Browsing by Author "Mahendra, B.A.G.G."

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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 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.
Challenges in the diagnosis of lipomatous tumours.
(College of Pathologists of Sri Lanka, 2014) Mahendra, B.A.G.G.
No abstract available
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.
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.
Design and development of a web based histopathology reporting system
(Sri Lanka Medical Association, 2017) Ediriweera, D.S.; Hettiarachchi, W.G.; Mahendra, B.A.G.G.; Liyanage, S.K.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.de.S.
INTRODUCTION & OBJECTIVES: The current histopathology reporting system in the unit has only basic features including report generation and limited data retrieval. Thus a newer system was required to address the issues faced in histopathology reporting, chiefly a prolonged turnaround time caused by lack of clinical data, inability to track delays in sample processing, delays in data entry and report dispatch. More efficient data retrieval for research purposes and monitoring of postgraduate training were also considered important. The aim of the study was to design and develop a generic histopathology reporting system that facilitates the generation of timely reports and helps in research and postgraduate training. METHODS: A software framework was designed and developed into a functional web based histopathology reporting system (WBHPRS) which can be easily customizable to different settings. This was designed using MySQL and PHP. Data entry was facilitated by using drop down menus and prompts. Standard templates for reports with the option to edit were uploaded enabling quick report generation. RESULTS: A WBHPRS has the ability to capture data throughout the process of generating a report, thus enabling the tracking of the specimen from surgery to dispatch of the report. The system also provides facilities for more efficient data retrieval due to a modified coding system. It facilitates postgraduate supervision enabling the trainer to determine the time taken, quality and quantity of work done by the trainees. CONCLUSION: This system has vastly enhanced features that will improve the timeliness of reporting and provide additional features useful in research and postgraduate training.
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.
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.
Implementation of an Online Histopathology Reporting System in the Department of Pathology, Faculty of Medicine, University of Kelaniya
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Hettiarachchi, W.G.; Ediriweera, E.P.D.S.; Mahendra, B.A.G.G.; Liyanage, S.K.; Hewavinsenthi, S.J.D.S.; Ratnayake, R.M.U.S.
The Department of Pathology, Faculty of Medicine, University of Kelaniya provides histopathology reporting for the Colombo North Teaching Hospital (NCTH) as an honorable service. The department currently uses a standalone Microsoft access database to generate reports and it has limited data retrieval capabilities. A newer system was required to address the issues faced, mainly a prolonged turnaround time caused by lack of clinical data, inability to track delays in sample processing, delays in data entry and report dispatch. More efficient data retrieval for research purposes and monitoring of postgraduate training were also considered important. The aim of the work was to implement anonline histopathology reporting system that has facility to track the reporting stage, postgraduate evaluation and data retrieval for researches. Every report is attached with a diagnostic code that can be used in research purposes. A web-based application was developed that has ability to capture data at each step from specimen receiving from the surgery theatre until dispatch of reports. The system has developed to easily customizable to different settings. Thus, it has facility to add new reporting templates, anatomical sites, surgical specimens or diagnostic codes to system through web forms. Data entry was facilitated by using drop down menus and prompts. Standard templates for reports with option to edit were uploaded enabling quick report generation. It facilitates postgraduate supervision by enabling the trainer to determine the time taken, quality and quantity of work done by the trainees. Mainly open source scripting languages and databases were used to developed the system: PHP, HTML 5, CSS Javascript, Ajax and MySQL. The system hosted on the faculty intranet and available 24/7 from anywhere at the faculty. The system supports both windows and androids operating systems and the system can be accessed in desktop and tablet computers using any commonly used modern web browsers.
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.
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.
Is Endoscopic examination alone adequate in determining the extent of disease in ulcerative colitis?
(College of Surgeons of Sri Lanka, 2006) Mahendra, B.A.G.G.
