Browsing by Author "Hewavisenthi, S.J.de S."

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The agreement among different scoring systems used in the assessment of histologicai activity in ulcerative colitis
(Sri Lanka Medical Association, 2007) Mahendra, B.A.G.G.; Hewavisenthi, S.J.de S.
INTRODUCTION: Histology is one of the most important criteria in determining the disease activity in ulcerative colitis which in turn is important in the choice of drug treatment, monitoring of therapy and in clinical trials. Many different histologicai scoring systems are used to determine the disease activity in ulcerative colitis. OBJECTIVE: To compare three different histologicai scoring systems used in assessing the activity in ulcerative colitis. DESIGN, SETTING AND METHODS: 41 mucosal biopsies of ulcerative colitis patients were reviewed. The histologica! disease activity in each of these was scored by the two authors at a conference microscope using three different histologicai scoring systems. They were A - Bristol activity index, B – scoring index by Saverymutty et al, and C - scoring index by Geboes et al. The correlation among the three histologicai scoring systems was calculated using Spearman rank correlation coefficient. RESULTS: The Spearman rank correlation coefficient between system A vs system B was 0.883 (0.000), system A vs. system C was 0.883 (0.000) and system B vs system C was 0.952 (0.000). The correlation among the three histologicai scoring systems was statistically significant (p<0.01). CONCLUSION: Therefore any one of these three systems can be recommended in scoring the histologicai activity in ulcerative colitis and the choice will depend on the ease of use and personal preference.
An Appendiceal skips lesion in ulcerative colitis,(VC)
(Sri Lanka Medical Association, 1998) Hewavisenthi, S.J.de S.; Deen, K.I.
Report to create awareness that skip lesions may occur even in ulcerative colitis (VC).
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.
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.
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.
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 Lanka
Choriocarcinoma presenting as a renal tumour
(Sri Lanka Medical Association, 2006) Ratnayake, S.A.G.R.; Hewavisenthi, S.J.de S.
No Abstract Available
Clinical, biochemical and histological characteristics of a Sri Lankan population of non-alcoholic steatohepatitis (NASH) patients
(Sri Lanka Medical Association, 2005) Hewavisenthi, S.J.de S.; Dassanayake, A.S.; de Silva, H.J.
BACKGROUND: Non-alcoholic steatohepatitis (NASH) is common and can progress to cirrhosis. It has been regarded as a 'disease of affluence' and there are only a few reports from developing countries. OBJECTIVE: To describe the clinical, biochemical, and histological characteristics of a cohort of NASH patients in Sri Lanka, and to determine their short term outcome following modifications of lifestyle. METHOD: Patients who had a liver biopsy for investigation of raised hepatic enzymes were assessed during the period May 1999 - May 2003. Patients who had an alcohol intake of over 40 g/week were excluded. Detailed clinical and biochemical data of patients with histologically confirmed NASH were compiled. Histological grading and staging was done using the Brunt system. The patients were advised on lifestyle modifications and the control of diseases known to be associated with NASH. They were followed up at 3 -monthly intervals. RESULTS: During the study period liver biopsies were performed on 296 patients and 100 ( 35.1%) were diagnosed as having NASH. (Men = 79, Mean age 37.2 years, SD 10.6). Risk factors for NASH included diabetes mellitus (55%), obesity (52%), hyperlipidaemia (54%), a family history of risk factors (66%) and a high dietary fat intake (66%). However, 44.3% of men and 33.3% of women were not overweight. Thehistological grading and staging of 80 biopsies showed Grade 1 in 31 (38.8%), Grade 2 in 29 (36.3%), Grade 3 in 20 (25%), Stage 1 in 57 (71.3%) Stage 2 in 13 (16.3%), Stage 3 in 2 (2.5%) and Stage 4 in 8 (10%). In 55/91 (60.4%) patients who were followed up for a median of 2.5 years (range 1-4 years) the serum transaminases returned to normal in a median of 7 months (range 3-14 months). CONCLUSION: The clinical, biochemical and histological features of NASH patients in our series are similar to that reported in western countries. However "lean males" accounted for a significant proportion. In the short term a majority of patients showed improvement in serum transaminases with lifestyle modification.
