Vesna Janevska, Liljana Spasevska, Blagica Dukova and Vlado Janevski
Intestinal Submucosal Lipomas
Background: Gastrointestinal tract is uncommon localization for lipomas, but if present they are 90% submucosal and 10% subserosal. Intestinal submucosal lipomas are the most common benign nonepithelial intestinal tumors usually found incidentally. Rarely, they may cause obstruction, ulceration, perforation, intussusceptions, prolapse and massive hemorrhage.
Methods: Fourty cases of intestinal submucosal lipomas were analyzed using 1. clinical symptoms, 2. imaging characteristics, 3. histopathological parameters. Twenty eight patients were treated with surgical intestinal resection because of intussusceptions, intestinal obstruction and intestinal bleeding and twelve patients underwent local tumor resection.
Results: Forty percents of patients were in 7th decade, 30% in 8th and 30% in the sixth decade. The male/ female ratio was 1:1. Colonic sumbucosal lipomas were found in 60% of cases, duodenal in 30% and jejunal in 10%. Forty percents of them were diagnosed in association with carcinomas, 20% with polypoid adenomas, 30% caused inflammation and ulcerations and 10% intussusceptions. Most of the tumors were asymptomatic.
Conclusion: Colon and duodenum are the most frequent locations of intestinal submucosal lipomas. They are rare tumors usually found incidentally in association with carcinomas and polypoid adenomas. The correct diagnosis of a symptomatic, submucosal lipoma indicates a local excision, and eliminates possible complications and an unnecessary extensive resection.
Vesna Janevska, Vlado Janevski, Oliver Stankov, Liljana Spasevska, Slavica Kostadinova-Kunovska and Julija Zhivadinovik
Adrenal cystic lesions are uncommon but due to the improved radiologic imaging techniques their appearance seems to increase.
Material and Methods: We analyzed the clinical and radiological findings of 10 patients with adrenal cysts and the pathological features of the operative material. Standard dissection procedure and paraffin embedded tissue sections were made, stained by HE and immunohistochemically with CD34, CD 31, Factor 8, Podoplanin, CKWS and AE1/AE3
Results: The mean age of the patients was 40.6 years; female to male ratio was 2.3:1. All the cysts were diagnosed as cystic lesions radiologically except one. The most present clinical symptom was abdominal pain.
The diameter of the cysts measured from 2 to 7 cm. Four of the cysts were diagnosed as pseudocysts and six as endothelial. Six cysts were lined by CD34+ and CD31+ cells, four were lined by Factor 8+ and podoplanin+ cells and four had no lining.
Conclusion: Endothelial cysts were more common cysts in our study and the immunohistochemical results suggested common vascular origin to all endothelial cysts and supported additional separation of angiomatous and lymphangiomathous adrenal vascular cysts.
Liljana Spasevska, Vesna Janevska, Vlado Janevski, Biljana Noveska and Julija Zhivadinovik
Pancreas is an extremely rare abdominal localization of the solitary fibrous tumor (SFT). It usually grows asymptomatically for a long time before a diagnosis can be made on the basis of symptoms and/or mechanical complications. Due to the rarity and nonspecific clinical presentation, this entity is diagnostically challenging.
We present a 47-year-old man with a history of progressive epigastric pain for the last two weeks, and jaundice, who was admitted to hospital for further investigation. Cystadenocarcinoma was suspected based on the radiologic findings, and a pancreatoduodenectomy was performed. The removed portion of the pancreas contained a 3.5 × 2 × 1.8 cm well-circumscribed, but not encapsulated white tumor mass with smooth cut surface, cystic component and duct dilatation within the tumor and within the adjacent pancreatic tissue. Based on the histology and immunostaining profile, a diagnosis of the solitary fibrous tumor was made. One week post-operatively, the patient died due to surgical complications.
Microscopic and immunohistochemical examinations are necessary for accurate diagnosis of cystic SFT of the pancreas. Because there is limited data regarding the biological behavior of SFT with extra-pleural localization the authors recommend clinical follow-up for SFT treatment if the criteria of malignancy are not met.
Elizabeta Trajkovska, Vesna Janevska, Liljana Spasevska, Vlado Janevski, Julija Zhivadinovik, Gordana Petrushevska and Blagica Dukova
Introduction: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. There is an increasing number of literature reports on synchronous occurrence of gastrointestinal stromal tumors and another malignancy of distinct etiology and evolution. The most reported cases include gastric synchronous occurrence of gastrointestinal stromal tumors and adenocarcinoma and gastric gastrointestinal stromal tumors and colonic adenocarcinoma.
Case report: We present a case of a 77-old female, with synchronous cecal moderately differentiated adenocarcinoma in Stage IIA according to the TNM classification and ileal spindle cell type GIST with low malignant potential, positive for c-Kit, CD34, vimentin, Actin, and negative for S100.
Conclusion: The synchronous occurrence of small bowel gastrointestinal stromal tumors and other primary gastrointestinal malignancies has been rarely reported. There is a need of further investigations to identify the relationship between gastrointestinal stromal tumors and colorectal cancers.
We report a case of synovial sarcoma of liver in a 44 year old man, presented as a tumor mass in left hepatic lobe. The patient was admitted at the hospital with clinical symptoms of acute abdomen and severe pain in the right upper quadrant.
Imaging examinations showed a tumor mass in the left hepatic lobe and free liquid in the abdominal cavity, due to the rupture of the tumor. A resection of 2 segments of the left hepatic lobe, where the tumor was located, was performed. Morphological, immunohistochemical and FISH studies confirmed the diagnosis of monophasic synovial sarcoma. Additional clinical and imaging examinations, made after the surgery, did not confirm tumor mass in any other localization. The patient refused any therapy other than surgery, at that time.
A relapsing tumor mass was found 6 months later and another surgical intervention was done. The patient received five monotherapy cycles of Doxorubicin, 75 mg/m2, after the second surgical intervention. He is still alive 11 months after the first operation receiving the same therapy and having second relapsing inoperable tumor mass filling the retroperitoneal space and a great fraction of the abdominal cavity.
Medullary thyroid carcinomas (MTCs) are rare neoplasms comprising 2-10% of all thyroid malignnancies. More than 75% are sporadic tumors and the remainder is familial and MEN2 related. Both sporadic and syndromic MTCs frequently show mutations in the RET proto-oncogene. It has been noted that some MTC cases present an indolent, and some an aggressive clinical course. Ki-67 expression is generally low, with documented exceptions, whereas high expression of Bcl-2 has been reported in majority of the cases. Some studies have shown that Ki-67 and Bcl-2 expressions have prognostic value, as well as RET mutational status. We analyzed 20 unrelated MTC cases for Ki-67, Bcl-2 expression and RET mutations and tested their intercorrelations, correlations to the morphologic features and stage of the tumors, as well as their influence on survival. In 13 of the 20 analyzed cases we found 23 sequence changes distributed in exons 8, 10-13 and 16. There were 11 different missense mutations, single nucleotide deletion with frameshift, and 8 different synonymous mutations. Only 4 of the sequence changes have been previously published. Twelve patients (60%) had tumors expressing one or more missense mutations or single nucleotide deletion and 7 of them (35%) had at least one damaging or possibly damaging RET mutation. Most of the tumors had low Ki-67 expression (mean 6.48% of cells) and high Bcl-2 expression (mean 68.3%). Significantly better survival was observed in cases with low Ki-67 (< 6.5%; p < 0.05), high Bcl-2 expression (> 68.3%; p < 0.01) and younger age at diagnosis (< 51 years; p < 0.05).