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    COLLAPSING GLOMERULOPATHY-RARE VARIANT OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS-CASE REPORT
    (Македонско лекарско друштво = Macedonian medical association, 2021)
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    Focal segmental glomerulosclerosis (FSGS) is classified into five variants, with the collapsing variant being the most rare one. However, the number of idiopathic cases is increasing and the presentation becoming more routine. We report the case of a 77-year-old female patient, with nephrotic syndrome and histopathologic features of glomerular capillary collapse. She presented with chronic renal failure with serum creatinine-126…154…174 μmol/L. Nephrotic syndrome with feet and ankles edema, progressively extended, at first failed to respond to diuretic therapy. The level of total serum protein fraction was 54g/l, albumin-29…24…28g/L. Urinalysis demonstrated proteinuria 7.8 g/l… 6.15g/L and 12.3 g/24 h. Presence of 25-30 erythrocytes and 2-3 leukocytes in urine sediment was also noticed. Renal biopsy was performed to determinate the presence of glomerular disease. The histopathological analysis showed fibrously thickened Bowman’s membrane, with discretely thickened glomerular basal membrane and collapsed vascular lumen on TEM analysis. The treatment of the patient included corticosteroids, angiotensin-converting enzyme inhibitor and lipid lowering agents, which resulted in lowering of the proteinuria, followed by withdrawal of the edema.
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    DIAGNOSTIC AND THERAPEUTIC MODALITIES IN THE MANAGEMENT OF A PATIENT WITH OCULAR SURFACE SQUAMOUS NEOPLASIA (OSSN)-CASE REPORT AND REVIEW
    (University Ss. Cyril and Methodius in Skopje, 2022)
    Nikolovska, Biljana
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    Duma, Christijan
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    Pandilov, Stefan
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    Rectal Metastasis from Early-Stage Endometrial Carcinoma Not Associated with Endometriosis: A Case Report and Literature Review
    (Kurume University School of Medicine, 2025-11-13)
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    Jovcheva, Ana
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    Endometrial cancer (EC) is the third most common malignancy in woman with excellent prognosis when diagnosed in early-stage. Recurrences are extremely rare in Stage I EC especially in rectum when not associated with endometriosis. We present a case of rectal metastasis from endometrial carcinoma after 8 years of primary diagnosis. A review of the literature showed only 6 published cases.
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    Serrated lesions and polyps of colon
    (Macedonian Society of Gastroenterohepatology, 2023-05)
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    Angelovska, Tamara
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    Introduction: Serrated lesions and polyps are characterized by the unique architectural pattern of epithelial infoldings into the gland lumen creating a sawtooth (“serrated”) type appearance. Most serrated polyps are asymptomatic and therefore are incidental endoscopic finding. There are 4 main histologic types: hyperplastic polyps, sessile serrated lesion, sessile serrated lesion with dysplasia and traditional serrated adenoma. As many as 30% of colorectal carcinomas arise from serrated neoplasia pathway. Material and methods: Our study analyzed serrated lesions in a one-year period (2022) diagnosed at Institute of pathology, Faculty of medicine in Skopje. Polypectomies were performed at the University Clinic of Gastroenterohepatology in Skopje. All polyps were formalin fixed, paraffin embedded and the sections were routinely stained with HE. Results: We had 99 cases of serrated polyps of colon of which 49 cases were hyperplastic polyps and 50 were sessile serrated lesions. Twenty-seven cases of hyperplastic polyps were males and 22 were females. Thirty-one males had sessile serrated lesions and 19 were females. There were 26 cases of serrated lesions with dysplasia and 24 without dysplasia. Sixteen patients had associated another type of lesion, the most common was conventional tubulovillous adenoma. Conclusion: Serrated lesions in our study were more common in males. Small hyperplastic polyps in distal colon have no malignant potential. Dysplasia was found in almost half of the cases with serrated lesions. Although most of the serrated lesions contain no dysplasia, missing serrated polyp with dysplasia on endoscopy may increase the risk for postcolonoscopy cancer. Follow up intervals are recommended especially in large serrated polyps (>1cm) because of the risk for colorectal carcinoma.