Colerectal carcinoma: audit of histopathology reports
(College of Pathologists of Sri Lanka, 2000) Hewavisenthi, S.J.de S.; Samarasekera, D.S.; Priyadharshani, J.W.S.
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
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.
Colorectal carcinoma - an audit of histopathology reports
(Sri Lanka Medical Association, 2000) Hewavisenthi, S.J.de S.
METHOD: An analysis of 213 reports issued by some histopathology departments in the Colombo and Gampaha districts was done to ascertain whether certain macroscopic and microscopic features considered important in patient management was included in the histopathology reports. RESULTS: 213 reports, which included 76 rectal carcinomas, were audited. The peritoneal surface and Radial margin involvement were reported in only 6% and 19% of the reports respectively. Vascular and lymphatic invasion was commented on in only 15%, and the site of rectal tumor was not mentioned in any. Though 71-8% of the reports carried information regarding lymph node rnetastases, this information was incomplete; 26% of the reports did not include the total number of lymph nodes retrieved. All other features were included in over 75% of the reports. CONCLUSIONS; Reporting was found to be inadequate with regard to peritoneal and radial surface involvement vascular and lymphatic invasion within the tumor, lymph node metastases, and in the case of rectal tumors whether the tumor was above, at or below the peritoneal reflection.
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 Available
Do pathologists and clinicians understand each other?
(Sri Lanka Medical Association, 2000) Hewavisenthi, S.J.de S.; Fernando, W.P.A.
OBJECTIVE: Pathologists use many phrases in histopathology reports to convey the level of diagnostic certainty. This could be variably interpreted by the clinician. Our study was carried out to determine the level of diagnostic certainty the pathology report conveys to a clinician, their preferences, and the frequency of usage of these phrases. METHOD: A questionnaire constructed using the 13 most frequently encountered phrases in pathology reports was circulated among 15 pathologists and 15 clinicians. Both groups were asked to score the level of diagnostic certainty of each of these phrases. Pathologists were asked to comment on the frequency of usage and clinicians their preference for each of these phrases. RESULTS; 'Consistent with' and 'those/that of were the most commonly used phrases (73%). There was variation in the interpretation of both these phrases amongst the pathologists. A high degree of diagnostic certainty was conveyed to 100% of the clinicians by the former and only 73% by the latter. 'Diagnostic of and 'Characteristic of were the phrases most commonly preferred by the clinicians (86%). There was concordance in interpretation of the former phrase between both groups. But this phrase was used frequently only by 20% of the pathologists and occasionally by 33%. CONCLUSION: A wide individual variation in interpretation of phrases exist among both groups. Therefore a limited number of mutually acceptable phrases or a "single line" conclusion is recommended.
Gastric disease in patients presenting with dyspeptic symptoms
(Sri Lanka Medical Association, 2002) Hewavisenthi, S.J.de S.; Suranimala, H.D.C.; Alwis, W.H.D.
INTRODUCTION: Upper gastrointestinal endoscopy and biopsy is a relatively common procedure that is now frequently used in the investigation of patients with 'dyspeptic symptoms'. OBJECTIVES: To correlate the endoscopic findings with histological features. To ascertain patterns of gastric disease occurring in patients undergoing upper gastrointestinal endoscopy and biopsy for dyspeptic symptoms. METHODS: 419 endoscopic biopsies performed on patients with dyspeptic symptoms during the period April 2000 to October 2001 were reviewed. In all patients biopsies were performed on an area of the gastric mucosa showing an endoscopic abnormality. The patients included 258 males and 161 females with ages ranging from 11-86 years (median 45.5). Most biopsies were obtained from the antral region (322/419). RESULTS: 110/419 (26%) biopsies were histologically normal despite an 'endoscopic abnormality' being reported. 15 biopsies (3.5%) were non-diagnostic due to biopsy artefacts, poor preservation and other factors. 13/419 (3%) biopsies revealed neoplastic lesions (11- malignant, 2-fundic gland cysts). Of the non neoplastic gastric disorders 33 (7.9%) were peptic ulcers, 202 (48%) chronic gastritis, 40 (9.5%) reactive gastritis, 6 (1%) portal gastropathy, 1 hyperplastic gastropathy. Helicobactorpylori was identified in 112/202 (55%) of the biopsies with chronic gastritis. CONCLUSIONS: Endoscopic and histologic correlation was satisfactory in a majority, 74% of the biopsies showing histological evidence of disease. Helicobactor pylori induced gastritis was the commonest (27%) pathology encountered in patients investigated for dyspeptic symptoms.
