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 A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature(Elsevier, 2022) Medagoda, K.; Salvin, K.A.; Mahendra, B.A.G.G.Purpose: This is a case report of a patient with a conjunctival myxoid stromal tumor (COMST), mimicking a phlyctenulosis. Tumors of the conjunctiva and cornea occupy a large spectrum ranging from benign lesions of myxoma to aggressive, life-threatening malignancies. Phlyctenulosis and phlyctenular keratoconjunctivitis are hypersensitivity reactions to a foreign antigen. Observations: A 64-year-old male presented with six-month history of non-painful lump in the conjunctiva of the left eye. It was a mobile, non-tender, non-ulcerated, non-hemorrhagic, non-pigmented lesion and was non-adherent to the sclera. The differential diagnosis of phlyctenulosis or a soft tissue tumor was considered. The lesion was completely excised. The microscopy showed an ill-defined hypocellular myxoid lesion composed of stellate and spindle-shaped cells with eosinophilic cytoplasm, containing round-ovoid and spindle-shaped nuclei with a vesicular chromatic pattern. The tumor cells were diffusely and strongly positive for vimentin and CD 34 and were negative for S100. The immunomorphological features were compatible with a conjunctival myxoid stromal tumor. Complete systemic evaluation excluded the possible association with systemic myxomas. Conclusions and importance: Myxoid tumors of the conjunctiva are benign tumors, however, they can mimic other benign conditions like phlyctenulosis or more sinister lesions like malignant tumors. Therefore, it is important to do an excisional biopsy to ascertain the definitive pathology of an indeterminate conjunctival lesion. COMST may be the index presentation for the detection of previously undiagnosed myxoma syndromes. One such association is with cardiac myxomas, which can result in vascular embolic events. Therefore, it is important to do cardiac screening in all patients diagnosed with a COMST.Item Heterotopic salivary gland tissue in the gastro-oesophageal junction: a rare entity(College of Pathologists of Sri Lanka, 2021) Dharani, K.; Medagoda, K.; Kumarage, S.K.; Mahendra, B.A.G.G.Introduction: Gastric and pancreatic heterotopia are the two most common types of heterotopias seen in the gastrointestinal tract (GIT). These are the two most common types of heterotopias seen in the oesophagus as well. The occurrence of heterotopic salivary gland tissue (HSGT) in the GIT is rare, and most reported cases are colorectal and anal lesions with only a few cases involving the oesophagus. Case report: A 69-year-old man presented with a seven-month history of gastro-oesophageal reflux disease (GORD). The upper gastrointestinal endoscopy showed a moderate hiatus hernia with a pale pink mucosal patch close to the gastro-oesophageal junction. The biopsy showed oesophageal tissue with morphological changes of mild reflux oesophagitis. The submucosal tissue contained organized glandular structures with mucinous glands and intercalated ducts resembling mature salivary gland tissue. There was no evidence of Barrett oesophagus, dysplasia or neoplasm. Discussion and conclusion: HSGT is most commonly seen in the head and neck region of the body, and its occurrence in the GIT is rare. Occurrence of oesophageal HSGT is extremely rare and most cases have presented with symptoms of GORD. Although HSGT is usually benign and a rare phenomenon, clinicians and pathologists need to be aware of this condition to prevent a delay in diagnosis and inappropriate management.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 Challenges in the diagnosis of lipomatous tumours.(College of Pathologists of Sri Lanka, 2014) Mahendra, B.A.G.G.No abstract availableItem The Role of the pathologist in the assessment of disease activity in ulcerative colitis(College of Pathologists of Sri Lanka., 2018) Mahendra, B.A.G.G.; Hewavisenthi, S.J.De S.ABSTRACT: In order to determine the role of the pathologist in assessing disease activity in UC, clinical and histological correlation of disease activity, correlation between endoscopy and histology and determining the most satisfactory method of scoring histological activity were assessed. A cohort of 41 patients attending a gastroenterology clinic in a tertiary hospital in Sri Lanka was studied. Their clinical activity was determined based on the simple clinical colitis activity index (SCCAI), endoscopically visible inflammation was recorded with reference to the extent of involvement and histology was assessed using three different histological scoring systems. The Spearman rank correlation coefficients between SCCAI and the three histological scoring systems were 0.298, 0.286, and 0.238 respectively denoting poor correlation. The kappa value of agreement between endoscopy and histology was poor (k=0.136). The Spearman rank correlation coefficients between the three histological scoring systems were 0.883, 0.883 and 0.952, reaching a level of statistical significance (p<0.01). The clinical activity and histological activity do not correlate and this is especially when assessing the more proximal colon. Endoscopy and histology also shows no correlation highlighting the importance of microscopic assessment of endoscopically normal mucosa. Finally, the histological scoring systems correlate fairly closely with one another enabling histopathologists to choose one that is most practical for routine use.