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 the 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 assessed endoscopically versus that determined histologically. METHOD: 41 patients with ulcerative colitis were identified. In each of these patients endoscopy was performed and the appearance was recorded. In each patient 1-6 mucosal biopsies (mean - 3.2) were obtained for histological evaluation. A total of 136 biopsies were examined histologically and compared with the endoscopic appearance of the corresponding area of the bowel. The sensitivity of endoscopy in detecting the presence of true inflammation was also studied for the different regions of the bowel. RESULTS: 125 biopsies showed histological involvement. The endoscopy and histology were both positive in 68. The endoscopy was negative whilst the histology was positive in 57 biopsies. Endoscopy and histology were both negative in 10 biopsies and endoscopy alone was positive in only one biopsy.The kappa value of agreement was 0.136 denoting poor agreement between endoscopy and histology.Endoscopic examination had a high sensitivity in detecting proctitis. When more proximal regions of the bowel were biopsied, the sensitivity of endoscopic examination in detecting histological inflammation gradually declined. CONCLUSION: Since endoscopy and histology show poor agreement it is recommended that both should be performed to assess the true extent of disease in ulcerative colitis.
A Possible progression of an atypical leiomyoma to a leiomyosarcoma
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Liyanage, A K.; Herath, R.P.; Fernando, W.S.; Mahendra, B.A.G.G.
BACKGROUND: The spectrum of uterine smooth muscle cell tumours can range from leiomyoma to leiomyosarcoma. Atypical leiomyomasare a group of tumours with cellular atypia and a mitotic indexof up to 5/HPF that are classified between the innocuous leiomyoma and leiomyosarcomas. The absence of coagulative necrosis helps to differentiate it from leiomyosarcomas.Traditionally atypical leiomyomas are thought to have a low recurrence rate. CASE DETAILS: A 41-year-old woman underwent a myomectomy for ananteriorcervical fibroid.Histology revealed a smooth muscle tumour (SMT) withdiffusely scattered hyperchromatic large cells. The maximum mitotic count was 5/10 HPF.There was no coagulative necrosis or atypical mitotic figures. It was classified as an atypical leiomyomas and had close follow up. However, 30 months later she developed heavy menstrual bleeding. The ultrasound scan revealed an anterior fibroid. She underwent a total abdominal hysterectomy with ovarian conservation. The specimen showed a well-defined myometrial nodule of 7cm with haemorrhagic areas,compressing the cervix. It was a SMT with high a mitotic activity (11-12/HPF), atypical cells with bizarre nuclei and focal coagulative necrosis confirming a leiomyosarcoma (FIGO 1B). CONCLUSION: As atypical leiomyomashave a low risk profile and are mostly found in younger women,it invariably leads to treatment that offers fertility preservation. This case challenges the generalisability of this currently held viewpoint and recommends more extensive surgery or further heightened surveillance
A possible progression of an atypical leiomyoma to a leiomyosarcoma
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Liyanage, A.K.; Herath, R.P.; Fernando, W.S.; Mahendra, B.A.G.G.
BACKGROUND: The spectrum of uterine smooth muscle cell tumours can range from leiomyoma to leiomyosarcoma. Atypical leiomyomasare a group of tumours with cellular atypia and a mitotic indexof up to 5/HPF that are classified between the innocuous leiomyoma and leiomyosarcomas. The absence of coagulative necrosis helps to differentiate it from leiomyosarcomas.Traditionally atypical leiomyomas are thought to have a low recurrence rate. CASE DETAILS: A 41-year-old woman underwent a myomectomy for ananteriorcervical fibroid.Histology revealed a smooth muscle tumour (SMT) withdiffusely scattered hyperchromatic large cells. The maximum mitotic count was 5/10 HPF.There was no coagulative necrosis or atypical mitotic figures. It was classified as an atypical leiomyomas and had close follow up. However, 30 months later she developed heavy menstrual bleeding. The ultrasound scan revealed an anterior fibroid. She underwent a total abdominal hysterectomy with ovarian conservation. The specimen showed a well-defined myometrial nodule of 7cm with haemorrhagic areas,compressing the cervix. It was a SMT with high a mitotic activity (11-12/HPF), atypical cells with bizarre nuclei and focal coagulative necrosis confirming a leiomyosarcoma (FIGO 1B). CONCLUSION: As atypical leiomyomashave a low risk profile and are mostly found in younger women,it invariably leads to treatment that offers fertility preservation. This case challenges the generalisability of this currently held viewpoint and recommends more extensive surgery or further heightened surveillance.
