Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item The histopathology of endometrial biopsies performed for abnormal uterine bleeding: an audit in a tertiary care centre in Sri Lanka(College of Pathologists of Sri Lanka, 2021) Munasinghe, M.A.D.N.; Fernandopulle, S.M.; Hewavisenthi, S.J.de S.Introduction: The main indication for endometrial curettage and pipelle aspiration is abnormal uterine bleeding (AUB). Histological assessment is important in determining the various structural and non-structural aetiologies for AUB. Objectives: To describe the histomorphology of the endometrium in different age groups of patients presenting with AUB and to determine the percentage having organic causes for AUB in each of these age groups. Methodology: All the uterine curettage and pipelle aspiration specimens received during a period two years from January 2019 to December 2020 were included in the study. Evacuated products of conception were excluded. The patient characteristics, clinical information and the histopathological findings were obtained. All cases were stratified into age groups 20-39 (reproductive), 40-50 (perimenopausal) and >50 years (postmenopausal). The histological findings were classified as normal pattern (NP), ovulatory dysfunction (OD), exogenous hormonal effects (EHE), endometrial polyp (EP), chronic endometritis (CE), atrophic endometrium (AE), disordered proliferative endometrium (DPE), endometrial hyperplasia (EH) and carcinoma (CA). EP, CE, EH and CA were considered structural/ organic causes. Results: A total of 778 specimens were analysed. The age range of the patients was 25–80 years (reproductive - 98, perimenopausal - 440, postmenopausal - 240). Structural / organic causes were found in 20.41% (20/98) in the 20–39-year age group (EP-15.31%, CE-4.08%, EH-1.02%), 12.95% (57/440) in the 40–50-year age group (EP-6.36%, CE-2.04%, EH-4.09%, CA-0.45%) and 29.58% (71/240) in the >50 age group (EP-14.17%, CA-10.83%, EH-4.58%). The commonest histological finding for AUB in the >50 age group was AE (22.08%,53/240). NP was the commonest in both the perimenopausal (29.55%, 130/440) and reproductive groups (30.61%,30/98).Conclusion: There is a variation in the histomorphological findings for AUB among different age groups, and non-structural findings are commoner than structural / organic causes.Item Chondroblastoma with atypical features(College of Pathologists of Sri Lanka, 2020) Silva, K.G.H.; Mahendra, B.A.G.G.; Hewavisenthi, S.J.de S.Chondroblastoma (CB) is a rare bone tumour usually occurring in long bones of males in the second decade. Though these are considered benign, rare cases show aggressive behaviour and metastases. However, there are no defined histological criteria to diagnose aggressiveness, except soft tissue (ST) infiltration. With the identification of specific immunohistochemical and genetic signatures, recent research has nurtured the concept of malignant CB and raised concerns that malignant CBs are being frequently misdiagnosed. Here we report a case of a CB with unusual features, in a 62-year-old woman which includes rare location in the scapula, recurrence following a long period after excision, extensive soft tissue invasion, and predominant small round cell morphology. This case intends to add to the limited literature on aggressive CB as well as to the evolving concept of malignant CB. The case also highlights the importance of follow up of patients with CB preventing mutilating surgery.Item An audit of lymph node retrieval and histopathology reporting of pancreaticoduodenctomy specimens undertaken at a tertiary care referral center(College of Pathologists of Sri Lanka, 2017) Siriwikum, L.B.D.J.; Samarakoon, N.K.; Liyanage, S.K.; Mahendra, B.A.G.G.