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 Intraductal papillary neoplasm of extrahepatic biliary tract with an associated early invasive adenocarcinoma(EDORIUM Journals, 2014) Jayathilake, K.G.H; Siriwardana, R.C.; Navarathne, N.M.M; Mahendra, B.A.G.G.; Liyanage, C.A.H.INTRODUCTION: Intraductal papillary neoplasm of the bile duct is a premalignant lesion, which can develop into an adenocarcinoma. If treated early, at the non-invasive stage, it has an excellent prognosis compared to cholangiocarcinoma. CASE REPORT: A 61-year-old female presented with intermittent episodes of fever with chills and rigors, loss of appetite, pruritus, tea colored urine, and pale sticky stools for two years duration. After work up she underwent a left hemihepatectomy with resection of caudate lobe and extrahepatic biliary duct with lymph node clearance. Histology revealed an intraductal papillary lesion with no mucin production, expanding the common hepatic duct and the left hepatic duct, invading the subepithelial connective tissue at a focus near the distal end of the left hepatic duct. The tumor was qualified as an intraductal papillary neoplasia of pancreatobiliary type involving the extrahepatic bile duct with associated early invasive adenocarcinoma. She required no further adjuvant treatment and is disease free for one year on regular followup. CONCLUSION: The objective of this article is to emphasize the necessity of early diagnosis and aggressive and complete surgical resection to achieve maximum patient survival in this curable disease.Item A Retrospective study on perinatal post-mortems(University of Kelaniya, Sri Lanka, 2016) Liyanage, S.K.; Mahendra, B.A.G.G.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.A post-mortem examination is the key to the recognition of pathologies related to perinatal deaths. A perinatal death could be related to fetal, maternal or placental factors. A complete perinatal post-mortem (PPM) includes examination of the dead body and the placenta. The PPM findings assist the clinical team in confirming their clinical findings and uncover the additional pathologies, and the family for future pregnancy planning. This study was carried out to identify the number of perinatal post mortems (PPMs) reported during the study period, the number of PPMs with multiple congenital anomalies and the number of PPMs accompanied by a placenta and the number of placentae with identifiable pathology. This study was on already reported PPMs in a tertiary care center from January 2011- August 2016. Multiple congenital anomalies were noted in 14% (16/118) of the PPMs. Placentae were submitted for examination in 26% (31/118) with clinically significant placental pathologies in 23% (7/31). In 64% (76/118) of PPMs there were no gross abnormality in the fetus/baby. The placenta was not available for examination in 72% (55/76) and therefore, the possibility of placental pathology, which might have led to the death, could not be excluded.Item A Sudden death following cardiomyopathy in a child(Department of Forensic Medicine, Faculty of Medicine at University of Peradeniya, 2016) Perera, W.N.S.; Mahendra, B.A.G.G.Introduction: Paediatric cardiomyopathies are clinically heterogeneous heart muscle disorders responsible for a significant morbidity and mortality. Phenotypes include hypertrophic, dilated, restrictive and arrhythmogenic right ventricular cardiomyopathy. The aetiology is diverse and includes genetic and non-genetic causes. Restrictive cardiomyopathy (RCM) is uncommon in children, accounts for 5% of all cardiomyopathies and has the worst prognosis. Case Report: An eight-year-old girl with a history of syncopal attacks over one year, developed acute dyspnoea. She had a cardiac arrest on admission and died despite resuscitation. Her past clinical records showed an echocardiogram report revealing biventricular diastolic dysfunction, good ventricular systolic function, biatrial dilatation and biventricular hypertrophy. Myocardial biopsy showed mild interstitial fibrosis. She had been diagnosed as having RCM. At autopsy the heart weighted 210g with biatrial dilatation, symmetrical biventricular wall thickening (both right and left ventricular wall thickness 18mm) and subendocardial fibrosis. The histology of the myocardium revealed hypertrophy and mild disarray of myocytes and interstitial fibrosis. There was no amyloid or iron deposits, granulomas or tissue eosinophilia. Cause of death was ascertained as acute cardiac failure following cardiomyopathy. Discussion and Conclusion: RCM is a disease characterized by a primary decrease in ventricular compliance resulting in diastolic failure. This patient had classic functional and structural features of RCM which include biventricular diastolic dysfunction, good ventricular systolic function and biatrial dilatation. An increased biventricular wall thickness which is a classic feature of hypertrophic cardiomyopathy (HCM) suggests clinical overlap with HCM. Mixed phenotype of RCM/HCM has shown significant transplant free survival compared to pure RCM. Relatively less symptoms and longer survival in this child could be explained by mixed RCM/HCM phenotype.Item Follow up of histopathology and cytopathology reports that are duly signed out - are standard procedures required?(College of Pathologists of Sri Lanka, 2014) Ratnayake, R.M.U.S.; Somarathna, T.; Mahendra, B.A.G.G.; Hewavisenthi, S.J.