Browsing by Author "Ratnayake, R.M.U.S."

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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.
Comparison of Mucin Patterns in Colonic Pathologies by Histochemistry.
(College of Pathologists of Sri Lanka, 2019) Ratnayake, R.M.U.S.; Epitakaduwa, C.; Jayatunge, D.N.U.; Ediriweera, D.; Hewavisenthi, S.J.D.S.
INTRODUCTION: High Iron Diamine Alcian blue (HID-AB) is a well-established technique for demonstrating colonic acid mucins namely sulphomucins (brown- black) and sialomucins (blue). In certain colonic pathologies expression of sulphomucin, the predominant mucin in normal colonic epithelium is altered. OBJECTIVE: To compare the changes in the pattern of mucin staining in, adenocarcinoma (AC), normal colonic epithelium, solitary rectal ulcer (SRU), transitional zone mucosa (TZ) (i.e.: normal non dysplastic mucosa adjacent to adenocarcinoma) and in ulcerative colitis (UC). METHOD: AC-21, normal colonic epithelium-30, SRU-23, TZ-20, UC-29 biopsies were stained with the HID-AB stain. Two investigators assessed the percentages of mucin staining by counting the number of cells staining for sulphomucin and sialomucin in an area of colonic epithelium measuring 1mm in length. The differences in these 5 categories were assessed for statistical significance using the one-way ANOVA test and a Post Hoc Comparison of the mean values was carried out to establish which groups were different. RESULTS: ACs showed no sulphomucin or sialomucin staining while normal colonic epithelium showed nearly 100% sulphomucin staining. The percentage mean value for sulphomucin staining was AC-12.47%, normal colonic epithelium - 96.7%, SRU-35.7%, TZ-48.98%, and UC –75.43%. Hence the differences between these categories reached a level of statistical significance except between TZ and SRU. CONCLUSION: The patterns of mucin staining observed with HID/AB staining included relatively similar changes in mucin staining in the TZ and SRU, the loss acid mucin staining in AC and the relatively mild degree of sulphomucin loss in UC. Though there are significant differences in mucin staining between some of these colonic pathologies practical problems were encountered in using HID/AB as a diagnostic tool.
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.
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.
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.
Lymphoid tangles is a useful cytological feature in the diagnosis of Hashimoto thyroiditis
(Sri Lanka Medical Association, 2007) Ratnayake, R.M.U.S.; Hewavisenthi, S.J.de S.
INTRODUCTION: A cytological diagnosis of Hashimoto thyroiditis (HT) is made in the presence of Hurthle cells in a background of plasma cells and lymphocytes. The presence of lymphoid tangles as a diagnostic feature has been described only in isolated case reports. OBJECTIVE: To assess the value of lymphoid tangles in the cytological diagnosis of HT. DESIGN, SETTING AND METHODS: Forty one smears with an unequivocal cytological diagnosis of HT and 41 smears of colloid storing goitres (CSG) were selected. 10 high power fields of the most cellular smear were assessed for lymphoid tangles defined as haemotoxyline stained fibrillary material. The presence of lymphoid tangles were graded as Grade 0 - absence of tangles/10 hpf; Grade 1 - presence of tangles in <50% /lOhpf and Grade 2 - presence of tangles in >50% /lOhpf. The observer had no knowledge of the initial diagnosis. The likelihood ratio was calculated; those above 10 and below 0.1 considered as strong evidence for the presence or absence of disease respectively. RESULTS: In the 41 CSG smears, 33 (80.4%) showed no tangles and 8 (19.5%) showed grade 3 tangles. None of the smears showed grade 2 tangles. All 41 cases of HT revealed lymphoid tangles with 34 (82.9%) having grade 2 tangles and 7 (17%) grade 1 tangles. The likelihood ratio was 0.00, 0.85 and 34.0 respectively for Grade 0, Grade 1 and Grade 2 tangles. Grade2 lymphoid tangles were strongly predictive of a diagnosi s of HT. CONCLUSION: The presence of Grade 2 lymphoid tangles in the smears is a useful diagnostic feature in HT.
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.