Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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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 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 Sub clinical intestinal mucosal inflammation in diarrhea predominant Irritable Bowel Syndrome (IBS) in a tropical setting(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2010) de Silva, A.P.; Manamperi, A.; Hewavisenthi, S.J.de S.; Ariyasinghe, M.P.; Dassanayake, A.S.; Jewell, D.P.; de Silva, H.J.BACKGROUND: There is evidence for potential roles for gut flora and the host immune response in the pathophysiology of IBS, and especially, for low grade colonic mucosal inflammation in the pathophysiology of post-infectious IBS. AIM: To investigate for evidence of sub-clinical intestinal mucosal inflammation in diarrhea- predominant IBS (IBS-D) in a tropical setting. METHODS: In a prospective study over one year, we investigated 49 patients with IBS-D [median age 34 years (range 18-59; M:F 36:13], based on Rome III criteria. None had alarm symptoms: unintentional significant loss of weight, bleeding per rectum or malaena. None were on NSAIDS or proton pump inhibitors. All patients had normal ESR, CRP, TSH and stools reports. 14 individuals with a family history of colon cancer [median age 46.5 years (range 23-56); median 46.5, M:F 6:8] were selected as controls. Stools of patients and controls were tested for calprotectin. During colonoscopy, serial biopsies were obtained from the ileum, caecum, ascending, transverse and descending colon, and rectum. In addition to histology, tissue expression of IL-8 and IL-10 were assessed in biopsy specimens using semi-quantitative RT-PCR. RESULTS: Colono-ileoscopy was macroscopically normal and faecal calprotectin was undetectable in cases and controls. Microscopic colitis not otherwise specified(MNOS) was seen in 10/49 cases and 1/14 controls (p=0.43, Fisher's Exact test). Histology was normal in others. A history suggestive of an episode of infectious diarrhea (ID) was seen in 16/49 cases and 0/14 controls (p=0.013). There was no significant association between ID and the presence of MNOS. Tissue expression of IL-8 was significantly higher and IL-10 significantly lower in cases compared to controls (target/standard cDNA ratio, median (range) IL-8: 1.25 (0.75-2) Vs 0.85 (0.63-1.3), p<0.0001, Mann-Whitney U test; IL-10: 0.33 (0-0.63) Vs 0.55 (0.5-0.7), p<0.0001). There was a significant inverse correlation between IL-8 and IL-10 expression (Pearson Correlation, (-) 0.509; p<0.01). In patients with IBS-D, cytokine abnormalities were not significantly different in those with or without a history of ID or the presence or absence of MNOS. CONCLUSION: There is evidence for subclinical intestinal mucosal inflammation in patients with IBS-D in a tropical setting, whether or not a history of ID or MNOS was present or absent.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 Is endoscopic examination alone adequate for determining the extent of disease in ulcerative colitis(Sri Lanka Medical Association, 2006) Mahendra, B.A.G.G.; Hewavisenthi, S.J.de S.BACKGROUND: Endoscopic and histological examination of the mucosa are the mainstay in the diagnosis of ulcerative colitis. Assessing the extent of disease is important in management of these patients. Sometimes an endoscopic examination alone is performed without biopsy and histological examination. OBJECTIVE: To compare the extent of disease in ulcerative colitis as judged endoscopically versus that determined histologically. METHOD: 27 patients with ulcerative colitis were identified. In each patient the endoscopy was performed and the appearance was recorded in a diagrammatic form. In each patient 1 -6 (Mean 3.8) mucosal biopsies were obtained for histological evaluation. A total of 101 biopsies were examined histologically and compared with the endoscopic appearance of the corresponding area of the bowel as depicted in the diagramme. RESULTS: 93 out of 101 biopsies showed histological involvement. The endoscopy and histology were both positive in 41/101, the endoscopy was negative whilst histology was positive in 52/101, endoscopy and histology were both negative in 7/101, and endoscopy alone was positive in 1/101 biopsies. The Kappa value of agreement of .081 denoted a poor agreement between endoscopy and histology. CONCLUSION: Since the endoscopy and histology show poor agreement it is recommended that both should be performed to assess the true extent of disease in ulcerative colitis.Item Colonic mucin patterns in ulcerative colitis: Implications in disease progression and colorectal carcinoma risk(Sri Lanka Medical Association, 2006) Hewavisenthi, S.J.de S.; Dayarathne, K.W.N.; Laffcrar, M.Abstracts available