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Subject: Re: Biopsy interpretation and recommendation?
Forum: The Hepatitis Forum

Topic Area: Hepatitis C

My recent biopsy results reveal,"...portal spaces to be expanded with a moderate chronic inflammatory inflitrate. There are scattered cells beyound the portal space. Trichrome stains reveal an increase in connective tissue in portal areas and early bridging fibrosis. An iron stain is negative."
DX: moderate hepatitis c (grade III) and periportal fibrosis (stage II)
My LFT's have been within range, one slightly elevated ALT(53)range 0-50. No symptoms to my knowledge. No evidence of cancer/tumor. U/S normal. RNA is high (over a million).
My GI suggests that I consider tx in the not too distant future. I personally am in favor of waiting for more promising drugs, I understand that pegylated ifn may be available in about a year and that it shows promise. Incidently, I don't drink, drug or smoke and am trying to take care of myself physically so I'm not leading a high-risk lifestyle. I have probably had HCV for 20-30 years and am pleased with my bio results... they don't seem too bad given that length of time... do they? Am I in denial or minimizing the danger? How does this Biopsy read to you? What would your recommendations be? Can I wait awhile? Am I a good candidate for tx? What about Pegylated?
I realize that I have asked lots of questions and have never met you. It may be difficult for you to answer given that, but I greatly appreciate your time and consideration! Thank you, Bill

Dear Bill:

Well you do have some tough questions but I appreciate hearing from you anyway. Let me make a couple of comments although you are ultimately going to make the decision about treatment now or waiting.

It sounds like your pathologist is hedging her/his bets on your biopsy. On the one hand, the pathologist is saying that you have early bridging fibrosis which is a somewhat advanced form of fibrosis (though not as advanced as cirrhosis) but on the other hand, the person also says you have periportal fibrosis (stage II) which is considerably less advanced. All in all, if you have had hepatitis C for 20 to 30 years and your platelet count is normal and you have no evidence of liver cancer, you can probably wait a year.

However, I should warn you that predicting the availability of new drugs can be complicated. I think pegylated interferon should be available within a year but its hard to be sure. In addition, it may be that the best results are with pegylated interferon in combination with ribavirin and I am not sure when that combination will be available.

I tell my patients with early fibrosis that they can wait and my patients with advanced fibrosis (especially with thrombocytopenia) that they should consider treatment soon. I am not exactly sure where your biopsy puts you. Maybe a compromise is to get into one of the on-going trials using pegylated interferon. If you tell me where you liver, I may be able to identify hepatologists in your area doing trials.

I hope this information is helpful to you. Good luck with your situation. If you have additional questions or more information, feel free to post the material back to MEDHELP. The direct number to our Liver Clinic at Henry Ford is (313) 916-8865. We have an active group of liver specialists with an interest in the care and research of hepatitis C.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question physician when you have a question pertaining to your health.

Follow Ups:

• Biopsy interpretation and recommendation? Bill 6/28/1999 (1)
  • Re: Biopsy interpretation and recommendation? HFHSM.D.-D.M. 7/03/1999 (0)

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