Quality of the specimens received at a histopathology laboratory of a medical faculty in Sri Lanka
(Sri Lanka Medical Association, 2015) Weerasinghe, T.M.B.; Weddagala, W.M.S.R.; Weerasekara, W.M.M.O.R.; Wasala, W.M.A.D.; Weerasinghe, M.P.A.M.; Mahendra, B.A.G.G.; Pathmeswaran, A.
INTRODUCTION AND OBJECTIVES: The accuracy of the histopathology reporting depends on the completeness of the request forms and the condition of specimens. To assess the completeness of histopathology request forms and the condition of specimens received by a pathology laboratory, Medical Faculty, University of Kelaniya METHOD: This cross sectional study was conducted at the pathology laboratory of a medical faculty in Sri Lanka. We included 342 consecutive specimens received from the professorial units of the teaching hospital during the study period, September to November 2014. Data were collected using a checklist consisting of 10 items for the request form, 6 for the label, 7 for the container and sample. SPSS16.2 was used to analyze the data. RESULTS: Only 56.1% had completed request forms. Patients' sex and a short clinical history with a probable diagnosis were missing in!2.6% and 24.6% respectively. Labelling was incomplete in 14.6% and date of specimen collection was missing in 11.4%. Compatibility of the 6 items on the label with the request form was observed in 71.3%, and the most mismatched item was the date of specimen collection (17%). Appropriate container was used in 89.5%. Inadequate amount of fixative was found in 13.2% of specimens. Only 24% of specimens fulfilled all requirements. CONCLUSION: This study demonstrates that the quality of the specimens is poor mainly due to the incomplete request forms, poor labelling and use of inappropriate containers. Redesigning the request form and introducing printed labels and standard set of containers may improve the quality of specimens.
Reducing the public health expenditure through a surgical method that facilitates early mobilization of lower limb burns
(Sri Lanka Medical Association, 2017) Perera, C.; Hajith, Z.M.; Mahendra, B.A.G.G.
INTRODUCTION & OBJECTIVES: Grafted skin in the conventional way tends to contract towards the midline bridging across the joints. Prolonged immobilization following skin grafting promotes contracture across the joints. In the advanced graft orientation technique (AGOT) devised by the Burns Unit of the National Hospital of Sri Lanka (BU-NHSL), the graft is orientated in a tension free direction. This method does not require prolonged splinting or immobilization. The aim of the study was to assess the impact of graft orientation on early mobilization and prevention of contracture in lower limb (LL) burn patients. METHODS: A total of 61 patients treated with AGOT for LL burns at BU-NHSL (study group-SG) were compared with 21 patients who were primarily treated with conventional skin grafting for LL burns at local hospitals and referred for reconstruction at BU-NHSL (control group-CG). Vancouver Scar Scale (VSS) and range of motions (ROM) of involved joints were measured one year following the date of burn in the SG. These were measured prior to reconstructive surgery in the CG. Comparison was done using independent t-test. RESULTS: Mean value of VSS in the SG and the CG were 2.8889 (SD+1.65878) and 9.4074 (SD+3.21366) respectively. Spared normal joint ROM was seen in 95.6% of the SG. 100% in the CG had reduced joint ROM. CONCLUSION: AGOT has a lesser possibility of contracture across the grafted joints. Lower VSS value in the SG suggests that the quality of grafted skin is closer to normal skin. This technique is beneficial in low and middle income countries where access to specialized burn rehabilitation and health budget is limited.
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.
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.
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.
Synovial sarcoma [Letter to the Editor]
(College of Pathologists of Sri Lanka, 2012) Mahendra, B.A.G.G.; Hewavisenthi, S.J.de S.
No Abstract Available.