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    A review of the main placental histopathological findings in SARS-CoV-2 infection: analysis of COVID 19 positive patients - single center experience
    (Wiley, 2022-10)
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    Background: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, is a severe systemic thrombotic syndrome that emerged in 2019, with an ensuring pandemic. In so far postulated available literature there is a lack of clarity on the exact mechanism how the SARS-CoV-2 virus acts on the placenta. There is a direct effect on the placenta which leads to hypoxia and an indirect effect that is reflected through proinflammatory responses. Aims: To emphasize the spectrum of histopathological and transmission electron microscopy changes in the placenta of COVID infected pregnant women. Methods: The current study was designed as a prospective study on 39 pregnant women with SARSCoV-2 confirmed infection on nasopharyngeal samples. Gross dissection sampling was performed according to Amsterdam Placental criteria. The standard procedure of paraffin embedded section, stained with H&E was routinely used. Moreover the tissue was stained with immunohistochemistry to present the inflammatory response of the placenta, with the following antibodies: CD3, CD20 and CD68. Results & Conclusions: Histological studies of placental tissue revealed the presence of maternal vascular malperfusion (MVMs) or foetal vascular malperfusion (FVMs) lesions and mild inflammatory lesions. The most prevalent histopathological changes were decidual arteriopathy and increased perivillous f ibrin deposition. Ultrastructural analyses showed spherical-like coronavirus particleswithanelectron intermediate-density core as well projections from the surface as spike-like structures in the syncytiotrophoblasts. In conclusion, there are significant histomorphological changes that indicate maternal malperfusion.
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    Chorangioma of placenta: single center analysis
    (Wiley, 2022-10)
    Kochoska, Milka
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    Kochmanovska Petreska, Svetlana
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    Ristovski, Grigor
    Background: The most common benign neoplasms of the placenta are non-trophoblastic tumours. They include chorioangioma, teratoma, leiomyoma and hepatocellular adenoma. Chorioangioma is the most common subtype. The incidence of chorangioma is 0.5–1.0%. Small chorangiomas are clinically insignificant. Giant chorioangioma is rare tumours, measuring more than 4 cm in diameter and seen in association with elderly primi, twin pregnancy, hypertension, diabetics, and female fetus. Giant chorioangioma is associated with complications that can affect the mother, fetus, or neonate. Aims: This is a retrospective study of chorangioma cases seen at Institute of Pathology, Medical faculty, Skopje during a 10-year period from 2012 to 2021. Methods: Macroscopic findings, gestational weeks at delivery, maternal age and outcome of pregnancy were evaluated. Histological and immunochistochemical analyses of the placental chorangiomas were preformed. Results & Conclusions: In period of 10 years 6 causes of placental chorangioma were clinically identified and histopathologically confirmed. Four cases were giant chorangiomas measuring from 8 to 13 cm. One of the cases was identified as chorangioma of the umbilical cord. Three of the cases shows potential maternal risk factors like primary infertility, extreme obesity and post COVID status. The median gestational age of delivery was 33 + 6 weeks and 39.6 weeks, respectively. The maternal age range was between 25 to 34 years. Four of the pregnancies had favourable outcome with no complications during and after birth. One was with foetal distress and one with premature delivery. Microscopic examination of the mass showed numerous proliferative thin walled capillaries lined by f lattened endothelium and separated by fibrous stroma. This was further confirmed by IHC for CD34, which showed strong reactivity of endothelial cells.
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    Immunohistochemical expression of ER, PR and AR in papillary thyroid carcinoma
    (Springer, 2024-09)
    Kochoska, Milka
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    Angelovska, Tamara
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    Background & objectives: From all types of thyroid carcinomas, papillary thyroid carcinoma (PTC) is the most common type. The present study aimed at evaluating the immunohistochemical expression of estrogen receptors (ERs), progesterone receptors (PRs) and androgen receptors (ARs) in PTC compared to goiter. Methods: The retrospective study included 12 cases of PTC and 6 cases of goiter. The cases were diagnosed in the period between December 2020 and March 2021. All of them were retrieved from our database and immunohistochemical staining of formalin fixed paraffin embedded tissues was performed, for ERs, PRs and ARs. Results: From twelve cases of PTC, three were male and nine were female with age range from 19 to 72. All of the goiter cases were female patients, with age range from 34 to 64. Six out of twelve PTC cases were positive for ER in comparison to two out of six goiter cases with a statistically significant difference (p < 0,05). Regarding PR, eight out of twelve PTC cases were focaly positive, and all of the goiter cases were negative. Ten out of twelve cases of PTC were positive for AR, in comparison to one out of six goiter cases with a statistically significant difference (p < 0,05). Conclusion: The results of the present study indicate that malignant cells in PTC express ER, PR and especially AR, in comparison to goiter. That is suggesting that these hormonal receptors may play a role in thyroid cancer tumorigenesis, and that these patients may benefit from hormonal therapy, which should be verified in further studies.