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.de S.Pancreaticoduodenectomy (PD) is currently the main surgical option for malignancies in the ampullary region, which includes ampulla of Vater tumours (AVT), distal bile duct tumours (DBDT), periampullary duodenal tumours (DT) and tumours of the head of the pancreas (PT). Nodal status and many other important pathological features have a significant impact on tumour prognosis and therapy. The aim of this study was to determine the total number of lymph nodes (LNs) retrieved from PD specimens, whether grouping of LNs improves the total yield and to assess the level completeness of histopathology reporting of PD specimens. Forty two PD requests and histopathology reports were assessed to determine the total number of LNs retrieved and whether the LN were grouped (G)or non-grouped (NG). The significance of difference in the number of LNs in the two groups were assessed using the Wilcoxon signed rank test. The tumours were subcategorized as AVT, DBDT, DT and PT and the reports were audited against the respective minimum data sets of the Royal College of Pathologists of United Kingdom to determine the overall completeness and the parameters poorly reported in the reports. The overall median LN yield was 14.5 and the median LN yield was 15 and 10 in G and NG respectively which was statistically significant. The completeness of the histopathology reporting was 63.6%- 77.3% in AVT (n-18), 73.9% - 95.6% in DBDT (n-5), 68.1% - 90.1% in DT (n-8), 70.8% - 83.3% in PT (n-11). The lengths of the bile duct, lesser and greater curvature of the stomach, tumour differentiation, involvement of resection margins and named blood vessels were poorly reported. In conclusion, the total LN retrieval improved by grouping according to the Union of International Cancer Control (UICC) protocol. Histopathology reporting of some of the data items requires improvement. Hence adoption of a pro forma for synoptic reporting and establishment of national guidelines on reporting and handling of specimens is recommended.Item Continuing medical education (CME) in pathology: the role of the college of pathologists of Sri Lanka.(College of Pathologists of Sri Lanka., 2003) Hewavisenthi, S.J.de S.; de Silva, M.V.C.No Abstract AvailableItem Colonoscopic ultrasound is associated with a learning phenomenon despite previous rigid probe experience(Springer India, 2009) Siriwardana, P.N.; Hewavisenthi, S.J.de S.; Pathmeswaran, A.; Deen, K.I.Colonoscopic ultrasound (CUS) enables total colonoscopic examination combined with staging of tumor. Rigid probe transrectal ultrasound (TRUS) is reliable in assessing rectal cancer. Both the modalities are associated with an initial learning curve. We evaluated the predictability CUS in preoperative staging of rectal cancer during the learning curve, despite experience with TRUS. Forty-four patients with non-obstructing rectal cancer were assessed by colonoscopy and colonic ultrasound using a 7.5 MHz rotating transducer. Accuracy of ultrasound staging was compared with pathological staging. Tumor staging and nodal staging at pathology and ultrasound were named pT, pN and uT, uN, respectively. The pathological staging was pT1 in two (4.5%), pT2 in 16 (36%), pT3 in 21 (48%) and pT4 in five (11.5%) rectal cancer specimens. CUS understaged the tumor in 11 cases and overstaged it in 10 cases. Overall, the positive predictive value was 61%, negative predictive value 73%, sensitivity 61%, and specificity 73%. Lymph nodes were not visualized in 14. The overall un-weighted kappa of CUS staging of RC was 0.18 (poor). The predictive value in tumor staging of CUS is suboptimal in the learning phase, despite previous experience with TRUS.Item Quality of life and impact of bile reflux after retro colic retro gastric gastrojejunostomy in Whipple surgery(Biomed Central, 2017) Siriwardana, R.C.; Lokubandara, R.W.M.A.; Hewavisenthi, S.J.de S.; Liyanage, S.K.; Jayatunga, D.S.P.; Liyanage, C.A.H.Background: Delayed gastric emptying and bile reflux are common concerns in long-term survivors after Whipple surgery. The study was designed to assess modified retro colic retro gastric gastrojejunostomy in reducing macro and microscopic bile reflux and impact on dyspepsia related quality of life in long-term survivors. Methods: Out of 43 patients operated, 23 long-term survivors were included. All underwent gastroscopy and bile reflux was grouped as normal, yellowish bile lakes and presence of greenish bile lakes. Six standard gastric biopsies were taken. Microscopic bile reflux index (BRI) was calculated and a score more than 14 was considered significant. Validated Nepean dyspepsia index-short form (NDI-SF) was used to assess the severity of dyspepsia-related quality of life and compared with age and gender-matched control. Results: The median age was 48 (21–70) years. Median survival of the group was 37 months (6–40). Endoscopically, 20/23 (87%) had macroscopic bile reflux (74% yellowish bile lakes, 13% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean bile reflux index score was 9.7 (range 1.77–34). Mean NDI–SF score of Whipple group was 23.1 (SD 8.88). In controls, mean score was 19.9 (SD 8.23), showing no significant difference (p = 0.245). Conclusions: Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. The modified technique had good long-term results.Item Are we addressing ethical issues in histopathology adequately ?