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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Incidental thyroid cancer in the pyramidal lobe and implications for thyroidectomy(The Sri Lanka Medical Associtation, 2022) Pinto, D.; Mahendra, G.; Fernando, R.The embryological remnants (ERs) must be removed to achieve a safe and complete ‘total’ thyroidectomy. Residual ERs, after thyroidectomy, may cause recurrence of the initial pathology. This poses management dilemmas, including a difficult reoperation. Active search and removal of the ERs intraoperatively is essential. Primary overt malignancy is rare in ERs. Literature reports several cohort studies of same. The incidence of a micropapillary carcinoma in an ER has not been reported and this brief report describes two patients with Incidental micropapillary carcinoma in the pyramidal lobe, reiterating the need to make removal of ERs the accepted norm in total thyroidectomies.Item Trends in early onset colorectal cancer (EOCRC) in a South Asian cohort: data from a specialized tertiary care center in western Sri Lanka(The College of Surgeons of Sri Lanka, 2022) Chandrasinghe, P.; Godahewa, S.; Mahendra, G.; Hewavissenthi, J.; Kumarage, S.Introduction Early onset colorectal cancer [EOCRC] has significantly increased during the past decade globally. It is defined as cancers diagnosed in those aged 50 years or less. Most research on EORC are from western populations where the tumour biology and risk factors may differ from other regions. Evidence on EOCRC from the South Asian region is particularly scarce. This study presents the basic trends in presentation and overall survival [OS] pattern of EOCRC using data from a single specialized tertiary care institution over two decades. Methods A total of 723 patients treated at the University surgical unit of the North Colombo teaching hospital from 1995 to 2020 were included in the analysis. Overall survival of the EOCRC was compared with that of the older population using Kaplan- Meier survival curves. Survival patterns over two time periods [pre-2010 vs post-2010] were also compared between the two populations. The stage at presentation, family history of colorectal or related cancers, tumour site, and tumour stage were also compared. Results The proportion of EOCRC in this cohort has not shown a significant increase over the past two decades [2001-2010: 24% vs 2011-2020: 21%]. The advanced tumour stage at presentation and the presence of significant family history are also comparable. EOCRC cohort demonstrates a better OS for the entire study period [Median survival: < 50 years – not reached; >50 years – 91 months; 95%CI – 72-132; P<0.001]. However, this survival advantage is only observed during the pre-2010 period [Median survival: < 50 years – 160 months; 95%CI – 120 – not reached; >50 years – 84 months; 95%CI – 62-132; P=0.01] and becomes comparable in the 2010-2020 period [P=0.16]. OS of the EORC has not also improved over the two decades from 2001 to 2020 [P=0.51]. Conclusion There is no significant increase in the EOCRC rates in this population over time although the rate has remained high throughout. The OS of the EOCRC population is better compared to the older population. A significantly better OS is observed during the pre-2010 period in the EOCRC but is not present in the post-2010 period. Advancement in therapy may have improved the survival of the older population during the latter part but not that in the EOCRC due to its inherently aggressive nature. This paper provides preliminary data on EOCRC from Sri Lanka. The South Asian population may have a different disease pattern with younger age at onset compared to the western populations and needs to be further explored.Item Possible progression of an atypical leiomyoma to a leiomyosarcoma: a case report(Menopause Society of Sri Lanka, 2021) Ekanayake, C.D.; Herath, R.; Fernando, S.; Mahendra, G.; Balawardene, J.; de Silva, A.The spectrum of uterine smooth muscle cell tumours (SMT) ranges from leiomyomas to leiomyosarcomas (LMS). Atypical leiomyomas (AL) are a uterine SMT of a contentious nature due to its indeterminate malignant potential. Although the risk of recurrence is low there is limited experience on management. On the other hand, it is generally believed that the uterine LMS arises de novo, rather than from a precursor lesion.Item Acute on chronic osteomyelitis due to coliforms in a Sri Lankan child with homozygous sickle cell disease(Sri Lanka College of Paediatricians, 2021) Hoole, T.J.; Arunath, V.; de Silva, M.H.A.D.; Muthukumarana, O.G.W.; Kumarasiri, I.M.; Rathnasiri, G.B.A.M.R.; Mahendra, G.; Premawardhena, A.; Mettananda, S.No Abstract AvailableItem Ectopic pancreatic rest in the stomach(College of Surgeons of Sri Lanka, 2020) Pinto, D.; Kumarage, S.; Mahendra, G.No abstract availableItem Umbilical endometriosis-A simple but challenging diagnosis for surgeons(College of Surgeons of Sri Lanka, 2014) Jayathilake, K.G.H.; Withana, S.; Siriwardana, R.; Mahendra, G.; Liyanage, C.Item Total pancreatectomy for cholangiocarcinoma of the distal common bile duct associated with lipomatous pseudohypertrophy of pancreas(EDORIUM Journals, 2015) Jayatunge, S.P.; Mahendra, G.; Siyabalapitiya, S.; Siriwardana, R.C.; Liyanage, C.Introduction: Fatty replacement of the exocrine pancreas also known as lipomatosis, adipose atrophy or lipomatous pseudohypertrophy is a well recognize benign condition. This fatty infiltration can occur either focally or involving the whole pancreas. Case Report: We report a rare case of lipomatous pseudohypertrophy of the pancreas associated with cholangiocarcinoma of the distal common bile duct (CBD). A 51-yearold female presented to our unit with a history of obstructive jaundice. Radiological imaging suggested a cholangiocarcinoma of the distal CBD with pancreatic lipomatosis, without any clinical evidence of exocrine or endocrine dysfunction. She underwent a radical bile duct excision and a total pancreatectomy. Histology revealed lipomatosis of the pancreatic body and tail with sparse pancreatic tissue adjacent to the tumor. After an uneventful recovery, she was started on lifelong insulin and pancreatic enzyme supplements. Even though pathogenesis of pancreatic lipomatosis remains controversial, it is most likely due to obstruction of the pancreatic duct in this presentation. Conclusion: It is import to undertake total pancreatectomy for this dual presentation with specialized endocrinological support in the stormy postoperative period.