Igor Aluloski, Mile Tanturovski, Gordana Petrusevska, Rubens Jovanovic and Slavica Kostadinova-Kunovska
Aim: To evaluate the factors that influence the surgical margin state in patients undergoing cold knife conization at the University Clinic of Gynecology and Obstetrics in Skopje, Republic of Macedonia
Materials and methods: We have retrospectively analyzed the medical records of all patients that underwent a cold knife conization at our Clinic in 2015. We cross-referenced the surgical margin state with the histopathological diagnosis (LSIL, HSIL or micro-invasive/invasive cancer), menopausal status of the patients, number of pregnancies, surgeon experience, operating time and cone depth. The data was analyzed with the Chi square test, Fisher’s exact test for categorical data and Student’s T test for continuous data and univariate and multivariate logistical regressions were performed.
Results: A total of 246 medical records have neen analyzed, out of which 29 (11.79%) patients had LSIL, 194 (78.86%) had HSIL and 23 (9.34%) patients suffered micro-invasive/invasive cervical cancer. The surgical margins were positive in 78 (31.7%) of the patients. The average age of the patients was 41.13 and 35 (14.23%) of the patients were menopausal. The multivariate logistic regression identified preoperative forceps biopsy of micro-invasive SCC, HSIL or higher cone specimen histology and shorter cone depth as independent predictors of surgical margin involvement in patients undergoing cold knife conization.
Conclusion: In the current study, we have found no association between the inherent characteristics of the patient and the surgeon and the surgical margin state after a CKC. The most important predictors for positive margins were the severity of the lesion and the cone depth.
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).