(College of Pathologists of Sri Lanka, 2015) Rathnayaka, R.M.U.S.; Beneragama, D.H.; Hewavisenthi, S.J.de S.Item Predictive value of tumor proliferative indices in periampullary cancers: Ki-67, mitotic activity index (MI) and volume corrected mitotic index (M/V) using tissue microarrays(Springer-Verlag, 2010) Aloysius, M.M.; Hewavisenthi, S.J.de S.; Bates, T.E.; Rowlands, B.J.; Lobo, D.N.; Zaitoun, A.M.BACKGROUND: Morphometry [nuclear Ki-67 labelling, mitotic activity index (MI), and volume-corrected mitotic index (M/V)] for periampullarycancers using tissue microarrays has not been performed previously. The purpose of the study was to assess these indices on tissue microarray (TMA) sections constructed from patients with periampullary cancers and study their association with clinicopathological variables. METHODS: Immunohistochemical staining for Ki-67 was performed on formalin-fixed pancreatic TMA sections. Expression of Ki-67 was assessed as the percentage of cancer cell nuclei expressing MIB1, MI as the mean percentage of Ki-67 from 10 random high-power fields, and M/V was calculated after standardizing MI for connective tissue volume and microscope parameters in the tumor using established protocols. RESULTS: Patients > or =70 years with periampullary cancers had higher Ki-67 expression (>15) compared with patients <70 years of age (chi(2) = 3.9, P = 0.047). Ki-67 expression was higher in tumors > or =2 cm (chi(2) = 4.9, P = 0.028) compared with smaller tumors. Higher MI (>15) was clearly associated with worsening histological grade (chi(2) = 9.2, P = 0.010). The median survival for tumors of the pancreaticobiliary subtype (pancreatic ductal adenocarcinoma and cholangiocarcinoma) was 43 months in the group with an M/V score of <20, compared with 18 months for the group with a score > or =20 (P = 0.001). There was no statistically significant difference in survival, based on M/V score, for tumors of the intestinal subtype (ampullary and duodenal adenocarcinoma). CONCLUSIONS: In periampullary cancers, Ki-67 and MI are proliferative indices predictive of tumor behavior. M/V was predictive of survival in tumors of the pancreaticobiliary subtype.Item Choriocarcinoma of the ovary: a case report(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Ekanayake, C.D.; Wijesinghe, P.S.; Herath, R.P.; Puliyadda, T.M.N.K.; Hewavisenthi, S.J.de S.Ovarian choriocarcinoma whether gestational or non-gestational, is an extremely rare malignant germ cell tumour. We report a young patient with an ovarian choriocarcinoma who was successfully treated with fertility sparing conservative surgery and adjuvant chemotherapy. Sri LankaItem Incidence of inflammatory bowel disease in Gampaha district: details of the Sri Lankan component of the Asia-Pacific Crohn's and Colitis Epidemiology Study(Sri Lanka Medical Association, 2014) Kasturiratne, A.; Mufeena, M.N.; Mettananda, K.C.D.; Fernandopulle, N.; Rajindrajith, S.; Waraketiya, P.R.; Weerasinghe, S.K.; Ranaweera, A.; Hewavisenthi, S.J.de S.; de Silva, A.P.; de Silva, H.J.The aim of this report is to provide details of the methodology and results of the Sri Lankan component of the Asia-Pacific Crohn's and Colitis. Epidemiology Study. Fourteen state and private hospitals with specialist services in the Gampaha and Colombo districts were kept under surveillance over a 12 month period to recruit patients with newly diagnosed Inflammatory Bowel Disease (IBD) who were permanent residents of the Gampaha district. Thirty five cases (ulcerative colitis-21, Crohn's disease-13, IBD-undetermined-1) were detected, giving a crude annual IBD incidence of 1.59 per 100,000 population.