc. Materials and Methods: This study is a prospective cohort study conducted at The University Clinic of Gynecology and Obstetrics Skopje, Republic of North Macedonia in February and March 2021. The study involved 8 patients, diagnosed with PAS, from whom maternal plasma samples were taken. Measurements of concentration of antithrombin III, plasminogen activator inhibitor 1(PAI1), soluble Tie 2 (sol Tie2), vascular endothelial growth factor receptor 2(VEGFR2), in the third trimester of pregnancy were done. Results: In all 8 patients, a PAS diagnosis was detected. In previous ultrasound findings, placenta praevia was diagnosed in 4 of 8 patients, and the remaining 4 had ultrasound signs for placenta accreta. In terms of biomarker values, we received significant values in all 4 biomarkers we examined. Conclusion: The examination of these biomarkers is useful for predicting and early diagnosis of PAS. We confirmed antithrombin III, PAI-1, soluble Tie2 and soluble VEGF 2 receptor as new biomarkers for this condition.
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    THE CONNECTION BETWEEN ANTITHROMBIN 3, PLASMINOGEN ACTIVATOR INHIBITOR 1, VACUOLAR ENDOTHELIAL GROWTH FACTOR RECEPTOR 2, SOLUBLE TIE 2 IN MATERNAL PLASMA, WITH ABNORMAL PLACENTAL INVASION ПОВРЗАНОСТА НА АНТИТРОМБИН 3, ПЛАЗМИНОГЕН АКТИВАТОР ИНХИБИТОР 1, ВАКУЛАРЕН ЕНДОТЕЛИЈАЛЕН ФАКТОР НА РАСТ РФЕЦЕПТОР 2, РАСТВОРИЛИВ ТИЕ 2 ВО МАЈЧИНА ПЛАЗМА, СО НЕПРАВИЛНАТА ПАЛЦЕНТАРНА ИНВАЗИЈА
    (De Gruyter, 2022-02)
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    Abnormal placental invasion, placenta accreta spectrum (PAS), is an abnormally adherent pla-centa to the uterus with inability to detach properly af-ter delivery of the fetus. Certain maternal plasma biomar-kers show association with abnormal placental invasion. Methods. This was a prospective cohort study, con-ducted at PHI UGAK, Skopje, Republic of North Mace-donia from 02.2021 to 01. 2022. The study included 28 patients diagnosed with PAS. Maternal plasma samples were taken from all patients. The concentration of anti-thrombin III, plasminogen activator inhibitor 1 (PAI1), VEGFR2, Sol Tie 2 was measured in the third trimes-ter of pregnancy. Results. In all 28 patients, a diagnosis of PAS was detec-ted, while previous ultrasound, placenta previa was diag-nosed in 24 of these 28 patients, and the remaining 4 had ultrasound signs of placenta accreta. Meanwhile, the average value of antithrombin in the studied group was 192.1±28.2 my/ml, higher than in the control group which was 139.4±6.2 my/ml, with significance p<0.05 (p=0.039853). The average value of PAI in the studied group was 4.7±1.5 ng/ml, lower than in the control group which was 7.4±1.4 ng/ml, with significance p<0.05 (p=0.000234). The average value of VEGFR in the studied group was 7.1±1.7 ng/ml, higher than in the control group, which was 5.8±0.6 ng/ml, with signify-cance p<0.05 (p=0.039853). The average value of Sol Tie in the studied group was 13.2±2.2 ng/ml, higher than in the control group, which was 10.8±0.9 ng/ml, with significance p<0.05 (p=0.003532). Regarding the values of the examined biomarkers, we can conclude that we obtained significant values. Conclusion. The examination of these biomarkers can be used for prediction and early diagnosis of irregular pulsatile invasion. For this condition we validated the values as new biomarkers