Gastrointestinal stromal tmours (GIST) revisited
(College of Pathologists of Sri Lanka, 2002) Hewavisenthi, S.J.de S.; de Silva, M.V.C.
Getting the best results from the histopathology report-the responsibilities of the clinical team
(College of Surgeons of Sri Lanka, 2005) Hewavisenthi, S.J.de S.
No Abstract Available
Granulomatous colitis: Can pathology help in differentiating intestinal tuberculosis from Crohns disease ?
(College of Pathologists of Sri Lanka, 2012) Hewavisenthi, S.J.de S.
No Abstract Available
Histological evaluation and H. pylori status of dyspeptic patients without gastrooesophageal reflux
(College of Surgeons of Sri Lanka, 2004) Hewavisenthi, S.J.de S.; Suranimala, H.D.C.; Alwis, W.H.E.; Senevirathne, K.A.D.C.
OBJECTIVE: To identify different types of gastric pathology in patients with dyspeptic symptoms without gastro oesophageal reflux, to assess the prevalence of H, pylori in their biopsies and to correlate the histological changes with the presence of these organisms. METHOD: 788 dyspeptic patients were included in the study during the period April 2000 - August 2002. Their gastric biopsies were reviewed and diagnoses were classified as normal, chronic gastritis, reactive gastritis, portal gastropathy, peptic ulcer, neoplastic and others. 22 non diagnostic biopsies were excluded. The biopsies in which H. pylori was identified were graded histologically as mild, moderate and severe for organism density, chronic inflammation, activity, intestinal metaplasia and glandular atrophy in accordance with the updated Sydney classification. RESULTS: Gastric pathology identified in the dyspeptic patients studied included normal (187), chronic gastritis (373), reactive gastritis (50), portal gastropathy (9), peptic ulcers including both gastric and duodenal ulcers (128), neoplastic (15) and others (4). H pylori was identified in 210 patients. 189 (90%) of these were associated with chronic gastritis. Chronic inflammation in gastric biopsies was graded as mild in 75, moderate in 104, severe in 31 and activity was graded as absent in 45, mild in 115, moderate in 3 8 and severe in 12. Associated intestinal metaplasia was present in 32/210 > ymild (26), moderate (6)?y and glandular atrophy was present in 42/210 (mild (36), moderate (8)). H .pylori density was mild in 165, moderate in 39 and severe in 6. The H. pylori density showed a significant correlation with inflammation and activity. CONCLUSION: Chronic gastritis was the single most common condition diagnosed in dyspeptic patients without gastro oesophageal reflux. Overall, H. pylori was identified in 27.4% of dyspeptic patients. In most biopsies chronic inflammation was moderate and activity was mild or absent, and this was associated with a low H. pylori density. The incidence of metaplasia and glandular atrophy was low.
Histological study of macroscopically normal mucosa adjacent to tumour in colorectal resection specimens
(College of Pathologists of Sri Lanka, 2012) Ratnayake, R.M.U.S.; Hewavisenthi, S.J.de S.
OBJECTIVE: To study the histological features of macroscopically normal mucosa in colorectal carcinoma specimens and attempt to correlate the severity of these changes and the distance of the mucosa from the tumour. METHOD: Ninety three resection margins from 52 specimens were categorized according to the distance from the tumour, 0-1cm, 1.1-5cm and more than 5cm. The histological parameters assessed included, lymphoid aggregates, acute inflammation, chronic inflammation, crypt distortion and villous change. These were graded as absent, mild, moderate and severe. The presence of intraepithelial lymphocytes, cystically dilated ducts and epithelial erosions were recorded as absent or present. Results were analyzed using Pearson Chi- square test and Fischer-Exact statistics. .RESULTS: The histological features found included, lymphoid aggregates in 40% acute inflammation in 15% chronic inflammation in 16% crypt distortion 17%, cystically dilated glands 21%, epithelial erosion 13% and villous change 32%. The presence of cystically dilated glands showed a significant correlation with the distance from the tumour. CONCLUSION: Varied histopathological features were observed in the mucosa adjacent to the tumour, awareness of which can prevent misinterpretation and over diagnosis of these features.