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    A clinicopathological study of invasive apocrine carcinoma of the breast: a single centre experience
    (Springer, 2024-09)
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    Kochoska, Milka
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    Angelovska, Tamara
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    Jovcheva Trajkovska, Ana
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    Background & objectives: Breast cancer is a divergent and multiplex disease encompassing distinct histologic and molecular genetic types. The aim of the study was to analyse clinicopathologic characteristics of patients with apocrine breast carcinoma using integrated state of art technologies. Methods: We performed a study that included 17 cases that met the criteria for apocrine breast carcinoma diagnosed between 2015 and 2023 at the Institute of Pathology in Skopje. We used TruSight Tumour 15 Gene Panel (Illumina) to analyse gene mutations in nine patients. Furthermore, protein expression of α-methylacyl-CoA racemase (AMACR) was analysed. Results: The median age of the patients was 61,9 years. All the patients were diagnosed with histological grade three. The average tumour size was 3,46cm and positive lymph nodes were detected in 70,5% of the patients. Most of the patients presented at stage II and III (III 35, 3%; II: 47,0%; and I: 17,7%), and the mean Ki67 index was 30%. Majority of the cases (58,8%) were triple negative while HER-2 overexpression and/or amplification was detected in 41,2%. AMACR expression was detected in 73,3% of the cases. Clinically relevant genomic alterations were detected in of 66,7% of the patients. Most frequent altered genes were TP53 (66,7%), PIK3CA (11,1%) and ERBB2 (11,1%). Conclusion: Our study revealed that most of the cases were triplenegative with clinically relevant genomic alterations in more than 60% of the cases. These neoplastic lesions also have AMACR overexpression. The current evidence states that AR-positive breast carcinomas may have limited clinical benefit from adjuvant chemotherapy. Cancer genomic profiling of apocrine carcinomas emerges to be an optimistic approach that could reveal possible targets for individualized treatment.
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    Inflammatory myofibroblastic tumor of the appendix
    (Serbian Pathologists and Cytologists Association, 2022-05)
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    Inflammatory myofibroblastic tumor (IMT), also called inflammatory pseudotumor is a rare disease of mesenchymal origin, first described in 1937. Cases of IMT involving the appendix are exceptional, and they can mimic malignant appendicular tumors. Case report: A 25-year-old woman presented to the emergency department with pain in her right lower abdomen for three days. This was associated with increased body temperature and nausea. Other clinical findings included acute abdomen and laboratory analysis with mildly elevated inflammatory markers. No past history of serious illnesses or abdominal surgery. Because of the lack of specific clinical or imaging signs, IMT still offers a great deal of diagnostic challenge. The macroscopic examination of the appendix revealed a surgical specimen of 5.0x2 cm. The tip of the appendix was distended by mucinous material and had signs of acute appendicitis. Histological examination of the specimen stained with hematoxylin and eosin, revealed a mass showing fibroblastic proliferation accompanied by a dense inflammatory infiltrate in the mucosa and a clear widening of the submucosa. A few areas showed myxoid changes with spindle cells, alternating with polyclonal plasma cells and lymphocytes. Immunohistochemical analysis showed positivity for vimentin and partial positivity for CD68, SMA and desmin. Conclusion: Awareness of this type of tumor in the differential diagnosis of appendiceal masses, avoids overtreatment, and highlights the need of long-term follow-up regarding the tendency for local recurrence and small risk of distant metastasis.
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