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  • Author: Vesna Janevska x
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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.


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.


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.


Metastasis of renal cell carcinoma (RCC) to the pancreas is a rare entity accounting only 0.25–3% of all pancreatic tumors. We present a rare case of isolated three focal pancreatic metastases from RCC, occurring 15 years after the left nephrectomy. The majority of the pancreatic metastases are asymptomatic, as it was in case of our patient excluding the weight loss for the last three months. We demonstrate the importance of the medical history, radiological examinations, histological and immunohistochemical analysis in making a definitive diagnosis.

Telomerase Activity and MDS/EVI Gene Fusion in Myelodysplastic Syndrome. Correlation to the Immunohistochemical Expression of Ki-67, Bcl-2 and p53 in Bone Marrow Biopsy Samples

Background. Myelodysplastic syndrome (MDS) as a complex disorder comprised of 7 entities may arise as a primary disorder, or in a setting of an underlying disease, or as therapy related (secondary MDS). Some cases show MDS/EVI1 gene fusion, and some studies have pinpointed the association between the high-risk MDS and increased telomerase activity.

Aim. To determine the frequency of MDS/EVI1 gene fusion in cases of primary MDS, and to evaluate the possibility for detection of increased telomerase activity in peripheral blood samples from patients with MDS.

Material and methods. We isolated DNA from 35 bone marrow biopsies, and measured the blood telomerase activity (RTA) in 21 of the patients. We performed immunostainigs for Ki-67, Bcl-2 and p53 on the biopsy samples in order to test the correlations to the RTA and MDS/EVI1 presence. MDS/EVI1 fusion was detected with touch-down-direct PCR, and RTA was measured using the "TeloTAGGG-PCR-ELISA-plus kit".

Results. We found MDS/EVI1 fusion in 17.39% of high-risk MDS cases (overall 11.43%). RTA was highly variable in the analyzed group, with 1,8 fold increase of the mean RTA compared to the controls. It was due to the significant RTA increase in high-risk MDS cases, compared to the low-risk cases (p<0.01).

Conclusion. RTA showed correlation to the immunohistochemical expression of Ki-67, and MDS/EVI1 fusion was correlated to the Bcl-2 expression.


Introduction: Epidermal growth factor receptor (EGFR) signaling plays an important role in various cancers, including hepatocellular carcinoma (HCC). We aimed to evaluate immunoexpression of EGFR in HCC and surrounding non-tumor liver tissue and to correlate it to multiple clinicopathologic data.

Material and Methods: We analyzed 60 patients with HCC for multiple clinicopathologic characteristics and survival.

Presence of the immunosignal and the percentage of positive tumor cells at the whole tumor tissue sample and adjacent cirrhotic liver tissue were semi-quantitatively determined.

Results: Nineteen patients (31.67%) were female and 41 (68.33%) were male ranging in age from 31 to 85 years, median 61.88±10.51.

Mean survival time for female patients was 8.86±1.76 months, for male 13.03±1.50 months and overall survival was 11.6051±1.19 months.

The most patients had: T2 status (41.67%), no enlarged lymph nodes (90%), vascular invasion (63.33%) and well differentiated (43.33%) tumors.

EGFR immunoexpression was determined in range from 0% to 100% in both tumor and non-tumor tissue with mean value of 39.58% in tumor and 86.86% in cirrhotic tissue (p<0.00).

Higher percent of tumor EGFR positive cells were found in cases with higher T status, higher levels of AFP and poorly differentiated carcinoma, but not significantly.

Lower percent of tumor EGFR positive cells were found in patients with vascular invasion and enlarged lymph nodes, but also not significantly.

EGFR expression in tumor tissue significantly influenced survival of the patients (p<0.05).

Conclusion: The study showed that expression of EGFR in lower percentage of tumor cells was associated to favorable prognosis, making it a potential prognostic marker and therapeutic target.


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.

Synovial Sarcoma of the Liver - A Case Report

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.


Introduction. 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.

Material and Methods. The material consisted of surgical specimens obtained from 30 patients with skin SCC, who underwent surgery.

Tissue samples were routinely processed by standard paraffin technique stained by Hematoxilin-Eosin and immunohistochemically with antibodies against smooth muscle actin (SMA) and CD34. The BVD in the invasive front of the neoplasms was correlated to the healthy skin, tumor status (pT), depth of invasion and grade of histological differentiation (pG).

Results. The histological analysis has shown a high statistical difference in the density of blood vessels in SCC compared to the healthy skin and statistical difference in BVD in neoplasms with different depth of invasion and different grade of differentiation. The density of neovascularzation increased with the deeper invasion and the worse differentiation.

Conclusion. The increased vascularization at the invasive front of SCC with deeper invasion and worse differentiation has pointed out to its possible role in neoplasm progression.


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).